Lip enhancement
Encyclopedia
Lip enhancement is a type of cosmetic surgery or non-surgical procedure that aims to improve the appearance of the lips by increasing their fullness through enlargement.
of facial fat
including the lips. In most cultures, this translates as no longer attractive, youthful nor desirable. The procedure to enlarge lips can also reduce the fine lines and wrinkles above the top lip, flaws often referred to as "smoker's lines."
Around 1900, surgeons tried injecting paraffin
into the lips without success. Liquid silicone
was used for lip enhancement, starting in the early 1960s but was abandoned thirty years later due to general—and later, unfounded—fears about the effects of silicone on general health.
About 1980, injectable bovine collagen
was introduced to the cosmetic surgery market and became the standard against which other injectable fillers were measured. However, that collagen does not last very long and requires an allergy
test, causing the patient to wait at least three weeks before another appointment, after which more waiting is required to see cosmetic results.
Currently, fillers containing hyaluronic acid like Restylane
and Juvederm
have captured the attention of consumers and physicians in Europe, North America, South America and Australia.
Some of the first widely used lip augmentation substances were:
that are used to inject the very sensitive lips. Nonetheless, topical
anesthesias are often used for lip enhancement procedures.
Some of these new techniques and substances include.
again. Several studies have found fat grafting of the lip to be one of the best methods of maintaining a semi-permanent fuller and softer lip. When the lips are overfilled, the results can be comic, often supplying fodder to tabloid newspapers and offbeat websites. This look is sometimes mockingly called a 'trout pout.' Overaggressive injections can lead to lumpiness while too little can result in ridges.
Common reactions can range from redness, swelling or itching at the injection site(s). Other possible complications include bleeding
, uneven lips, movement
of the implants or extrusion, when an implant
breaks through the outermost surface
of the skin. The usual, expected swelling
and bruising can last from several days to a week.
Some patients are allergic to the common local anesthetics like lidocaine
and probably should not consider lip injections. A few others react badly to the skin test patients must take before receiving collagen, again, because the substance contains animal byproducts. Other patients who should forego procedures to the lip include those who have active skin conditions like cold sores, blood clotting problems, infections, scarring of the lips or certain diseases like diabetes or lupus
that cause slower healing. Patients with facial nerve
disorders, severe hypertension
or recurrent herpes simplex
lesions should also eschew lip augmentation. As in all surgeries, smokers complicate completion of their procedure as well as the speed of healing
.
Fat transfer can last longer than other injected materials but can have lumping or scarring effects. The length of time a fat transfer may last in the lips is often determined by how much the area moves and how close it is to a major blood supply. In addition, the donor fat must be harvested from another area of the patient's body which leaves another—albeit tiny—surgical wound
. However, donor fat harvesting techniques have become extremely well refined.
Gore-tex, despite its impressive rates of success in lip augmentation and other procedures, is nonetheless a foreign body which bears a slight risk
of becoming infected or rejected.
History
Full lips with an accentuated border have often been associated with beauty and youth. However the ideal size of lips has changed over the decades with the current trend towards fuller lips. It has been suggested that this is because the lips occupy both sides of the face and, with the smile, constitute a major focal point of overall facial beauty. Tribal peoples worldwide have introduced various materials into and through the upper and lower lips of both genders to enhance beauty. Unfortunately, one of the effects of human aging is atrophyAtrophy
Atrophy is the partial or complete wasting away of a part of the body. Causes of atrophy include mutations , poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself...
of facial fat
Fat
Fats consist of a wide group of compounds that are generally soluble in organic solvents and generally insoluble in water. Chemically, fats are triglycerides, triesters of glycerol and any of several fatty acids. Fats may be either solid or liquid at room temperature, depending on their structure...
including the lips. In most cultures, this translates as no longer attractive, youthful nor desirable. The procedure to enlarge lips can also reduce the fine lines and wrinkles above the top lip, flaws often referred to as "smoker's lines."
Around 1900, surgeons tried injecting paraffin
Paraffin
In chemistry, paraffin is a term that can be used synonymously with "alkane", indicating hydrocarbons with the general formula CnH2n+2. Paraffin wax refers to a mixture of alkanes that falls within the 20 ≤ n ≤ 40 range; they are found in the solid state at room temperature and begin to enter the...
into the lips without success. Liquid silicone
Silicone
Silicones are inert, synthetic compounds with a variety of forms and uses. Typically heat-resistant and rubber-like, they are used in sealants, adhesives, lubricants, medical applications , cookware, and insulation....
was used for lip enhancement, starting in the early 1960s but was abandoned thirty years later due to general—and later, unfounded—fears about the effects of silicone on general health.
