The upper and lower lips are one of the five main facial features that makes up and helps define the most recognizeable central third of the face. In today’s society, full lips are viewed as healthy and sensual, thin or wrinkled lips cast the opposite image. While the lips are paired, they are not identical due to their embryological origins. The upper lip is uniquely different than the lower as it has a central cupid’s bow or two-peak wave form which differentiates it from the smooth and continuous lower lip. That is a key aesthetic difference and very important consideration in any form of lip augmentation.
While injectable fillers are the most common form of lip augmentation, they are not for everyone and every form of injectable filler is not for lips. Patients who have thin lips can not be injected and end up with full pouty lips. The pink part of the lip will only stretch so much before it begins to look distorted, too full, and unnatural. Results like this are evident everywhere on TV and in the movies. Injections will not make a well-defined cupid’s bow nor make the height of the lip bigger either. While it acceptable to try a small amount of injectable filler in a thin lipped patient, and I frequently do, it is best to not overdo it. Let the patient decide whether the result is worth it. I always place injectable fillers in layers and ask the patient to give me their opinion with each new layer. Enough is when they tell me so. Surprisingly, no injectable filler is formally approved by the FDA for injection into the lip even though it is common practice. Only the hyaluron-based fillers such as JuvaDerm, Restylane or Perlane should be used in the lip as they flow in smoothly and have little risk of a foreign-body reaction….and they are completely reversible with time. The particulated fillers such as Radiesse and ArteFill should not be used in the lip as they do have risks of lumpiness and potential reaction to their particle component. As for silicone oil…be very wary. Not only is it not FDA-approved for any injectable application at this time, its track history from the 1960s and early 70s is not reassuring. (even if this is a newer more purified form)
For those thin-lipped patients, some consideration may be given to lip lifts and advancements if careful thought is given to the permanent scar. While these are powerful lip procedures and can do wonders in increasing the size of the pink part and in making a well-defined cupid’s bow, they do produce a fine line scar at the junction of the pink lip and skin. If the patient is certain they can live with that trade-off and has a high lipstick use frequency, this may be the procedure for them. That decision becomes a little easier in the older female where the thinning of the lips and the development of vertical wrinkles on the lip requires more than a simple lip fill with an injectacble can do. If the procedure is done well, it can look fairly natural. If the lip is advanced too much or the peaks of the cupid’s bow made too sharp, it can look very unnatural.
Often patients who have had temporary lip injections desire a more permanent fix. Options include fat injections and synthetic implants. Since fat has to be harvested from the patient in a sterile fashion, I always do this procedure in the operating room and is a strong consideration when the patient is going to be there for other plastic surgery procedures anyway. There really is very little to lose by doing it in that setting. While the take of fat grafts is definitely variable, some patients will do well with it. The test is what it looks like at three months after surgery, not in the first few weeks. If fat takes well, it will last longer than any synthetic injectable but it may not last forever as the lip does continue to age. Therefore, further fat inejctions may eventually be necessary. Permanent lip implants (Advanta) have been around for over a decade and in the right ‘qualified’ patient can do well. Qualifying a patient is one who has had lip injections and is really ready to accept a permanent implant over a temporary filler. My experience with Advanta, a soft spongy tube, has been quite good even though all patients will definitely be able to feel it.
Two of the most important things in creating natural lip results is that they must not be too big or have treatments which result in them ending up stiff or irregular. We touch the lip area very frequently so we are quite attuned to how it feels And the lips need to be soft and flexible to support easy and painless movement.
A good artistic sense in shaping the lips (they enhance the face but should be the focal point), consideration of the many lip treatment options, and preservation of soft flexible lips are needed to get the most natural lip augmentation results.
Dr. Barry Eppley
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana