Lip augmentation is a cosmetic procedure that modifies the shape of the

lips The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be ...

using fillers, such as

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whol ...

or implants. The procedure may be performed to increase lip size, correct asymmetry, create protrusion, or adjust the ratio of the top and bottom lips. The procedure typically involves surgical injection, though temporary non-surgical alternatives exist. Swelling and bruising are common after lip augmentation, and irritation or allergic reaction may also occur. Lip augmentations can have undesired cosmetic effects, including scarring and lumping, and implants pose the risk of shifting underneath the lip or breaking through the skin.

History

Around 1900,

surgeons In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

tried injecting paraffin into the lips without success. Liquid

silicone A silicone or polysiloxane is a polymer made up of siloxane (−R2Si−O−SiR2−, where R = organic group). They are typically colorless oils or rubber-like substances. Silicones are used in sealants, adhesives, lubricants, medicine, cookin ...

was used for lip augmentation, starting in the early 1960s but was abandoned thirty years later due to fears about the effects of silicone on general health and long term aesthetic outcome. About 1980, injectable

bovine Bovines (subfamily Bovinae) comprise a diverse group of 10 genera of medium to large-sized ungulates, including cattle, bison, African buffalo, water buffalos, and the four-horned and spiral-horned antelopes. The evolutionary relationship betwe ...

was introduced to the

cosmetic surgery Plastic surgery is a surgical specialty involving the restoration, reconstruction or alteration of the human body. It can be divided into two main categories: reconstructive surgery and cosmetic surgery. Reconstructive surgery includes cranio ...

market and became the standard against which other

injectable An injection (often and usually referred to as a "shot" in US English, a "jab" in UK English, or a "jag" in Scottish English and Scots) is the act of administering a liquid, especially a drug, into a person's body using a needle (usually a hypo ...

fillers were measured. However, that collagen does not last very long and requires an

allergy Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic derm ...

test, causing the patient to wait at least three weeks before another appointment, after which more waiting is required to see cosmetic results.

Aesthetics

The aim of lip augmentation is to provide an aesthetic, symmetric, and healthy appearance for the patient. Naturally, the face is not perfectly symmetric, and if the asymmetry is too big - with lip augmentation, the asymmetry can be corrected. The ideal upper / lower lip ratio is around 1:1.6, and this ratio is also achievable by lip augmentation.

Materials and techniques

In the late 1990s, with the huge popularity of surgical rejuvenation and concomitant increase of

procedures worldwide, more substances, along with

biocompatible Biocompatibility is related to the behavior of biomaterials in various contexts. The term refers to the ability of a material to perform with an appropriate host response in a specific situation. The ambiguity of the term reflects the ongoing de ...

materials commonly used in other medical applications for years, became available to

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 Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whol ...

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 A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which scientific or technological research, experiments, and measurement may be performed. Laboratory services are provided in a variety of settings: physi ...

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 taken from

cadavers A cadaver or corpse is a dead human body that is used by medical students, physicians and other scientists to study anatomy, identify disease sites, determine causes of death, and provide tissue to repair a defect in a living human being. Stud ...

and then denatured, purified and treated to remove viable

cell Cell most often refers to: * Cell (biology), the functional basic unit of life Cell may also refer to: Locations * Monastic cell, a small room, hut, or cave in which a religious recluse lives, alternatively the small precursor of a monastery ...

s that could pass along

disease A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...

. Under a local

anesthesia Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical or veterinary purposes. It may include some or all of analgesia (relief from or prevention of pain), paralysis (muscle relaxation), ...

, Alloderm is placed into the

mucosa A mucous membrane or mucosa is a membrane that lines various cavities in the body of an organism and covers the surface of internal organs. It consists of one or more layers of epithelial cells overlying a layer of loose connective tissue. It i ...

, or body, of the lips in small rolls to make them larger. Alloderm can also be placed into the

vermilion Vermilion (sometimes vermillion) is a color, color family, and pigment most often made, since antiquity until the 19th century, from the powdered mineral cinnabar (a form of mercury sulfide, which is toxic) and its corresponding color. It i ...