About 1980, injectable bovine collagen
Collagen
Collagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
was introduced to the cosmetic surgery market and became the standard against which other injectable fillers were measured. However, that collagen does not last very long and requires an allergy
Allergy
An Allergy is a hypersensitivity disorder of the immune system. Allergic reactions occur when a person's immune system reacts to normally harmless substances in the environment. A substance that causes a reaction is called an allergen. These reactions are acquired, predictable, and rapid...
test, causing the patient to wait at least three weeks before another appointment, after which more waiting is required to see cosmetic results.
Currently, fillers containing hyaluronic acid like Restylane
Restylane
Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...
and Juvederm
Juvéderm
Juvéderm , one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the faces of patients. The substance is largely hyaluronic acid, a substance normally found in the skin, muscles, and tendons of...
have captured the attention of consumers and physicians in Europe, North America, South America and Australia.
Materials and techniques
In the late 1990s, with the huge popularity of surgical rejuvenation and concomitant increase of cosmetic surgery procedures worldwide, more substances, along with biocompatible materials commonly used in other medical applications for years, became available to surgeons for use in augmenting thinning or misshapen lips into more plump and attractive features.Some of the first widely used lip augmentation substances were:
- Autologen, an injectable dermal material made from the patient's own skin. No risk of allergy exists but the results are very temporary because the body quickly absorbs the material.
- CollagenCollagenCollagen is a group of naturally occurring proteins found in animals, especially in the flesh and connective tissues of mammals. It is the main component of connective tissue, and is the most abundant protein in mammals, making up about 25% to 35% of the whole-body protein content...
requires an allergy test because the material is extracted from bovine hidesHidesA hide is an animal skin treated for human use. Hides include leather from cattle and other livestock animals, alligator skins, snake skins for shoes and fashion accessories and furs from wild cats, mink and bears. In some areas, leather is produced on a domestic or small industrial scale, but most...
. It lasts anywhere from four weeks to three months because it is also absorbed into the body. However, the allergy test must be observed for four weeks. - Dermalogen is taken from the patient's skin—and through a laboratoryLaboratoryA laboratory is a facility that provides controlled conditions in which scientific research, experiments, and measurement may be performed. The title of laboratory is also used for certain other facilities where the processes or equipment used are similar to those in scientific laboratories...
process—made into a high concentration collagen that can be injected into the lips. Some studies indicate it lasts somewhat longer than collagen. - Alloderm is donor tissueTissue (biology)Tissue is a cellular organizational level intermediate between cells and a complete organism. A tissue is an ensemble of cells, not necessarily identical, but from the same origin, that together carry out a specific function. These are called tissues because of their identical functioning...
taken from cadavers and then denatured, purified and treated to remove viable cellCell (biology)The cell is the basic structural and functional unit of all known living organisms. It is the smallest unit of life that is classified as a living thing, and is often called the building block of life. The Alberts text discusses how the "cellular building blocks" move to shape developing embryos....
s that could pass along diseaseDiseaseA disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
. Under a local anesthesiaAnesthesiaAnesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...
, Alloderm is placed into the mucosa, or body, of the lips in small rolls to make them larger. Alloderm can also be placed into the vermillionVermillionVermillion is an alternative spelling for Vermilion, a red pigment and color. It may also refer to:-Locations:*Vermillion, Kansas*Vermillion, Minnesota*Vermillion, South Dakota*Vermillion County, Indiana*Vermillion River...
, the pink area of the lip, to provide definition and a sharper borderBorderBorders define geographic boundaries of political entities or legal jurisdictions, such as governments, sovereign states, federated states and other subnational entities. Some borders—such as a state's internal administrative borders, or inter-state borders within the Schengen Area—are open and...
. - Radiance, a synthetic, laboratory produced solution containing calcium hydroxylapatite (bone) suspended in a gelGelA gel is a solid, jelly-like material that can have properties ranging from soft and weak to hard and tough. Gels are defined as a substantially dilute cross-linked system, which exhibits no flow when in the steady-state...
that has been safely used in medicine for years. Some studies indicate Radiance can last between three and five years. One researcher (Tzikas) found in a study of Radiance on 90 patients that 59 percent felt when injected, moderate to severe painPainPain is an unpleasant sensation often caused by intense or damaging stimuli such as stubbing a toe, burning a finger, putting iodine on a cut, and bumping the "funny bone."...
which disappeared two to five minutes later. But the substance produced results for an average of two years with a few patients reporting the plumping effects being sustained as long as three to five years. Of the 90 patients, four required surgical interventionSurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
due to nodulesNodule (medicine)For use of the term nodule in dermatology, see Nodule In medicine, a nodule refers to a relatively hard, roughly spherical abnormal structure....
in the lips. - Gore-TexGore-TexGore-Tex is a waterproof/breathable fabric, and a registered trademark of W. L. Gore and Associates. It was co-invented by Wilbert L. Gore, Rowena Taylor, and Gore's son, Robert W. Gore. Robert Gore was granted on April 27, 1976, for a porous form of polytetrafluoroethylene with a...
implants. In medical uses, Gore-Tex is known as EPTFE, or expanded polytetrafluoroethylenePolytetrafluoroethylenePolytetrafluoroethylene is a synthetic fluoropolymer of tetrafluoroethylene that finds numerous applications. PTFE is most well known by the DuPont brand name Teflon....
and, commercially as Advanta, UltraSoft, and SoftForm. The EPTFE is delivered to surgeons in strips that are 1/16 inch (2.4mm) and 3/16 (3.4 mm) diameter tubes.
