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LIP AUGMENTATION

 

                   

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Lip augmentation is one of the most popular cosmetic surgery procedures offered. As we age, we lose the fullness in our lips that makes them look young and pouty. Aging causes the lips to become thin and also causes the small wrinkles seen above the lip border.

Choosing the right injector for lip augmentation can be difficult, if you don’t know what to look for. Most patients seeking lip augmentation today want to achieve more fullness and poutiness, but also to appear natural. This is a much more delicate issue than just pumping filler into the lips. Facial balance consists of the lips, their maximal natural fullness, and the balance of the tissues around them. The distance from the lip to the nose is very important. The balance between the sides of the lips and also the central lip area is very important. The vermilion border and white roll of the lip should also be considered.

Start by evaluating the physician’s work by reviewing pre/post procedure photographs of their patients. If you want a natural look, you need to be very clear in stating your intent that you prefer natural lip definition, not augmentation to the injector! Make sure that both you and the injector are on the same page with what you are trying to achieve.

If your natural lips are very thin and you are trying to achieve lips like Angelina Jolie, then more than likely you will be disappointed. Going into lip augmentation, you need to realize your own natural lip structure and what volume level could be given without making your facial features out of balance. There is actually a maximal amount of volume that can be safely attained given each patient's own unique lip contours, anatomy and position within the face.


 

                                    

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Before undergoing the procedure of lip augmentation, it is imperative that you are in good general health. If you suffer from oral herpes, scarring, or certain diseases such as diabetes, lupus, connective tissues disorders, or blood clotting problems, you need to make sure you go over this in detail with your physician.

Good candidates for lip augmentation are those who have realistic expectations of the outcome. Injections or implants can enhance and improve your natural look, but they're not designed to create a radical change in your appearance. You want the procedure to enhance your features, not overpower them. Certain health risks or conditions such as blood clots, diabetes, or poor circulation can increase your chance of complications.


Common Lip Problems that respond well to Lip Augmentation:

  • Thin or flat lips

  • No upper lip

  • Fat lips

  • No bottom lip

  • Lopsided lips

  • Poorly defined lips or Cupid's bow

In cases where the lips are too large, or asymmetrical, a lip reduction might help. Lip lifts are used in patients that have a large top lift and have no tooth show when their lips are parted. These options are usually permanent as the structure of the lips is drastically altered.



 


 

Looking at before and after photos will help you decide what type of look you are searching for with lip augmentation.

Most physicians will give you a pre operative information packet; that will tell you what medication you can take and not take. It is very important that you do everything that your surgeon is suggesting so that you can have the best outcome from your procedure. There will be instructions about abstaining from aspirin containing products, alcohol and some herbal supplements for up to two weeks before your procedure. 

Read our section on "Medication to Avoid" before surgical procedures. 

Aspirin and aspirin containing products such as Advil; have a tendency to thin your blood which will inhibit blood clotting. This can cause some difficulties during and after surgery. As with every other cosmetic surgery procedure, abstaining from smoking would be ideal and some surgeons would like to see no smoking for a minimum of two weeks before the procedure. Smoking inhibits the oxygen needed to get to the blood cells, which you need for optimal healing.

Your physician might suggest you to pick up some Arnica Montana, Bromelain or Vitamin A to help with the swelling and bruising that might occur.

If you are going to have an invasive procedure such as a lip lift or lip implants, then your surgeon might order a complete blood count to be done before the surgery, as they want to be sure you are good health.



The five areas of the lips that should be discussed with your physician prior to any lip augmentation are:

 

                               

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AREAS OF LIPS THAT CAN BE ENHANCED

The vermilion border is the most common area that is enhanced with dermal fillers. The vermilion border is the junction between the white and red part of the lips. By injecting dermal fillers in this area, it is possible to define the lips, similar to wearing lip liner. It gives the lip no more volume, but outlines the border to make it clearer. It can also help with lines that cross through this area. For those who have 'lipstick bleeding', injecting a dermal filler in the vermilion border can also help. The lip body can also be injected. This is usually done to enhance pout.

 

 

Correction of vertical upper lip lines, if present, is also important in the enhancement of lips. This area is often a key area of concern for patients, and can be softened with a variety of fillers.

 

 

The oral commissures are located in the corners of the mouth, can also be filled. This area usually increases in size with age due to the effect of gravity on the cheek skin. Filling this area turns the corners of the lips upwards creating a more positive and happy appearance.

 

 

The philtrum consists of the two lines in the centre of the upper lip that connects to the nose. By enhancing this double-ridge, it is possible to give the upper lip more shape and curve, enhancing the sensuality of the lips.

 

 

The cupid's bow, or the V shaped area in the centre of the upper lip can also be enhanced with dermal fillers. This makes the V more pronounced. Done in conjunction with the philtrum, it can achieve a pleasant overall shape to the upper lip.

 

                      

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PROCEDURE PREPARATION


There are well over 25 different types of injectable fillers. These injectable fillers work by stimulating collagen around the filler, which acts to plump up the area that is injected. Injectable fillers range from temporary to permanent. Temporary fillers are products that usually last anywhere from a few weeks to 9 months; possibly longer depending on the individual, product and injector. However, there are newer products that may last up to a few years after injection. They come from animal sources, donated human sources (fat or tissue), or are completely synthetic.