, 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 A gel is a semi-solid that can have properties ranging from soft and weak to hard and tough. Gels are defined as a substantially dilute cross-linked system, which exhibits no flow when in the steady-state, although the liquid phase may still di ...

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 Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

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. *

Gore-Tex Gore-Tex is a waterproof, breathable fabric membrane and registered trademark of W. L. Gore & Associates. Invented in 1969, Gore-Tex can repel liquid water while allowing water vapor to pass through and is designed to be a lightweight, waterpr ...

implants. In medical uses, Gore-Tex is known as EPTFE, or expanded

polytetrafluoroethylene Polytetrafluoroethylene (PTFE) is a synthetic fluoropolymer of tetrafluoroethylene that has numerous applications. It is one of the best-known and widely applied PFAS. The commonly known brand name of PTFE-based composition is Teflon by Chemo ...

and, commercially as Advanta, UltraSoft, and SoftForm. The EPTFE is delivered to surgeons in strips that are 1/16 inch (2.4 mm) and 3/16 inch (3.4 mm) diameter

tubes Tube or tubes may refer to: * ''Tube'' (2003 film), a 2003 Korean film * ''The Tube'' (TV series), a music related TV series by Channel 4 in the United Kingdom * "Tubes" (Peter Dale), performer on the Soccer AM television show * Tube (band), a ...

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 A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

anesthesias are often used for lip augmentation procedures. Some of these new techniques and substances include: * Fat transfer.

Surgeon In modern medicine, a surgeon is a medical professional who performs surgery. Although there are different traditions in different times and places, a modern surgeon usually is also a licensed physician or received the same medical training as ...

harvest Harvesting is the process of gathering a ripe crop from the fields. Reaping is the cutting of grain or pulse for harvest, typically using a scythe, sickle, or reaper. On smaller farms with minimal mechanization, harvesting is the most l ...

through

liposuction Liposuction, or simply lipo, is a type of fat-removal procedure used in plastic surgery. Evidence does not support an effect on weight beyond a couple of months and does not appear to affect obesity-related problems. In the United States, lipo ...

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 Restylane is the trade name for a range of injectable fillers with a specific formulation of non-animal sourced hyaluronic acid (HA). In the United States, Restylane was the first hyaluronic acid filler to be approved by the U.S. Food and Drug A ...

, a non-animal, clear gel that is reported to be very close to the

hyaluronic acid Hyaluronic acid (; abbreviated HA; conjugate base hyaluronate), also called hyaluronan, is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglyca ...

found naturally in the body. According to the

American Society of Plastic Surgeons The American Society of Plastic Surgeons (ASPS) is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of surgeons certified by the American Board of Plastic Surgery or by the Royal College of ...

, there were 778,000 cases of Restylane injection in 2006, the most recent year for which statistics are available. The substance usually lasts six months and, sometimes, longer. While

Juvederm Injectable filler (injectable cosmetic filler, injectable facial filler) is a soft tissue filler injected into the skin at different depths to help fill in facial wrinkles, provide facial volume, and augment facial features: restoring a smoother ap ...

is extremely chemically close to Restylane; many surgeons report the former is slightly smoother to inject. Juvederm contains 35 percent more cross-linked hyaluronic acid than Restylane, therefore it is claimed to be longer lasting (up to 1 or 1.5 year). * 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 PMMA may refer to: * para-Methoxymethamphetamine, a stimulant drug * Philippine Merchant Marine Academy * Poly(methyl methacrylate), a transparent thermoplastic often used as a glass substitute {{disambig ...

(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.

Non-surgical alternatives

*Lip plumper is a

cosmetic Cosmetic may refer to: *Cosmetics, or make-up, substances to enhance the beauty of the human body, apart from simple cleaning *Cosmetic, an adjective describing beauty, aesthetics, or appearance, especially concerning the human body *Cosmetic, a t ...

product used to make lips appear fuller. These products work by irritating the skin of the lips with ingredients such as

Capsaicin Capsaicin (8-methyl-''N''-vanillyl-6-nonenamide) ( or ) is an active component of chili peppers, which are plants belonging to the genus ''Capsicum''. It is a chemical irritant for mammals, including humans, and produces a sensation of burnin ...