Current popular procedures
Since 2000, more products and techniques have been developed to make lip augmentation more effective and patient friendly. The relative ease of many injections is due to surgeons using tiny 30 and 31 gauge (about as thick as a dozen human hairs) needlesHypodermic needle
A hypodermic needle is a hollow needle commonly used with a syringe to inject substances into the body or extract fluids from it...
that are used to inject the very sensitive lips. Nonetheless, topical
Topical
In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.Many topical medications are epicutaneous, meaning that they are applied directly to the skin...
anesthesias are often used for lip enhancement procedures.
Some of these new techniques and substances include.
- Fat transferFat transferFat transfer is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. Autologous adipose tissue transplantation has been used for breast augmentation for cosmetic reasons and after breast cancer surgery...
. SurgeonSurgeonIn medicine, a surgeon is a specialist in surgery. Surgery is a broad category of invasive medical treatment that involves the cutting of a body, whether human or animal, for a specific reason such as the removal of diseased tissue or to repair a tear or breakage...
s harvestHarvestHarvest is the process of gathering mature crops from the fields. Reaping is the cutting of grain or pulse for harvest, typically using a scythe, sickle, or reaper...
through liposuctionLiposuctionLiposuction, also known as lipoplasty , liposculpture suction lipectomy or simply lipo is a cosmetic surgery operation that removes fat from many different sites on the human body...
or excisionSurgerySurgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
the patient's fat from places on the body where it can be spared and either injected or surgically placed into the lips. Surgical applications usually require general anesthesia. - RestylaneRestylaneRestylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid . Restylane was the first stabilized hyaluronic acid filler on the market and reportedly has been used in over 11 million treatments worldwide .In the United States,...
, a non-animal, clear gel that is reported to be very close to the hyaluronic acid found naturally in the body. According to the American Society of Plastic SurgeonsAmerican Society of Plastic SurgeonsThe American Society of Plastic Surgeons is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of surgeons certified by the American Board of Plastic Surgery or by the Royal College of Physicians and Surgeons of Canada who perform Plastic and...
, there were 778,000 cases of Restylane injection in 2006, the most recent year for which statistics are available. The substance usually lasts six months and, sometimes, longer. While JuvedermJuvédermJuvéderm , one of the newest of the so-called “injectable fillers,” is used by cosmetic, dermatological and plastic surgeons to soften deep folds and reduce wrinkles in the faces of patients. The substance is largely hyaluronic acid, a substance normally found in the skin, muscles, and tendons of...
is extremely chemically close to Restylane; many surgeons report the former is slightly smoother to inject. - ArtecollArtecollArtecoll, used in cosmetic plastic surgery as permanent soft tissue filler, is injected under the skin to plump up wrinkles and reduce folds of skin associated with aging such as the nasolabial fold which runs from the corner of the nose to the edges of the mouth. Artecoll has been used in Europe...
. Both Artecoll and ArteFill are not used to inject the body of the lips because the substance is heavy and would show as white through the thin skin of the lips. Additionally, both products contain tiny microspheres known as PMMA (polymethylmethacrylate) which remain in the face permanently. In cases where Artecoll has been used around the edges of the lips to remove fine lines and wrinkles, some patients have reported annoying nodules or small lumps. In a few cases, surgery was required to remove the Artecoll.
Risks and side effects
Most patients are satisfied with their lip augmentation procedure and would undergo the treatmentTherapy
This is a list of types of therapy .* Adventure therapy* Animal-assisted therapy* Aquatic therapy* Aromatherapy* Art and dementia* Art therapy* Authentic Movement* Behavioral therapy* Bibliotherapy* Buteyko Method* Chemotherapy...
again. Several studies have found fat grafting of the lip to be one of the best methods of maintaining a semi-permanent fuller and softer lip. When the lips are overfilled, the results can be comic, often supplying fodder to tabloid newspapers and offbeat websites. This look is sometimes mockingly called a 'trout pout.' Overaggressive injections can lead to lumpiness while too little can result in ridges.
