How many techniques are there to augment the lips?
There are basically two ways to augment the size of your lips. One way is to inject substances known as fillers into the lips to plump them out. There are several types of injectable fillers and several brands for each type. Most injectable fillers are temporary and are eventually absorbed by the body.
The second way to augment the lips is the use of lip implants, which are pieces of solid silicone or other material that are inserted into the lips to plump them up or enlarge them. Lip implants are permanent, but can be removed.
What types of injectable fillers are out there and what are the differences?
There are several types of injectable filler materials and a number of different brands for each.
Most available injectables are temporary. Collagen, which has been widely used for a long time, usually lasts between 3 to 4 months and requires you to have a skin/allergy test before it is injected. Fascian, which is made of strips of cadaveric connective tissue, lasts a little longer although not much.
There are a few injectable products which are permanent or semipermanent, such as Artecoll, Aquamid, and Metacrill. Artecoll is made from polymethylmethacrylate (PMMA) beads suspended in collagen. The PMMA is formulated into microspheres (extremely small round balls) suspended in collagen. After the product is injected, the collagen is broken down by the body over time, but the PMMA microspheres are left behind to be encapsulated by the body's own collagen, thus enlarging the lips. Aquamid, Bio-Alcamid, Argiform, and other polyacrylamide implants are made with a polymer that holds moisture.
Are there any permanent options in lip augmentation?
There are permanent and reversible options called lip implants. Brands include Gore-Tex, SoftForm, UltraSoft, and Advanta, which are made from expanded polytetrafluoroethylene (ePTFE). ePTFE has been used for decades in the body for all sorts of applications. These are the most popular implants and the only FDA approved implants. They are considered permanent, yet they possess the benefit of being removable in the event of a problem. The risks are infection, extrusion, palpability, and lessened mobility of the treatment areas.
How is lip augmentation with lip implants performed?
The surgery is not complex nor does it take a substantial amount of time. You are injected with local shots of lidocaine, for pain relief, and epinephrine, a vasoconstrictor, to restrict the amount of bleeding and bruising. After making four incisions at each corner of the mouth, the surgeon inserts the implant using either an implant pre-threaded on a tube called a trocar or a pair of long-nosed forceps. After insertion, the surgeon cuts the implant to the size best for the patient's individual lip and trims the ends of the implant if necessary. The incision areas are then sutured and you are cleaned up.
Where are the incisions made for lip implants?
In a lip augmentation procedure with lip implants, the incisions are made right at the corners where the lips meet on each side. The lips usually tend to heal quite fast as long as you don't mess with them. These means no touching or picking at your incisions, which can lead to infection.
What should I expect postoperatively?
You should expect to be swollen, tender, and very full-lipped postoperatively. You may have some difficulty drinking or eating without spilling a bit. Your lips may feel numb for several days due to swelling putting pressure on the nerves in your lips. Pain relievers prescribed by your doctor should alleviate any discomfort.
You will have your sutures removed in about 7 to 10 days. It may sting a bit during this process. The swelling will subside. However, you will be accustomed to the extreme swelling and once it subsides you may wish for a little more poofiness -- this is normal. Compare your before photo with an updated after photo to see the real difference.
Is lip augmentation painful? Is there much bruising?
It takes about a week for most of the swelling to subside, although it will be sensitive to light to medium pressure for about 3 weeks. There is really not too much bruising with most cases. Some patients are prone to bruising more than others.
Will I have to premedicate for dental work?
It is possible that you will be instructed to premedicate with antibiotics before any dental work to prevent infection where the lip implant is located.
Some surgeons and dentists believe plaque and bacteria are released during dental work, and can enter the blood stream. However, this is controversial and some surgeons believe that the same type of bacteria is released during routine flossing.
Incidentally, premedicating and following up for 3 days of antibiotic use is often recommended for the first year after breast implants, and for people who have pace makers and synthetic hip joints.
When will I be able to see the results?
The results are usually immediately visible. For implants and most injectables, your lips will be quite large and swollen and you will see a difference in the swelling as it subsides in the first week postoperatively (or post-injection). The swelling will more than likely subside more than you would like because you will have become accustomed to the size and think that your lips are small in comparison. Take photos of your lips before your procedure and compare.
With injectable fillers such as Artecoll and Metacrill. you may notice swelling at first, which will subside, but growth will occur in the weeks following injection.
What are the risks of lip augmentation?
There are not too many risks associated with lip augmentation, but it depends on the chosen implant or filler.
With lip implants, there can be infection and irritation if the ends of the implant are too long for the cavity or not rounded, if needed. The good thing is that lip implants are reversible and can be readily removed. Extrusion from the body can occur as the body attempts to reject the foreign material. Migration can be an issue as well. There may be permanent discolorations from the bruising. Possible hematomas resulting in additional surgeries and excessive scarring from delayed healing or trauma. Deformity from excess scar tissue arising from an infection or the surgery is also a possibility.
Injectable filers have some risks. With some products, notably collagen, there is the risk of allergic reaction. Other risks include infection, necrosis, granuloma formation, and severe inflammation. Injectable products usually cannot be removed.
I have heard that the risk of infection is quite high in lip implants, is this true?
The reason the risk of infection is high is because your mouth naturally has a lot of germs. Plus, your lips move a lot and can take longer to heal than other parts of your body that are not very mobile.
If you try and keep your mouth clean, rising regularly with an antiseptic mouthwash and do not "pick" at the incision sites, your wounds will have less of a chance of becoming infected. Washing all raw fruits and vegetables before you eat them and avoiding undercooked meats will also decrease your chances of infection. Good oral hygiene is imperative and any dental work should be tended to well before any lip augmentation procedures.
How are lip implants comparable with injectables?
Many injectables give wonderful, voluptuous and immediate results, but the results wear off. Lip implants are permanent, but more expensive. Injectables are cheaper than implants to start, but more expensive in the long run because you need to keep getting injections. There are semipermanent injectable fillers that give results that are longer lasting, but they are hard to remove if you don't like the results. If you would like permanent, yet reversible results, get the lip implants.
If it is a very full, pouty mouth that you want and if don't want anything permanent, get the temporary injectables, but be prepared to spend money on touch ups and maintenance.
Is lip augmentation reversible?
Lip augmentation with most injectables is temporary, therefore it goes away on its own. Lip augmentation with an implant is reversible. Permanent injectables are more difficult to remove, so consider this when you make your choice.
Will the movement of my lips be hindered or look "odd" when animated?
It is possible that you will notice a difference in your smile, how you speak, and how your lips look after a lip enhancement procedure, especially during the healing stage. Lip implants can feel very stiff and immobile; it takes some getting used to. You can't expect not to have a change in this area, The muscles of the lips move involuntary as well, so any change to this area is bound to change or affect lip movements.
Bitar Cosmetic Surgery Institute
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Bitar Cosmetic Surgery Institute
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George Washington University Hospital
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Washington DC, DC 20037