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Well-formed lips are a sign of youth. Lips which are thin, wrinkled, and disappearing into the mouth represent age. In the course of total facial rejuvenation, or in the younger patient who simply wants fuller lusher lips, the procedure to augment the lips is wonderful!
-Andrew Barnett, MD
Augmentation, Lifting, Shortening, Wrinkle Reduction
Lip enhancement is designed to provide a more youthful and attractive appearance. The lips should be full without looking “done”, should be smooth, should have a nice outward roll, and should be the right vertical height so your upper teeth show appropriately when you speak and smile.
Who is a candidate for lip enhancement?
Lip enhancement is beneficial to two groups of patients. One group has always had thin lips and would like to have a fuller smile. The second group would like to change the obvious signs of aging seen around the mouth. This is often characterized by a thinning of the lips, lengthening of the distance between the nose and the upper lip, a flattening and rolling in of the lips towards the teeth, and wrinkling. Many patients fall into both categories.
How is lip enhancement performed?
There are many different techniques designed for lip augmentation. They fall into categories:
- Surgery to lift the lip and roll the upper lip outward
- Injections to increase the volume of the lips
- Injections to fill crease lines
- Resurfacing to reduce wrinkles
- Injections to reduce muscle movement
Which method works best?
All methods work to address specific issues. Combining methods is common as many patients have multiple issues. Understanding the various methods or techniques is the first step in planning lip enhancement.
What is a Lip Lift or Lip Shortening?
As we age, the upper lip lengthens and flattens. This causes the lip to appear longer, to cover the upper teeth when one talks or smiles, and to roll in so the volume of the upper lip diminishes. Lip lifting is performed by making small incisions at the junction of the nose and the upper lip, in the natural crease, and removing a portion of the skin part of the upper lip. This technique is extremely effective at shortening the length of the upper lip, and very slightly rolling out the upper lip.
What about scarring with the lip lift?
There is a natural crease where the nose and lip meet. While the crease is more obvious in individuals with a droopy nasal tip, the crease is present in everyone. Placing the incision in the crease means that the thin scar also falls in the crease. Once the redness from surgery fades, any remaining scar generally appears as part of the natural crease.
How much do you shorten or lift the lip?
The correct amount! Judgment is critical, and one needs to consider the size of the mouth and smile, the vertical show of the upper teeth, and the natural shape of the mouth. It’s always best to be conservative, as it’s quite easy to do additional shortening.
Is the design for the lip shortening always the same?
No. Each patient’s lips and nose have a different shape, and the incisions will address the differences. In addition, by altering the shape of the incisions, a surgeon can alter the amount of lip at different parts of the lip. For example, one can lift the outer corners of the lip more than the central part if that is appropriate – it’s 3D sculpting and one has to think that way!
What about movement or sensation of the lips after shortening?
The technique does not remove or alter muscles so movement is generally unaffected after healing is complete. Swelling in the post operative period may temporarily change your smile, but it is only for a short time. The same for sensation.
What about injections to enhance the lips?
Injections are used for three different purposes – to increase the volume of the lips, to provide better definition between the pink part and the skin part of the lips (the VCJ or Vermillion Cutaneous Junction), and to address fine wrinkles or “smoker’s lines.”
To increase volume and to improve the VCJ, it is possible to use either hyaluronic fillers like Restylane™ , or your own fat. Both are effective but cost different amounts and last for different periods of time. The particulars will be discussed at your consultation.
To address the fine wrinkles or “smoker’s lines” thinner versions of the hyaluronic fillers are effective. Fat injections do not address fine lines, although they can impact the wrinkles of the pink part of the lip which occur when volume is lost from this part of the lip – the so-called “deflated” lip.
Other methods to increase the volume of the lips are available – such as dermal fat grafts. They are less popular now, but occasionally are used. Synthetic materials, such as Gortex™ or silicone implants, have fallen out of favor because they often create an unnatural stiff lip which look and feel artificial.
How about lasers or chemical peels?
Lasers and chemical peels, as well as sanding (dermabrasion) remove a thin layer of skin producing a raw surface. This removes the wrinkles and when the skin heals, the lip is generally smoother. These techniques are very effective, but there is a specific limitation. With resurfacing, pigment or skin color changes can be a problem. Certain skin types and colors are at higher risk. This will be addressed at your consultation. Lighter TCA peels can provide a nice, although limited improvement with a much lower risk of color change. The TCA peels can be repeated in the office allowing for excellent improvement over time, with substantially lower risks.
How are the procedures performed?
These procedures can be performed in the office or in the operating room, with local anesthesia including topical numbing. Sedation and general anesthesia are also available but limited to the operating room
How long is the recovery time?
While each patient recovers at their own rate, the lips are generally swollen for a few days to a few weeks. Bruising may be present during the early period. Some numbness is expected early on, but pain is usually quite minimal. During the recovery period you may use lipstick and resume most normal activities within a day or two.
Can Botox™ or Dysport™ reduce wrinkles?
Botox™ and Dysport™ weaken or paralyze muscles. When injected into the lip muscles, the muscles are temporarily weakened, and this reduces the wrinkles that occur when you purse your lips. While this technique is effective, most patients don’t like the look and feel of the “floppy” lip, so if used, it is used very sparingly and the results are subtle.
What size will my lips be after enhancement?
Augmentation is one technique used in lip enhancement and will only be used if you desire an increase in the size or volume of your lips. It is definitely possible to enhance your lips with no increase in size, so if you are happy with the size of your lips, there will be no change in the volume.
Increase in lip size occurs only when I specifically perform lip augmentation, either alone or as part of the lip enhancement process. Every patient I’ve spoken with expresses fear of ending up with “duck lips” – lips that are too large and stick out in an unnatural way. This should not happen. While swelling after surgery is common, following the initial recovery your lips should be natural and balanced in size and shape. With lips, less is more! As it is very easy to add additional filler in the office, it is best to start conservatively and enlarge gradually.
Are there risks to lip enhancement?
In qualified hands, there is a very low complication rate, but risks do exist. Infection, scarring, color or shape irregularities, numbness, swelling, and over or under correction are a few of these. At your consultation, we will have a comprehensive discussion about the entire procedure, including the risks and potential complications.
Is lip enhancement right for me?
That’s a decision only you can make. At your consultation, discuss your questions and concerns. Together we will be able to reach the decision that’s right for you.
To learn more about what you can expect during a Lip Enhancement, or to schedule your consultation with Dr. Barnett at either his San Francisco or Walnut Creek office, please complete the form on this page or call (415) 362-1221