The name for the facelift procedure, or rhytidectomy, comes from the Latin word rhytid meaning wrinkle. Rhytidectomy literally means wrinkle removal. While Board Certified Plastic Surgeons remove wrinkles from all over the body, in Cosmetic Plastic Surgery, the term rhytidectomy is used almost exclusively to describe the surgical procedure that removes wrinkles from the face.
While the facelift is the gold standard for facial rejuvenation, there are many options to consider. This video segment, taken from my appearance on KRON4′s Body Beautiful, discusses the changes that occur in the face as we age. It reviews treatments like botulinum toxin (BOTOX Cosmetic, Dysport) and fillers (Restylane, Perlane, Juvederm), mini-facelifts and the facelift. San Francisco Bay Area residents were able to call in with their questions and have them answered live on the air.
The 800 number in the video below was only used for viewer questions during the live broadcast. If you have questions, or would like to schedule a consultation appointment, please call my Walnut Creek Plastic Surgery office at (925) 943-6353.
This video is provided for general informational purposes only. Specific recommendations can only be made after a careful history and physical examination is performed. Some of the topics covered include:
Loss of facial volume as we age
The effects of gravity
Restoration of volume with fillers
Reducing facial animation lines with Botox/Dysport
What is a facelift?
What areas of the face are addressed with a facelift?
Is the neck included in a facelift?
How is facial volume replacement addressed?
Is it supposed to look tight?
The other segments of this broadcast can be found here:
Rhytidectomy (Facelift) San Francisco – Part 1 of 4 (You are here)
Lattisse - Now available in our Walnut Creek office.
Latisse®, the only FDA approved prescription treatment for making eyelashes longer, thicker and darker, is celebrating it’s first anniversary. If you are a Latisse user, or if you want to be, Allergan is offering the Latisse® first anniversary rebate program.
If you are already enjoying Latisse®, BOTOX Cosmetic® and Juvederm®, Allergan is giving away money. If you have been interested, and would like to get started now is a great time. To cash in you have to use Latisse® and either Botox® or Juvederm® before July 15, 2010. Here’s how it works:
1) Purchase a Latisse® kit between now and July 15, 2010. (Now available in the office.)
2) Come in for a BOTOX Cosmetic® or Juvederm XC® treatment before July 15, 2010.*
You will receive $50 back from Allergan for using Latisse® and either Botox® or Juvederm®. You will receive $100 back if you use both BOTOX Cosmetic® and Juvederm® XC with the Lattise®.
The above is advertisement from Allergan and is an example of eye lash growth possible with Latisse®. Your results may differ. Unlike most the pictures on this blog this is not an actual Dr. Mele patient.
*Minimum purchase requirements apply to Botox and Juvederm. The minimums are less than the amount normally used to treat the average frown line or wrinkle.
Dysport®, the leading (aka only) United States competitor of BOTOX Cosmetic® (aka Botox), has extended the Dysport® Challenge another month. Now, through May 31, 2010, Dysport® is offering cash back to you for trying Dysport®. Details were originally revealed in my previous post, Take the Dysport® Challenge San Francisco Bay Area. Whether you are considering your first wrinkle reduction procedure, or are a Botox disciple, this is how it works:
The Dysport® Challenge™
In my Walnut Creek Cosmetic Plastic Surgery Office, during April and May of 2010, you can get $75 off any Dysport® treatment. Plus, another $75 off your second treatment whether you love it or leave it.
Love It
If you love Dysport® you can get another $75 off your next Dysport® treatment.
Leave It
If do not love Dysport® you can get another $75 off your next BOTOX Cosmetic® treatment.
For all the details visit DysportUSA or click the logo at the top of this article.
Dysport San Francisco or Botox San Francisco?
The next Botox/Dysport Day in the office is Wednesday, May 19, 2010.
The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have released their annual statistics on cosmetic plastic surgery for 2009. Surgical and non-surgical procedures are tallied and compared to previous years. Overall the numbers are down 2% from 2008, but still up 147% since 1997, when the statistics were first compiled. Of the almost ten million procedures performed in 2009, 85% were non-surgical and 15% were surgical. He are some quick facts, a link to the full statistics can be found at the end of this article.
Additional information can be found on the ASAPS web site, or downloaded here. It is a large file, and may take a while…
*Dr. Joseph Mele offers these procedures through his Walnut Creek Plastic Surgery Office. Search the San Francisco Plastic Surgery Blog categories to the left, or click on the links above for more detailed information available on DrMele.com.
If the red color of the lips (the vermillion) is with barely visible, adding volume may not be enough. If the vermilion is short, over filling may lead to increased projection without adequately increasing the height of the vermillion. This can result in a “trout pout”, rather than a fuller more voluptuous lip.
Lip advancement surgery can help. This is not the most mainstream lip enhancement, but in carefully selected patients it is the best option. Originally designed to improve the function and appearance of the lips after removing lip cancer, it preferentially enlarges the red part of the lip (the vermillion). The upside, lip advancement surgery will reveal more vermillion and can be done with or without increasing lip volume. The down side, it leaves a scar along the border of the skin and the vermillion of the lip.
Here is an example of an average scar at 4 months after surgery. The volume is stable at this point in time, and the scar will continue to improve, it is hard to see already. Most patients can cover the scar one week after surgery with lipstick.
Lips before lip advancement with reduced height.
Lips after lip advancement with full restored height.
Lips before lip advancement with lip skin projecting farther forwards than the vermillion.
Lips before lip advancement with lip vermillion now projecting farthest forwards.
If you have very thin lips, that are barely visible when the lips are at rest, lip advancement surgery may be the answer to how to achieve fuller lips. If dermal fillers increase lip projection forward, but are not revealing more vermillion, lip advancement may help. Lip advancement surgery is the most direct and effective method of increasing the amount of red lip that shows.
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
In case you haven’t heard, BOTOX Cosmetic® (aka Botox) has a competitor: Dysport®. BOTOX Cosmetic® was the first to market here in the United States, and has enjoyed a monopoly, until now. Dysport® was first to market in Europe, and has now made it across the pond.
FDA Approved for Facial Wrinkle Reduction
Dysport® received FDA approval last year. It is very similar to BOTOX Cosmetic® in terms of onset of action and duration. While they are not equivalent, they are very similar. Both block unwanted muscle motion, and both reduce stubborn frown lines.
Dysport® came to market at a slightly lower price, but BOTOX Cosmetic® countered with customer loyalty, and discount coupons. The Dysport® people are once again trying to shake the status quo with the Dysport® Challenge™.
The Dysport® Challenge™
In my Walnut Creek Plastic Surgery Office, during March and April of 2010, you can get $75 off any Dysport® treatment. Plus another $75 off your second treatment whether you love it or leave it.
Love It
If you love Dysport® you can get another $75 off your next Dysport® treatment.
Leave It
If do not love Dysport® you can get another $75 off your next BOTOX Cosmetic® treatment.
For all the details visit DysportUSA or click the logo at the top of this article.
Botox/Dysport Day
The next Botox/Dysport Day in the office is Wednesday, March 17, 2010. Happy Saint Partick’s Day.
If this is too soon, the April Botox/Dysport Day is April 21, 2010.
Dermal fillers (Restylane®, Juvederm® and Perlane®) are the most popular way to enhance the lips. The procedure is safe, effective, predictable and relatively simple. It is the best way to “try out” large lips, as it is reversible. In order to maintain your results with lip filler, you need periodic touch-ups. These can be from 3 to 12 months apart depending on your lips.
Sometimes an alternative treatment is desired that has the potential to last years. Lip surgery can give longer lasting results. The local lip tissue can be advanced from inside the lip to provide fullness (V-Y lip advancement), or dermal tissue can be taken from elsewhere on the body and used as implant (dermal grafting).
This entry focusses on V-Y lip advancement, a procedure that rearranges the lips tissues to preferentially give fullness to the vermillion (the red part) of the lip. For information on other methods of lip enhancement, please see the links at the bottom of the page.
Lip Enhancement with Local Tissue Rearrangement
The upper row shows before and the lower row shows after lip enhancement with V-Y flaps. The soft tissue of the lip is moved forwards to enhance the fullness and natural curves of the lips. (Click picture for an enlarged view.)
This particular type of lip enhancement borrows fullness from the inside of the lip to enhance the outside. The soft tissue inside the lips can be pushed forward to enhance lip fullness and the central pout.
The Pro’s and Con’s of Surgical Lip Enhancement
The Advantages:
No artificial materials are necessary … no allergies or foreign body reactions.
Stability … Soft tissues won’t migrate.
Softness … Since lip is enhanced with lip, it feels like lip.
Results … Longer lasting results
The Disadvantages:
Recovery … weeks rather than a few days with the fillers.
Size … maximum volume is limited to the soft tissue available.
Cost … more than one filler treatment, but often less costly over time .
Complications … overall complications rates are low, but slighter higher than with fillers.
