Lip Augmentation with Dermal Fillers or Surgery for "The Perfect Pout"

LIP AUGMENTATION 
Things you should know
One of the most attractive features of a beautiful face are a set of full and healthy lips. They are a synonymous with  youth when robust, and a sign of aging as they become thinner and descend  with time. Many theories as to the reason behind the attractiveness of lips have emerged over the years, but there are objective findings that are self evident  in a set of beautiful lips.

6 Characteristics of beautiful lips
-Full and robust lips
-Healthy uniform surface with good hydration
-A distinct Cupids Bow with a defined Vermillion Border
-A ratio of lower to upper lip consistent with the golden number "Phi"
-The lower lip is normally fuller than the upper lip
-Symmetry
                                                                                 
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Other Considerations
On profile, the upper lip should ideally project approximately 2 mm beyond the lower lip, which, in turn, projects 2 mm beyond the most anterior portion of the chin.¹
The inclination of the lower lip is determined by it's fullness which also affects the appearence of the chin
It is important to inject the lips so as to maintain the ski-jump edge  of the upper lip when augmenting. This anatomical point is known as the Glogau–Klein point or G-K point for short ¹  
Aging changes the proportions of the lips as they descend and become thinner.

Lip augmentation.
There are variety of methods for lip augmentation available in the armametarium of the cosmetic plastic surgeon. Although no fillers are currently approved by the FDA for lip augmentation, this is a common of label use for non-permanent fillers such as Hyaluronic Acid (HA).
HA has the advantage of producing few side effects and being temporary, lasting up to a year.
Permanent solutions with methylmethacrylate (PMMA) and ophtalmic grade silicone are also available, but are not as widely used. These permanent fillers may produce secondary complications such as granulomas which may require excision (removal) via surgery or liposuction.
Fat grafting has gained popularity because it is autologous (from one's own body) and gives much longer lasting effects.
Commonly used Fillers and attributes

Product	Ingredient	Duration	Skin Test	Lidocaine (Local Anesthesia)
Zyderm 1	Bovine Collagen 35 mg/mL	3 mo	Yes	Yes
Zyderm 2	Bovine Collagen 65 mg/mL	3 mo	Yes	Yes
Zyderm	Bovine Collagen Cross Linked 35mg/ml With Glutaraldehide	3+mo	Yes	Yes
Restylane	NASHA 20 mg/mL 100,000 particles/mL	6mo	No	No
Perlane	NASHA 20 mg/mL, 10,000 particles/mL	6 mo	No	No
Juv馘erm Ultra Juvaderm	NASHA 24 mg/mL;	6-12 mo	No	No
Radiesse	Calcium 25–45 μm, calcium HA microspheres	Stimulatory Semi-permanent	No	No
Sculptra	PLLA hydrogel synthesized from corn	Stimulatory Semi-permanent	No	No
ArteFill	PMMA	Permanent	Yes	Yes
Silikon 1000d	Polydimethylsiloxane Highly purified medical grade	Permanent	No	No
Autologous fat Autologous fat Transplantation by aspiration and reinjection by MD		Months To Years

Your initial consult
During your initial consult you should ask everything you can about the procedure, make sure your plastic surgeon addresses any concern you may have regarding lip augmentation. Common questions are related to the shape and size of the augmentation, "is the procedure painful?" "How long will it take to recover and for the swelling to go down?"
In addition to asking questions, most cosmetic plastic surgeons will evaluate the general health of the patient and take pre-procedure photographs and measurements of your lips. Always tell your Surgeon what medications you take, especially any that may be considered blood thinners, such as aspirin.
Common medications that may cause bleeding during a procedure are:

1. Aspirin or other antinflamatory medications such as Ibuprofen
2. Garlic supplements
3. Ginkgo biloba
4. Fish oils (Omega Fatty Acids)
5. Coumadin
6. Heparin or Lovenox
7. Vitamin E
8. Antibiotics

A mirror should be used for the patient to point out any areas of concern to be addressed on the lips. Make sure that your expectations of the procedure are congruent with what the procedure can provide. Always ask your surgeon what he/she recommends and what you should expect

What to expect after augmentation
Although in the scheme of things, lip augmentation is a smaller less invasive procedure than surgery, it will require some downtime afterward. This is something to consider in the busy hussle and bussle of  NYC. I recommend  3-4 days to allow the local swelling to subside.
There  may also be  temporary distortion of the lips. It is recommended to apply ice packs to the site to mitigate these side effects. Pain is well controlled by applying filler with local anesthesia and lasts 4-6 hours on average. Control of  local discomfort for this procedure is usually addressed with NSAID type medications (eg. Ibuprofen) and patients tend to do well.
Pitfalls of Augmentation
Unfortunately, not all practitioners are familiar with what conforms with a natural youthfull appearence of attractive lips. Simply adding volume to the lips, often yields displeasing cosmetic results. Technical knowledge as well as a deep understanding of the regional anatomy is needed to acheive a good result. In addition to the previously mentioned, realistic expectations are equally important. Voluptuos lips are a very desirable trait, but the key to a succesfull outcome for maximum effect consists in applying "just enough" volume in just the right places.
The safe approach to augmenting lips in terms of a natural appearance consists in being conservative. In this particular case, sometimes "less is more"

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                                     Overdone non-natural looking results after lip augmentation


The key is to always augment the lips with the aim to get a natural appearance... no more and no less

*Always ask your plastic surgeon what is your best option when it comes to lip augmentation or any cosmetic procedure.


Stay tuned .........






Bibliography
1. Aesthetic Plastic Surgery. By Sherrell J Aston, Douglas S Steinbrech and Jennifer Walden. 
    Chapter 8 pg.412; 855-871 
2.Comparison of Filling Agents for Lip Augmentation Aesthetic Surgery Journal 2008 28: 556
   Deborah S. Sarnoff, Ritu Saini and Robert H. Gotkin
3. Assessing the options for lip augmentation. Malcolm D. Paul MD.  Aesthetic Surgery Journal 2004 24: 65