WHAT DOES THE SURGERY INVOLVE?
Although the lips can be enhanced temporarily or permanently it is always a good idea to try a temporary form of lip augmentation first before deciding on a permanent option. Many of the filler materials currently available are usable in the lips with good predictable results. We prefer to use either a hyaluronic acid based product (such as restylane or perlane) or a collagen based product. These are injected under local anaesthetic, last up to four months, and are gradually absorbed away. The collagen based products carry a tiny chance of an allergic reaction and are therefore tested prior to use. This risk does not occur with the hyaluronic acid based products, although redness and itching is estimated to occur in around one in 2000 patients. There are several different ways of filling the lips and these may involve increasing definition of the vermillion edges and white roll areas, filling the dry vermillion to produce a ‘Paris lip’ or filling the wet vermillion just behind the wet/dry border to produce a full pouting lip.
Permanent methods of lip augmentation involve either the use of material taken from other parts of the body such as fat (coleman lipostructure),dermis-fat grafts, or using externally derived materials such as alloderm(lyophilized dermis) or softform (hollow PTFE(Teflon) tubes).
Coleman lipostructure. Recently there have been great advances in the technique used to transfer fat from one part of the body to another allowing this to be a predictable and very safe method of lip augmentation. Under local anaesthetic a special needle is used to harvest fat cells atraumatically from the thigh or abdomen. The fat graft is then carefully refined prior to reinjection through a similarly atraumatic tiny needle. This technique needs no sutures (stitches) and leaves barely noticeable scars. Its only disadvantage is the possibility that it might need to be repeated to bulk up the fat graft if the result is inadequate.
Dermis-fat grafts are taken from the groin under local anaesthesia and threaded through channels made in the lips. They are a good option if the lip augmentation is being carried out at the same time as another procedure which necessitates an incision but has the disadvantage of producing a scar, albeit a hidden one, if no other surgery is being carried out in the same period.
Alloderm is lyophilized human donor dermis. With a brief local anaesthetic it gives a predictable lip enhancement. It is passed through tunnels in the upper and lower lips and to all intents and purposes is very similar to dermis-fat grafts. There is a risk of infection as it is a piece of foreign material but it has the advantage of predictability and not requiring an incision anywhere else.
Permacol is a similar material which has recently become available and which is gaining in popularity.
Softform consists of hollow PTFE (Teflon) tubes which are available in two different diameters. It can produce very pleasing results when used judiciously. It is usually inserted under local anaesthetic and gives a predictable result. It has the disadvantage of being a piece of foreign material and so there is a greater risk of infection and also, since it is malleable, it is at risk of encapsulation and distortion (just like a breast implant).
WHAT HAPPENS AFTERWARDS?
The lips swell slightly over the first 48 hours or so after treatment. Any wrinkles will appear over filled initially. In the case of temporary injectable dermal filler materials (restylane, collagen) the ultimate shape and contour will be apparent after approximately one week and should last three to four months. With coleman lipostructure, and dermis fat grafts, the fat graft initially swells slightly and then over the next two to three weeks the recontoured area assumes its final shape.
WHAT COULD GO WRONG?
Usually the result is very predictable and patients are very happy with the new shape. Occasionally there may be irregularity in the contour and this may require a small touch-up to achieve perfect results. Softform can contract with time and cause a feeling of tightness. It can also occasionally become infected and require removal as it is a piece of foreign material and cannot fight infection effectively.