Alternative Lip Augmentations
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
The two main goals of lip enhancement surgery are to:
Increase lip volume, and
Increase the amount of vermillion (the red part of the lip) seen.
To accomplish these different goals, different procedures may be selected.
Lip Enhancement Surgery – Volume, volume volume
Lips: Woman in her late 50's with thinning lips before lip implants (dermal grafts taken during a facelift)
Lips: After lip enhancement with dermal grafts. Notice restoration of the balance and projection of the lips.
Adding volume to the lips is how lip fillers work. Dermal fillers like Restylane®, Juvederm® and Perlane®, add volume from right off the shelf. The amount of volume is virtually unlimited, and can be added directly to where it is needed.
Surgery can add volume too. This can be accomplished with:
Lip Implants
Natural Implants (Dermal and/or Fat Grafts)
Man-Made Implants (Gortex, Silicone)
Man-Made Natural Implants (Restylane, Juvederm, Perlane, Collagen – man made but normally found in the lips)
Rearranging the soft tissue already present in the lip (V-Y flaps, lip advancement flaps)
This article focuses on Lip Implants, information on the other available methods of lip enhancement San Francisco, and lip augmentation can be found via the links at the bottom.
Lip Augmentation With Man Made Materials
Gortex® and SoftForm®
Lip implants have been used for years. The most frequently used artificial lip implants are made of Gortex®. It was selected because it is soft. In fact, one of the most popular Gortex® lip implants is named SoftForm®. While it can work well in carefully selected patients, unfortunately, it is not soft enough. I am not a fan of artificial lip implants for several reasons.
Because lips move, and because lips are softer than artificial lip implants, lip implants can:
Tether the lips, and prevent the lips from stretching when smiling fully (even when the implants is sectioned).
Be felt along the edges.
Can cause a visible bulge at the ends of the implant (especially with motion).
Can erode through the skin causing exposure and infection requiring removal of the implant
Silicone Lips
Silicone is available in two forms for lips: Solid (Silicone Lip Implants) and Liquid (Injectable Silicone). I am a fan of neither. Solid implants have the same problems as Gortex® implants, except worse. They are more stiff and thus more likely to erode and get infected.
Liquid silicone injections are even less predictable. They may give you the softest, poutiest lips one day, and then become hard, lumpy and uncomfortable without warning. Once this happens, it is rarely correctable, ask Lisa Rinna. Last year, while touring for the release of her book, Rinnavation, she confessed to having silicone injected into her lips. She also disclosed her personal silicone lip injection problems.
Lip Augmentation With Your Own Cells
Dermal Grafts
Because of the recent advancements of dermal fillers, I rarely use artificial lip implants any more. Instead, when injectable can’t do the trick, I rearrange what is already there. Dermal tissue can be taken from elsewhere on the body and used as an implant (dermal grafting), or the local lip tissue can be advanced from inside the lip to provide fullness (V-Y lip advancement discussed in the next article).
A small incision is made hidden in the corner of the lip, and the dermis is inserted under the vermilion. The results are similar to adding volume with a filler; however, can be much longer lasting. The swelling after this type of surgery lasts longer too. Instead of a couple days, it may take a couple weeks.
Fat Grafting
When more volume is necessary, fat can be retained on the dermal graft. This adds volume, with better volume predictability and better contours than injecting free fat grafts.
Free fat grafting is when fat is removed (liposuctioned) from one area, and reinjected into an area where more volume is desired. For small volumes this can be safe and predictable, and I use this technique most frequently for the nasolabial folds (the parenthesis around the mouth). On the lips it can be more problematic. We want soft lips, especially when kissing, and free fat grafting can cause firm lumps in the lips. Because better alternatives are now available, I rarely use free fat grafting to the lips.
These are minor surgical procedures, and can be done as an outpatient with local, sedation or under anesthesia. Lip augmentations can be done as a stand alone operation, or can be incorporate as part of plan for overall facial rejuvenation. My patients considering a facelift are frequently also experiencing lip thinning. A lip enhancing procedure can be incorporated to solve two problems at the same time.
Alternative Lip Augmentations
For information on other methods available for enhancing your lips, click on the links below:
Nothing says youth like full lips. Research shows that full lips are a requirement for a youthful face. Grace Gold of AOL’s StyleList reports in The Pursuit of Beauty: The Secret to Youth: Full Lips. Her inspiration? An article in the DailyMail.
Thin is Not Always In
It is an unfortunate truth that as we age, our lips shrink. Whether conscious or unconscious, the size of the lips is one of the most important variables programmed into our brains’ youth calculator. In other words, thin lips are aging. There are several ways to turn back the clock on lip aging, and dermal fillers are currently the most popular treatment.