Some of the risks with lip fillers are lumpiness, firmness, inflammation and even migration of the material may occur. The most common permanent injectable fillers today are Artefill and Silikon 1000. The indications of Artefill is for treatment of medium-to-deep wrinkles, folds and furrows, particularly nasolabial folds; acne scars, lip augmentation, etc. An allergy test is required with this product because of the bovine collagen component of the injection. Artefill is FDA Approved since 2006. Silikon 1000 is FDA Approved in the treatment for retina detachment however; it is being used “off-label” for the treatment of lip augmentation, nasolabial folds, and acne scars.

Depending on the extent of treatment, injection procedures typically last between fifteen and sixty minutes. Prior to the start of your procedure, the treatment areas will be cleansed, usually using an alcohol based cleaner. Unlike collagen injections, hyaluronic acid injections do not include an anesthetic agent, so if you elect to have Juvederm, Hylaform, Restylane, Perlane and Captique – a local or topical anesthetic may be used to numb the treatment area during the procedure such as a dental block or a regional block.

Using a syringe, the dermal filler is injected into the dermis at several points along the edge of the treatment area. After approximately two to three injections, the physician will massage the treatment area. The physician will continue injecting the filler along the length of the wrinkle or fold until maximum correction has been achieved. If a local anesthesia has not been used, you may feel some minor stinging from the injections. After the injection, the volume beneath the skin will increase, restoring a smoother, more youthful appearance.


 

 

 


 

Fat grafting of the lip ("lipo-sculpturing" or "structural fat grafting") is one of the methods of maintaining a permanent full and soft lip. Fat grafting is normally very well tolerated; however there is a lot of down time with the recovery from this procedure. Fat grafting generally doesn’t last that long in the lips due to the fact that the lips simply get too much movement in order for the fat to adhere to the area.

Structural fat grafting of the lip requires harvesting of fat from another site (usually the belly, thighs, or "love-handles"). The harvest site and treatment sites are anesthetized using a combination of local anesthetics and nerve blocks. Fat is removed from the donor site using a specialized harvesting cannula attached to a suction syringe.

The fat is processed by simple centrifugation prior to re-injection with fine cannulas. Approximately 1.0 cc of fat is use to rejuvenate the white roll above the lip and 1.5 to 3 cc of fat is often used to fill the body of the upper lip. Nearly twice that volume is often used on the body of the lower lip. Injection techniques place the fat cells within the lip muscle to provide the augmentation required.

Read more about Fat Grafting

 

 

 

 

 

Lip implants create a permanent yet reversible enhancement of the lips by defining their appearance more. These implants do not shrink and are never absorbed into the body. They also remain in place because scar tissue forms on the other end.

Gore-Tex. SoftForm, UltraSoft, and Advanta are all made from expanded polytetrafluoroethylene (ePTFE). This material resembles “foam rubber” more or less and has been used for years in the body for other type of surgical procedures. These are the only FDA approved synthetic implants on the market at this time. Complications from having lip implants include extrusion, infection, less mobility of the lips or the treatment areas. Also the implants can have the tendency to get hard.

The procedure of lip implant surgery is more invasive than just receiving an injectable dermal filler. You are first injected with a local anesthetic, similar to those you might receive at a dentist’s office, for pain. After numbness takes effect, a total of four incisions are made at each corner of the mouth and the implant is inserted into the lip through the incisions. The implant is trimmed, the incision sites are sutured, and the wounds are dressed. Your physician may use absorbing or non-absorbing suture material and there is usually minimal bleeding.

 

Please read here for more information about Lip Implants:

 

 

 

 

As with all facial or lip injections pain relief is a very common question. With the hyaluronic acid fillers, because they are delivered through a larger gauge needle, sometimes a sensitive patient will have to have a nerve block or a dental block.

The dental blocks of course are more invasive than a topical cream, but are much better for pain relief. The block is performed by injecting 1 to 2 cc of local anesthetic right next to where a major nerve group comes out of the bones of your face.

 

                                                   

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The entire segment supplied by this nerve bundle then "falls asleep" for 1 to 4 hours. If the block is performed through the mouth using some numbing cream or spray at the injection site, it can be painless. There are relatively few nerve receptors inside the mouth, and those are very susceptible to the topical creams.

 

 

 

EMLA Topical Cream is a local anesthetic which works by blocking the nerves from transmitting painful impulses to the brain.  It numbs the skin to pain from injections (dermal or lip fillers).

EMLA Cream (lidocaine 2.5% and prilocaine 2.5%) is an emulsion in which the mixture of lidocaine and prilocaine is a ratio of 1:1 by weight.  It is packaged in 5 gram and 30 gram tubes.

EMLA Topical Cream is available by prescription only. Your physician will either supply you with a tube or will write a prescription to pick up at the pharmacy for use before your dermal filler / lip augmentation or BOTOX appointment.

 

                                   

                                                 Photo courtesy of AstraZeneca - EMLA Cream

 

EMLA Cream Indications:

  • EMLA is indicated as a topical anesthetic cosmetic procedures for dermal fillers.
    normal intact skin for local analgesia and superficial minor surgery as pre-treatment for infiltration anesthesia.

 
EMLA Cream should be used the following way:

  • Wash and dry the area to be treated. Apply a thick layer of cream to the affected skin - never rub EMLA into the skin.

  • EMLA Cream should not be used on broken or damaged skin.

  • Avoid getting EMLA Cream in the eyes, nose, or mouth. If by accident it should get in the eye area, rinse with plenty of water. If swallowed, call your local poison control center.

  • Wash your hands after using EMLA Cream.

  • Apply EMLA Cream at least 20 minutes before the treatment.

  • The numbing effect will last approximately an hour after the procedure.
     

 

 

 

 

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