CosmeticSurgery.com Staff Report
Medically Reviewed by Dolores Kent, M.D, FACOG
CONSUMER BRIEF: Plastic and cosmetic surgeons are rejuvenating lips with injections, fat grafts, inert inserts and with flaps of skin and fat from your own body. Here's a look at the state of the art as more people ask surgeons to pump up their kissers, bringing them back closer to the full, luscious lips of youth.
A 52-year-old New York City woman -- who was very striking in her youth -- noticed her looks fading with age. In particular, her once lush lips had seriously thinned. (She asked not to be identified.) Because her husband, an extremely successful businessman, was frequently invited to New York City's top social gatherings, she grew increasingly embarrassed about her diminished features. Then, she visited plastic surgeon Andrew Jacono, M.D. and had her lips, and a few other facial features, plumped up with Restylane. With more self-confidence in her enhanced appearance, she began enjoying New York's social life much more. She now likes her rejuvenated look so much, she is considering facial plastic surgery to make the changes permanent.
Lips, Lips, Lips
Ever since Romeo offered his eager lips -- as "two blushing Pilgrims" -- to Juliet, women and more men have been concerned about the attractiveness of their lips. The trend currently continues, unabated, with the usual reasons for having lip augmentation: either the person was born with thin lips or the patient is somewhat older and the lips have lost youthful plumpness due to natural aging, accident or injury.
About 16,000 people opened their wallets or purses for surgical lip enhancement in 2006, according to the American Academy of Facial Plastic & Reconstructive Surgery (AAFPRS).
The eight percent of men who augmented their kissers represent a 20 percent increase over 2005 statistics, according to the American Society of Plastic Surgeons (ASPS). Statistics also show 750,000 cases of hyaluronic acid injections for both men and women -- almost always Restylane or Juvederm -- which are frequently used to augment lips. Thus, many lip enhancements go uncounted because they are tallied under facial injectables.
Current methods to augment lackluster lips include:
- Filler injections
- Fat grafts
- Flaps and other surgery
The art of beautiful lips took a step forward when Dr. Jacono, a dual board certified New York plastic surgeon, divided the human lip into 15 separate zones to develop a procedure known as French Lips.
A 20-something patient shows the results, right, after having “French lips” enhancement. Her before picture is on the left.
(Photos, courtesy of Andrew A. Jacono, M.D.)
"Lips are an essential part of facial symmetry and beauty," says Dr. Jacono who creates the Gallic lips with injectable fillers and fat injections. He also provides more permanent French Lips through a surgical procedure, V to Y lip advancement, a technique which results in the fullest, most pouty lips possible, much like the natural lips of actress Angelina Jolie. The procedure also increases the curve of the Cupid's bow, the indentation just under the nose.
Today's consumers crave the quickest results possible. Newly-developed fillers like Restylane and Juvederm, Radiesse and Perlane are now popular because they provide almost instant gratification. But, alas, most fillers are eventually absorbed into the body requiring additional injections to maintain the rejuvenation.
TIP: According to the ASPS, hyaluronic acid fillers like Juvederm and Restylane are the gold standard for plumping the inner body of the lip. But semi-permanent fillers like Radiese and Artecoll are best around the mouth and along the edge of the lip but are less safe for use in the body of the lip. ArteFill is not intended for use in the lip.
However, help is on the horizon. A whole crop of new injectables -- Evolence, Puragen, Laresse and Aquamid -- are headed toward plastic surgery offices and the diminished lips of countless consumers.
The upside of injections, besides almost instant results is: no need for surgical incisions and very little -- if any -- time out for patient recovery.
TIP: Virtually all surgeons say the result of any facial injectable procedure is highly "provider dependent." Translation: tremendous skill and practice are required for facial filler injections, so choose a surgeon who has been performing many lip enhancement injections. His or her Web site should offer dozens of before and after pictures.
In a procedure known as “Beautiful Lips,” Santa Monica, California, plastic surgery Jeffrey D. Hoefflin, M.D. shows on the left a 48-year-year old patient who wanted fuller lips. The patient had alloderm placed throughout her lips and fascial grafts placed in the center of her lips, below the Cupid’s bow. She is shown one month after the procedure.
