Lip augmentation

Published on 22/05/2015 by admin

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Last modified 22/05/2015

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CHAPTER 72 Lip augmentation

Arnold W. Klein, Bruce W. Ayers

History

Throughout history men and woman alike have been attracted to ample, full and pouty lips. Full lips are synonymous with youth and for hundreds of years, people have sought to augment lips. Throughout recent history, many surgical procedures and techniques have evolved which allowed surgeons to do this. Some of these procedures have enjoyed greater popularity than others and some have simply not worked well at all; others have caused disastrous results. Across all cultures, the lips are seen as the aesthetic center of the lower face, and in females they are a landmark of beauty and physical attraction for men. Full and defined lips impart a sense of youth, health and beauty and sexuality to the bearer. Like many facial features, as the lips age, they become less attractive. The hallmark sign of the aging lip is the loss of volume. As the lips lose volume, they become thin and flat and lose their shape. The lines which result from repeated dynamic movement take permanent residence and the corners of the mouth begin to turn inward, which reduces the width of the mouth. Part of the reason behind this is the loss of structural support in the lower face. Throughout our lives, as we grind our teeth, undergo dental work and experience age-related osteoporotic bone loss with a resultant thinning of the mandible, the distance from the lips to the chin is significantly decreased. As we lose dental height and support, the face appears different in that the ends of the lips tend to hang down, contributing to the marionette lines or labio-mandibular grooves. Ultimately, as with all areas of facial cosmetic surgery, the trend towards minimally invasive, office-based procedures, with minimal down time and reduced pain has undergone a vast transformation, and today this concept appears to be the guiding principal in facial cosmetic correction.

In 1984, with the approval of injectable bovine collagen, the goal of simply eradicating dynamic lines and wrinkles caused by aging, sun exposure and smoking moved toward correcting volume loss. No longer did people want a flat, pulled two-dimensional appearance, but rather a full three-dimensional natural appearance. Physicians began to enlarge the cupid’s bow, increase the length of the lower lip and to enhance the projection mass of both the upper and lower lip. The use of bovine collagen as a safe, easy to use, predictable injection agent permitted physicians to provide stable reproducible lip augmentation, which was natural in appearance and provided for a superior cosmetic result. Unfortunately, the dermatologic and plastic surgery literature provided little guidance regarding the proper aesthetic characteristics of lips, and while many women’s magazines presented models with voluptuous, full lips, and many celebrities were admired for their beautiful lips, there were no standard guidelines available to assist physicians with lip augmentation. The unfortunate result of this lack of general information was improper and cosmetically displeasing results. We have all seen frequent examples of women who display lips which have lost their natural proportions, been excessively augmented and appear uneven and unnatural. We believe that techniques which favor subtle correction which prevents the untrained eye from noting the procedure produce a favorable and natural result. In 1984, Arnold W. Klein helped to pioneer lip augmentation that began to focus on increasing volume and on an aesthetically pleasing appearance, rather than simply eradicating lines. This technique has evolved into a better understanding of how lip enhancement should be done. Above all, it must never be detectable to the untrained eye. Lips are about volume, but more importantly, shape, balance and symmetry. Indeed, the areas of the cupid’s bow and philtral pillars could only be slightly altered in that any significant distortions in these areas would draw attention to the lip enhancement and possibly present an unnatural and distorted result.

With the FDA approval of the first hyaluronic acid (HA) preparation for soft tissue augmentation in 2004, this opened the door to a new generation of injectable dermal fillers. The hyaluronic acid products have proved exciting materials which work superbly in soft tissue augmentation. HAs are a naturally occurring polysaccharide found in the dermis and through the cross-linking process, a greater tissue residence time has resulted. As injectors refine their techniques and as manufacturers work on better cross-linking materials and techniques, these agents have proved superior to bovine collagen and in the right hands with the best technique, we routinely obtain lasting results which approach and in some cases exceed one year.

Physical evaluation

Patient selection is not as critical in evaluating patients for lip augmentation due to the fact that as we age, we all will begin to experience the loss of structural support in the lower third of the face and lose volume in the lips. However, there are some important factors to consider when evaluating a patient for lip augmentation:

• Evaluate general health and medical condition of your patient.

• Take photographs for before and after comparison.

• Measure lip dimensions.

• Assess whether or not your patient has undergone prior lip augmentation procedures and if so, which injectable fillers were used. This is critical to a good outcome.

• Discuss with your patient what she or he expects from the procedure. Many patients have unrealistic expectations of lip augmentation and as a result will not be entirely pleased with the result.

• Examine the degree of structural/bony loss the patient has experienced and the degree of volume lost in the lips. This will help determine how much filler you will need and how much you will need to rebuild the support in the lower third of the face.

• Explain to your patient what your plan is for their procedure, what you recommend and what they should expect. This is generally where we explain to some patients that contrary to what they may have been told or have seen, it is not appropriate to inject large amounts of filling material into the lips as this will not provide an aesthetically pleasing result. We explain that there is more to lip augmentation than just injecting volume into the lips; we must also rebuild structural support on which the lips sit.

• Pain is always a significant concern to our patients and lip augmentation can be a painful procedure if not done properly. Take the time to reassure the patient that you will take certain steps and explain what they are so they will not experience pain.

• Discuss with your patient postoperative expectations from ice application, use of pain relievers, the possibility of bruising, and temporary distortion due to swelling. Most patients expect that they will have the final result the minute the procedure is completed and many do, but educating the patient is critical.

Anatomy and architecture of the lip

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