Common reactions can range from redness, swelling or itching at the injection site(s). Other possible complications include bleeding
Bleeding
Bleeding, technically known as hemorrhaging or haemorrhaging is the loss of blood or blood escape from the circulatory system...
, uneven lips, movement
Motion (physics)
In physics, motion is a change in position of an object with respect to time. Change in action is the result of an unbalanced force. Motion is typically described in terms of velocity, acceleration, displacement and time . An object's velocity cannot change unless it is acted upon by a force, as...
of the implants or extrusion, when an implant
Implant
Implant can refer to:*Implant , or specifically:**Brain implant**Breast implant**Buttock implant**Cochlear implant**Contraceptive implant**Dental implant**Mini dental implant**Extraocular implant**Fetal tissue implant...
breaks through the outermost surface
Surface
In mathematics, specifically in topology, a surface is a two-dimensional topological manifold. The most familiar examples are those that arise as the boundaries of solid objects in ordinary three-dimensional Euclidean space R3 — for example, the surface of a ball...
of the skin. The usual, expected swelling
Swelling (medical)
In medical parlance, swelling is the transient enlargement or protuberance in the body and may include tumors. According to cause, it may be congenital, traumatic, inflammatory, neoplastic or miscellaneous....
and bruising can last from several days to a week.
Some patients are allergic to the common local anesthetics like lidocaine
Lidocaine
Lidocaine , Xylocaine, or lignocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.- History :Lidocaine, the first amino...
and probably should not consider lip injections. A few others react badly to the skin test patients must take before receiving collagen, again, because the substance contains animal byproducts. Other patients who should forego procedures to the lip include those who have active skin conditions like cold sores, blood clotting problems, infections, scarring of the lips or certain diseases like diabetes or lupus
Systemic lupus erythematosus
Systemic lupus erythematosus , often abbreviated to SLE or lupus, is a systemic autoimmune disease that can affect any part of the body. As occurs in other autoimmune diseases, the immune system attacks the body's cells and tissue, resulting in inflammation and tissue damage...
that cause slower healing. Patients with facial nerve
Nerve
A peripheral nerve, or simply nerve, is an enclosed, cable-like bundle of peripheral axons . A nerve provides a common pathway for the electrochemical nerve impulses that are transmitted along each of the axons. Nerves are found only in the peripheral nervous system...
disorders, severe hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
or recurrent herpes simplex
Herpes simplex
Herpes simplex is a viral disease caused by both Herpes simplex virus type 1 and type 2 . Infection with the herpes virus is categorized into one of several distinct disorders based on the site of infection. Oral herpes, the visible symptoms of which are colloquially called cold sores or fever...
lesions should also eschew lip augmentation. As in all surgeries, smokers complicate completion of their procedure as well as the speed of healing
Healing
Physiological healing is the restoration of damaged living tissue, organs and biological system to normal function. It is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area....
.
Fat transfer can last longer than other injected materials but can have lumping or scarring effects. The length of time a fat transfer may last in the lips is often determined by how much the area moves and how close it is to a major blood supply. In addition, the donor fat must be harvested from another area of the patient's body which leaves another—albeit tiny—surgical wound
Wound
A wound is a type of injury in which skin is torn, cut or punctured , or where blunt force trauma causes a contusion . In pathology, it specifically refers to a sharp injury which damages the dermis of the skin.-Open:...
. However, donor fat harvesting techniques have become extremely well refined.
Gore-tex, despite its impressive rates of success in lip augmentation and other procedures, is nonetheless a foreign body which bears a slight risk
Risk
Risk is the potential that a chosen action or activity will lead to a loss . The notion implies that a choice having an influence on the outcome exists . Potential losses themselves may also be called "risks"...
of becoming infected or rejected.
Discussion
Cosmetic surgery providers often advise their patients that many options now exist for improving the appearance of the lips. Most practitioners also admit that successful lip augmentation is highly dependent on the skill of the provider, with that skill stemming from many years of experience injecting the lips of many types of patients. Moreover, the surgeon must master the various injection techniques. With many injectables, the benefit to the patient is an immediate return to normal, usual activities. A few surgeons offer a procedure known as surgical flap augmentations in which small sections of skin near the lips or inside the mouth are excised and added to the lips. But the technique does not add volume and achieves only a slight outward protrusion of the lips.See also
- Oral and maxillofacial surgeryOral and maxillofacial surgeryOral and maxillofacial surgery is surgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. It is an internationally recognized surgical specialty...
- OtolaryngologyOtolaryngologyOtolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....
- Plastic surgeryPlastic surgeryPlastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...
- Lip liftLip liftright|thumb|300px|Lip Lift: the pre-operative aspect , and the post-operative aspect of corrected lips.A lip lift is a plastic surgery procedure that corrects the cosmetic appearance of the lips by reshaping them to increase the prominence of the vermilion border; and to enhance the facial area...