Lip enhancement
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2008-06-14T18:05:35Z
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'''Lip enhancement''' is a type of [[cosmetic surgery]] that aims to improve the appearance of the [[lips]] by increasing their fullness through enlargement.
==History==
Full lips with an accentuated border have often been associated with [[beauty]] and [[youth]]. 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.{{Fact|date=June 2007}} 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 [[atrophy]] 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.<ref>Heidingsfeld ML. Histopathology of paraffin prosthesis. J Cutan Dis 1906; 24:513-521</ref>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]].<ref>Duffy D. Injectable liquid silicone: New perspectives. In: Klein ed. Tissue Augmentation in Clinical Practice: Procedures and Techniques. New York Marcel Dekker 1998; 235:267</ref>
About 1980, injectable [[bovine]] [[collagen]] was introduced to the [[cosmetic surgery]] market and became the standard against which other [[injectable]] fillers were measured.<ref>Klein AW. Implantation technique for injectable collagen. J Am Acad Dermatol 1983;9:224-28</ref>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]].
==Materials and techniques ==
In the late 1990s, with the huge popularity of surgical rejuvenation and concomitant increase of [[cosmetic surgery|cosmetic]] and [[plastic 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.
*'''[[Collagen]]''' requires an allergy test because the material is extracted from bovine [[hides]]. 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 [[laboratory]] 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 [[Tissue (biology)|tissue]] taken from [[cadavers]] and then denatured, purified and treated to remove viable [[cell (biology)|cell]]s that could pass along [[disease]]. Under a local [[anesthesia]], 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 [[vermillion]], the pink area of the lip, to provide definition and a sharper [[border]].
*'''Radiance''', a synthetic, laboratory produced solution containing calcium hydroxylapatite ([[[bone]]) suspended in a [[gel]] 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 [[pain]] 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 [[intervention]] due to [[nodules]] in the lips.<ref>Tzikas,T. L. Evaluation of the Radiance FN Soft Tissue Filler for Facial Soft Tissue Augmentation. Arch Facial Plast Surg. 2004; 6:234-239</ref>
*'''[[Gore-Tex]] implants'''. In medical uses, Gore-Tex is known as EPTFE, or expanded polytetrafluoroethylene 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]].<ref>Fezza JP.Advanta implants, Facial Plast Surgy, 2004 May;20(2):185-9</ref>
==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) [[needles]] 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.
*'''[[Fat transfer]]'''. Surgeons [[harvest]] through [[liposuction]] or [[excision]] 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.
*'''[[Restylane]]''', 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 Surgeons]], there were 778,000 cases of Restylane injection in 2006, the most recent year for which statistics are available.<ref>[www.plasticsurgery.org/media/Press_Kits/Procedural-Statistics-Press-Kit-Index.cfm 2006 Procedural Statistics Press Kit<!-- Bot generated title -->]</ref>The substance usually lasts six months and, sometimes, longer. While [[Juvederm]] is extremely chemically close to Restylane; many surgeons report the former is slightly smoother to inject.
*'''[[Artecoll]]'''. 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.<ref>Blanchard, M. Filler material may cause nodules, lumps in lips. Cosmetic Surgery Times, 15 June, Issue, 2002</ref>
==Risks and side effects==
Most patients are satisfied with their lip augmentation procedure and would undergo the [[treatment]] 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.<ref>Niechajev, Igor. Lip enhancement: surgical Alternatives and Histologic Aspects. Plastic & Reconstructive Surgery. 105(3):1173-1183, March 2000</ref>When the lips are overfilled, the results can be [[comic]], often supplying [[fodder]] to [[tabloid]] newspapers and [[offbeat]] websites. 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.<ref>Coleman, SR. Long term survival for fat transplants: controlled demonstration. Aesthetic Plastic Surgery 2996; 19:421-425</ref>
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.
==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 technique. 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.<ref>Giovanie Botti, Rene Villedieu. Augmentation cheilopolasty by using mucomuscular flaps. Aesthetic Plastic Surgery; Vol 19 (1) 1995, 69-74</ref>
==See also==
* [[Cosmetic surgery|Cosmetic facial surgery]]
* [[Otolaryngology]]
* [[Oral and maxillofacial surgery|Maxillofacial surgery]]
* [[Plastic surgery]]
==References==
{{reflist}}
==External links==
*[http://www.cosmeticsurgery.com/articles/archive/an~232/ Before and after pictures of reasonable lip enhancements]
[[Category:Plastic surgery]]
[[Category:Oral and maxillofacial surgery]]
[[Category:Otolaryngology]]