Lip enhancement, also known as lip enlargement or lip augmentation, has been practiced by cosmetic surgeons since around the 1960's. It has become much more common recently, mostly due to a tremendous surge in media attention in supermodels, but also because the techniques and materials have been improved tremendously in recent years. As a result, Lip enhancement is more safe, predictable, and comfortable procedure more easily customized to the patients desires, lifestyle, and budget. This page will describe the spectrum of techniques including the newest advances in lip enlargement.
The spectrum of procedures for enlargement of the lips ranges from a simple 20 minute office procedure with no anesthesia, immediate return to work, and no swelling or discomfort all the way up to a two hour hospital procedure under general anesthesia, significant swelling, 1-2 weeks off work, and some pain. There is a broad range of possibilities in between. For this reason it is easy to understand that no one procedure or technique fits all. It is something that needs to be highly individualized to the patients' desires and expectations, anatomy, lifestyle, and time available to be out of work and social situations.
Both men and women frequently seek this procedure. The desire for lip enlargement ranges from slight and modest all the way up to a very dramatic change. Many patients have some unevenness in the size and contour of the upper or lower lip or both, and this needs to be considered when choosing the type of procedure. Small lips usually means the amount of pink tissue visible and how much it "turns up", especially in the upper lip. This is a situation that can be present from birth and not only seen in the aging process where tissue bulk is diminished over time. Patients desiring this procedure range in age from 20 to well into their 70s. Other features which have to be taken into account other than the size and asymmetry of the pink portion of the lips are the length of the upper lips, creases and folds at the corners, and drooping of the corners.
Unlike some other plastic-surgery procedures, nearly anyone can be a candidate for lip augmentation. Especially today, while having fuller, "poutier" lips are in style, more people are considering lip-enhancement procedures, not only to enlarge their lips, but also to correct any asymmetries or crookedness.
Men and women, teen-agers, twentysomethings and octogenarians are all eligible for a lip-augmentation procedure. Up to 40 percent of lip-augmentation patients under 35 choose to have their lips surgically enhanced if they have "underdeveloped" - thin, flat lips. Older patients - who account for about 60 percent of lip-augmentation patients - tend to opt for the procedure to reverse a byproduct of the aging process. As we age, muscle tension and tone become more lax; lips begin to hang, lengthen and thin.
Most people seeking lip augmentation simply have small or thin lips. This refers to the pink portion or what we call the mucous membrane. It is usually most obvious in the upper lip and less on the lower lip (since the lower lip has the advantage of gravity and tends to roll out more even when thin). Patients desire a larger and more pouty appearance with more fullness and turning up and out of the lips. Many seek more evenness in the fullness.
In some cases your underlying dental architecture can influence the posture of your lips and cause your lips to droop or hang. Be aware of this if your teeth are very crooked or you have an overbite or underbite. Your plastic surgeon should be aware of this and may first want you to consult an oral surgeon to discuss your options before considering lip augmentation.
The degree of desire for enlargement varies according to the patient from mild to moderate to extreme. The amount of enlargement depends on the anatomy.
There are two general categories of procedures that enhance the lips. These are injections of materials such as collagen and grafting in substances such as fat, alloderm, or gortex. The results can be temporary or permanent. All of these have advantages and disadvantages, different types of anesthesia, recovery periods, pain and time off work. Anesthesia ranges from none or very little in an office setting, up to general anesthesia in the hospital as an outpatient. The procedure can take from twenty minutes up to two hours. You can usually bathe and shower as usual the next day. There can be minimal swelling and bruising and no numbness with immediate return to work, up to tremendous swelling and bruising and numbness that last for days to weeks with one to two weeks off work. There can be no stitches or incisions, or a few at the corners of the mouth. When present, the stitches are usually removed in 7-10 days. Results can be temporary or permanent depending on the technique. No dressings or drains are used. The procedure can be easily combined with other plastic surgery procedures.
Collagen (Zyplast ®)
The traditional collagen used for lip augmentation is purified bovine collagen. This type of collagen requires a test injection that is administered in the forearm about one month before the injection in the lips. This is done to rule out a possible allergy to this type of collagen in the patient. If no allergy is present, the procedure is performed in the office with the use of a topical anesthesia. Several injections are performed along the borders of the lips. There is usually some swelling for the first 1-2 days after administration of the collagen but this quickly resolves. Occasionally some lumpiness can be felt in the lips after the procedure but this typically resolves with massage by the patient. Results with this type of collagen generally last 3-4 months. Patients can receive repeat injections when the effect disappears.
Hyaluronic acid (Restylane ®)
Hyaluronic acid is a substance found in the tissues of all living things. Restylane is a synthetic hyaluronic acid and therefore does not require a test injection. This filler is administered in the same fashion as collagen. The results with hyaluronic acid generally last 6 months. As with collagen, swelling in the lips usually lasts 1-2 days. Also any lumps in the lip generally resolve with patient massage. This substance may also be administered repeatedly when the results disappear.
Both collagen and hyaluronic acid may also be used in facial wrinkles.
Alloderm
Alloderm essentially is a sheet of human collagen tissue which has been purified and rendered non-immunogenic. It is the relative of Dermalogen which is its injectable form. It is well tolerated and does not cause allergies or need to be pre-tested for allergies. It is inserted as an outpatient procedure performed under a local anesthetic. Incisions are made at the corners of the inside of the lips and Alloderm is rolled up and inserted from one side to the other. A few tiny stitches at the corners in the small incisions are all that is needed. Post-surgery swelling is mild to moderate and disappears mostly within 3-5 days. It is very soft and natural. There is a tendency for this to become reabsorbed and the result seems to diminish or disappear after about 6-12 months.
Gortex
This is related to the same material that keeps you dry in a rainstorm. Gortex is desirable because it is a biocompatible material that passes easily through tissue. It comes in sheets or strands. It has been used successfully as a human implant in over 5 million implantations without any allergic reactions. Although commonly used for blood vessel bypasses, it has been approved for tissue augmentation procedures and used in this way since about 1988. There is a slight potential for infection and when this occurs, the material can be easily removed usually with no untoward side effects. It is soft and pliable and the results are permanent. Placement is extremely technique sensitive and if placed less than perfectly, can show or distort especially when smiling broadly. It is much like Alloderm in terms of the incisions and anesthesia. It can be easily surgically "fine-tuned" by adding or removing strands as needed.
Dermis-fat grafts
It has been well known and performed from the 1950s that excising
fat from the body with a partial thickness of the skin still attached improves
the survival of the fat when implanted elsewhere. This dermis-fat graft procedure
is popular for lip enhancement. It requires an incision somewhere on your body
- usually in the groin area - to take out a wedge of skin with fat still connected
to it. The dermis serves to bring in the body's own blood supply to ensure
the fat graft's survival. The incisions and the stitches and minimal pain are
similar to the procedures described above. The swelling is significant so patients
need to plan about a week out of work.
Disfavor with this technique centers around the unpredictability of the partial skin attached to the fat. Although the enlargement is good and predictable, the partial skin with its collagen can scar and contract and occasionally distort the mouth and smile. If this happens, your doctor will have to perform a second operation to remove the graft and this can be difficult.