. This makes the lips swell, temporarily creating the appearance of fuller lips. *Suction pumps, a special device for lips uses vacuum pumping to increase blood pressure in each lip and to pull them out a bit, making it quite an instrument to adjust proper lip length/value in a slow determinite step-by-step way.

Risks and side effects

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. When the lips are overfilled, the results can be comic, often supplying fodder to

tabloid Tabloid may refer to: * Tabloid journalism, a type of journalism * Tabloid (newspaper format), a newspaper with compact page size ** Chinese tabloid * Tabloid (paper size), a North American paper size * Sopwith Tabloid The Sopwith Tabloid an ...

newspapers and offbeat websites. This look is sometimes mockingly called a 'trout pout.' Overaggressive injections can lead to lumpiness while too little can result in

ridges A ridge or a mountain ridge is a geographical feature consisting of a chain of mountains or hills that form a continuous elevated crest for an extended distance. The sides of the ridge slope away from the narrow top on either side. The line ...

. Common reactions can range from redness, swelling or

itching Itch (also known as pruritus) is a sensation that causes the desire or reflex to scratch. Itch has resisted many attempts to be classified as any one type of sensory experience. Itch has many similarities to pain, and while both are unpleasan ...

at the injection site(s). Other possible complications include

bleeding Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vag ...

, uneven lips, movement of the implants or extrusion, when an

implant Implant can refer to: Medicine * Implant (medicine), or specifically: **Brain implant **Breast implant ** Buttock implant **Cochlear implant **Contraceptive implant **Dental implant ** Fetal tissue implant ** Implantable cardioverter-defibrillato ...

breaks through the outermost surface of the skin. The usual, expected swelling and

bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur close ...

can last from several days to a week. Some patients are allergic to the common local anesthetics like

lidocaine Lidocaine, also known as lignocaine and sold under the brand name Xylocaine among others, is a local anesthetic of the amino amide type. It is also used to treat ventricular tachycardia. When used for local anaesthesia or in nerve blocks, lid ...

and probably should not consider lip injections. Some react badly to the skin test that patients must take before receiving collagen. Other patients who should forego procedures to the lip include those who have active skin conditions like

cold sores Herpes labialis, commonly known as cold sores or fever blisters, is a type of infection by the herpes simplex virus that affects primarily the lip. Symptoms typically include a burning pain followed by small blisters or sores. The first attack ...

, blood

clotting Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The mechanism o ...

problems,

infections An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

, scarring of the lips or certain diseases like

diabetes Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

lupus Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Commo ...

that cause slower healing. Patients with facial

nerve A nerve is an enclosed, cable-like bundle of nerve fibers (called axons) in the peripheral nervous system. A nerve transmits electrical impulses. It is the basic unit of the peripheral nervous system. A nerve provides a common pathway for the ...

disorders, severe

hypertension Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated. High blood pressure usually does not cause symptoms. Long-term high b ...

or recurrent

herpes simplex Herpes simplex is a viral infection caused by the herpes simplex virus. Infections are categorized based on the part of the body infected. Oral herpes involves the face or mouth. It may result in small blisters in groups often called col ...

lesions A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals. Types There is no designated classifi ...

should also eschew lip augmentation. As in all surgeries, smokers complicate completion of their procedure as well as the speed of

healing With physical trauma or disease suffered by an organism, healing involves the repairing of damaged tissue(s), organs and the biological system as a whole and resumption of (normal) functioning. Medicine includes the process by which the cells ...

. 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 A wound is a rapid onset of injury that involves lacerated or punctured skin (an ''open'' wound), or a contusion (a ''closed'' wound) from blunt force trauma or compression. In pathology, a ''wound'' is an acute injury that damages the epider ...

. However, donor fat harvesting techniques have become extremely well refined.

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 various injection techniques. 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.Giovanie Botti, Rene Villedieu. Augmentation cheilopolasty by using mucomuscular flaps. Aesthetic Plastic Surgery; Vol 19 (1) 1995, 69-74

References

{{DEFAULTSORT:Lip augmentation Oral and maxillofacial surgery Oral surgery Plastic surgery Lip surgery