(Photo, courtesty of Dr. Hoefflin.)
Says Allison Pontius, M.D. of Plastic Surgery Associates of New York: "Experience is really crucial in consistently doing a good job of lip enhancement. But the patient plays a role, too. Some actually like the 'trout pout' look of overfilled lips while others want a more natural lip. The really important thing is communication with the doctor about how you want the lips to look."
Your lips can also be augmented with a variety of inert materials used for decades in medicine. For instance, ePTFE, a medical form of Gortex, and Alloderm, human donar tissue, are frequently used to put more pout in your pucker. But Alloderm can deflate after a year, while Gortex is permanent and also increases the reddish color and projection (how far forward the lips stick out.)
TIP: Gortex always carries the slight risk of infection and creating kinks in your lips. What's more, your internal lip tissue grows into and through Gortex implants so the lip can become hard to the touch. And if things go South, Gortex is extremely difficult for surgeons to remove.
If none of that suits your fancy, you can always choose fat to be surgically implanted into your lip. While many surgeons are adept at injecting prepared fat cells into your lips, a few doctors implant small sections of actual fat.
"I patented LiveFill, a procedure that places small pieces of fat taken from your body and placed into the lip," says Brent Moelleken, M.D. a board certified plastic surgeon and university professor in Los Angeles. "My studies revealed that, at harvest, only 20 percent of injected fat cells are alive while 88 percent of LiveFill is viable."
Other surgeons offer a lip lift to reduce the length of the upper lip while making more of the red portion visible. Adding filler to the lip also adds length and can make it pout excessively, but just reducing the space above the lip provides a more youthful shape.
"Patients often complain their upper lip covers too much of their teeth," says Ricardo Rodgriguez, M.D., a Baltimore plastic surgeon. Performed in the office under a local anesthetic, a lip lift starts with an incision directly under the nose to remove a small strip of skin and tissue, allowing about one-eight inch more of teeth and the reddish color of lips to show, resulting in a more youthful and pleasant shape to the mouth and lips.
"The patient then almost always looks happier and more relaxed," Dr. Rodgriguez says.
The oldest technique for enlarging lips is using flaps of skin and tissue. But the procedure requires an incision inside the mouth to provide tissue for augmenting the lips.
TIP: Lip flaps provide a long-lasting result but require somewhere around a three week recovery period.
Richard Ellenbogen, M.D., one of the plastic surgeons featured on E! Entertainment's Dr. 90210, offers "Expression Surgery," a procedure which lifts down-turned corners of the mouth to eliminate or reduce the frowning appearance caused by drooping facial tissues. "It's called 'Expression Surgery' because the sagging expressions of some people over 50 can send unspoken and unintended messages like anger, hostility or sadness," Dr. Ellenbogen says.
Another type of lip augmentation works on the same principle as breast implants.
VeraFill are small implants surgically inserted into the lips and then filled with saline for the plumping effect.
"The patient is very much awake and taking part in how much the lips are filled," says James Newman, M.D., a board certified plastic surgeon in San Mateo, California. "Plus, the procedure is reversible. If the patient feels her lips are too large, she can have some saline taken out." According to Dr. Newman, the procedure is normally done under local anesthetic and a dental nerve block.
In England, the same implant is known as FulFil. According to the manufacturer, Evera Medical in Foster City, California, about 600 patients worldwide now have lip implants, with no infections or ruptures.
While patients now have many choices for having fuller lips, it's often wise to remember Jerry Seinfeld's classic observation on highlighting lips.
The comic once observed that, where lipstick is concerned, the important thing is not so much the color, but to accept Nature's final word on where your lips end.
EDITOR'S NOTE: While our medical reviewer, Dolores Kent, M.D. sees patients for lip augmentation, most ask for labiaplasty consults and gynecological procedures.
Read more about lip augmentation
Find a lip augmentation doctor in your state
More before and after photos of lip augmentation patients