Off the shelf dermal fillers, are safe, effective and convenient. These lip fillers are supplied as prefilled, single use syringes. Any volume can be used, and a simple block with local anesthesia, makes the procedure an in office option. All three of these products have received FDA approval for new formulations with Lidocaine in the mix to ease the injections.
What Makes Lip Fillers so Popular?
Lips before enhancement with a Dermal Filler (Restylane®, Juvederm® and Perlane® are the most popular in the US)
Lips after enhancement with a Dermal Filler. Notice the augmentation and preservation of the normal curves.
The advantage of this type of lip enhancement is its simplicity. I can choose different products for different lips. Lip enhancement can be performed in the office, with local anesthesia if needed, and the results are quickly apparent. There is sometimes mild discomfort, swelling, and bruising, which normally resolve quickly. While the enhancement is instant, it is best to have a few days for the lip augmentation to settle before an important event.
Dermal fillers provide two main benefits for the lips: increased volume, and wrinkle reduction. Lip enhancement is performed for small, thin lips, to increase volume. In this situation, the main goal is to increase the size of the lips. Lip enhancement can also be used to smooth the wrinkles that can form around the lip. Sometimes called Smoker’s Lines, they can occur without smoking. Often radially aligned, the wrinkles that form around lip edges can cause the lipstick to bleed. For lip wrinkles, the primary goal of lip enhancement is to attenuate the aged appearance. Both volume enhancement and wrinkle reduction may be desired for the same pair of lips, and these techniques can be easily combined for optimal results.
The longevity of the results can vary. Most results last 3-6 months, and many patients experience longer satisfaction. It is the perfect product to try out larger lips. The volume can be gradually increased to your comfort, and maintained.
But, what if you are looking for a longer lasting result? The are several surgical alternatives for enhancing lips. While no results are permanent, surgery can give longer lasting, natural results.
Lip augmentation is a popular and very satisfying procedure. Full lips are one of the most significant signs of youth. In my San Francisco Bay Area, Walnut Creek office, I perform hundreds lip enhancements. The most common method for lip augmentation is with a dermal filler like Restylane®, Juvederm® or Perlane®. While fillers of the most widely used method for lip augmentation, there are several other options available.
When I first started writing this week’s article on Lip Enhancement Walnut Creek, my goal was to quickly cover today’s options for lip augmentation. I realized, however, this is going to take more than one post. Over the next two weeks I will briefly review the latest trends in enhancing lips. Be it the ubiquitous injectable fillers you see advertised daily on TV, or lip enhancing surgical procedures known to a smaller group who desired a longer lasting result, and who can afford a little more downtime.
There is more to lip augmentation than meets the eye. In the coming weeks, links to the latest and the most popular ways to enlarge and rejuvenate your lips will be activated at the end of this article. I will try to illustrate each method with lip enhancement before and after pictures. The goal is to provide general information, but to determine the methods best for your lips, you will want to make an appointment with a board certified plastic surgeon, and explore your options.
It Seems So Simple
Plastic surgery often looks simple, but it takes careful planning and the meticulous attention to detail to makes it look simple. Lip enhancement is more than just lip enlargement. While making the lips larger is often the goal, it must be done carefully to keep the lips balanced. It is important to match the volume of the lips to the size of the face, and more importantly, to maintain proper proportions between the upper and lower lips. Hint: the lower lip is meant to be bigger.
So What is Important for Beautiful Lip Enhancement?
The goals:
Volume, volume, volume … the correct volume is very important
The shape of the lips … maintaining or creating the curves
The projection of the lips … the proper pout (not the trout pout)
The height of the lips … must match the facial proportions
The amount of vermilion (red stuff) seen on the lips … fillers may not be enough
The softness of the lips … one of the big benefits of HA’s over Collagen
The motion of the lips … one of the limiting factors for lip implants
Correcting the wrinkles around the lips … last but definitely not least
Most lip enhancement treatments can help with more than one of these goals, but no treatment is perfect. It is important to discuss all the available options with a Board Certified Plastic Surgeon who is experienced in all methods of lip enhancement. This way, you can be certain that you are getting the best possible treatment for your individual lips.
Alternative Lip Augmentations
Several alternative methods are available for enhancing your lips. To learn more click on the links below:
Lip Enhancement 101 – Lip Augmentation San Francisco (Lip Enhancement): Introduction (You are here.)
Lip augmentation is a popular and very satisfying procedure. Full lips are one of the most significant signs of youth. In my 
