• 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:

• Lip Enhancement 101 – Lip Augmentation San Francisco (Lip Enhancement): Introduction
• Dermal Fillers (Most comon in US are Restylane®, Juvederm®, & Perlane®)
• Dermal Grafts and other Lip Implants (You are here.)
• Local flaps (V-Y advancement)
• Lip Advancement (Vermilion Advancement)

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.

To learn more click on the links below:

• Lip Enhancement 101 – Lip Augmentation San Francisco (Lip Enhancement): Introduction
• Dermal Fillers (Most comon in US are Restylane®, Juvederm®, & Perlane®) (You are here.)
• Dermal Grafts and other Lip Implants
• Local flaps (V-Y advancement)
• Lip Advancement (Vermilion Advancement)

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.)
• Dermal Fillers (Most comon in US are Restylane®, Juvederm®, & Perlane®)
• Dermal Grafts and other Lip Implants
• Local flaps (V-Y advancement) (coming soon)
• Lip Advancement (Vermilion Advancement) (coming soon)

Radiant Life – RLM Success Files features breast augmentation by Dr. Joseph A. Mele.

As seen in Radiant Life Magazine.
(Click to enlarge.)

Radiant Life® Magazine is The Aesthetic Wellness Magazine, and is dedicated to innovations in cosmetic plastic surgery. The current issue of Radiant Life® features an article by Lindsay Haakenson on the latest innovations in Breast Augmentation entitled Breast Surgery 2.0.

Radiant Life Magazine approached me with a short deadline and the need for an example of modern breast augmentation. My staff contacted a few of our many satisfied patients. Jennifer was the first to respond, and she immediately agreed to both an interview with Radiant Life Magazine and the use of her pictures, and for that she gets my sincere thanks. This is a true testimonial* to how worthwhile breast augmentation surgery has been for her. Thanks goes out to my other happy patients who also graciously responded, and to Lindsay Haakenson for including me.

Jennifer first came into the office for a consultation after noticing her breast volume had decreased after pregnancy. She was interested in restoring what mother nature had both given and then taken away. She expressed a desire to maintain proportions with her body, and wanted a natural look that would be attractive, without being distracting.

The excerpt to the right is from the Breast Surgery 2.0. At the top are her breast augmentation before and after pictures. Before submuscular (subpectoral) breast augmentation, her breasts where asymmetrical, small, had a relatively low set nipple and a constricted base. The distance between the nipple and the inframammary fold was short, and the remaining breast tissue was firm. She had a mild form of what is sometimes referred to as a tubular breast.

The simplest way to correct a tubular breast is with a subglandular breast augmentation. Often a periareolar mastopexy is performed to lift and reshape a protruding nipple/areolar complex at the same time. Okay, that may not sound so simple, and in Jennifer’s case, the easiest way was not necessarily the best way.

Every patient requires careful thought and consideration. In Jennifer’s case, the tubular deformity was mild, and a periareolar breast lift was not needed. The lack of breast tissue higher on the chest meant that the upper pole of the implant was more likely to be seen. A saline implant was placed behind the muscle to help soften the upper pole of the implant, and to give a more teardrop shape. A periareolar incision was used, and this, as is usual, healed very well.

For a more pronounced tubular breast deformity, this approach may not work. Unlike the approach using a periareolar lift, it will not correct a bulging areola that is often seen in concert with the narrow constricted breast base. If you are considering breast augmentation, it is important to seek a qualified and experienced, board certified plastic surgeon, so that the safest and most predictable plan can be constructed.

I want to thank Jennifer for volunteering to share her results with you. The best part of my job is helping my patients. I am thrilled that Jennifer is happy with the results of her breast augmentation.

* As per the latest American Society of Plastic Surgeons Code of Ethics this is a true testimonial. I have not reimbursed my patient in any way for her kind words, and I have not paid Radiant Life Magazine to be included in this article. To read the entire Radiant Life Magazine article, click here. You need to be able to view pdf files in order to display the contents properly. To download the latest version of Adobe Reader for free click here.

I have had the opportunity to discuss post weight loss plastic surgery live on KRON4’s Body Beautiful. The 800 number appearing on the video was only for the live show. To contact my Walnut Creek plastic surgery office for additional information, or to schedule a private consultation appointment, please call (925) 943-6353. Alternatively, a contact form on the lower left side of this web page has also been provided for your convenience, or click on this link for an expanded contact form.

Topics covered in this segment of Body Beautiful include:

• Arm Lift Surgery, with Brachioplasty before and after pictures.
• How do age and health effect plastic surgery?
• How do I get rid of my baby pooch? Exercise, Tummy Tuck, both?
• How can lumps left after liposuction be corrected?
• What is the difference between liposuction and lipodisolve?

Post Bariatric Procedures

More information about Post Bariatric Plastic Surgery can be found on the Post Bariatrics page of DrMele.com. Here are links to video presentations about the more common Post Bariatric Plastic Surgery Procedures, and links to the first 3 parts of the above video can be found at the bottom of the page.

• Breast Augmentation
• Breast Lifts
• Breast Reduction
• Gynecomastia Reduction
• Face Lifts
• Liposuction
• Arm Lifts (Brachioplasty)
• Thigh Lifts
• Tummy Tucks (Abdominoplasty)
• Lower Body Lifts

Post Bariatric Surgery (Plastic Surgery after Massive Weight Loss) Links:

Post Bariatric Surgery San Francisco – Part 1 of 4
Post Bariatric Surgery San Francisco – Part 2 of 4
Post Bariatric Surgery San Francisco – Part 3 of 4
Post Bariatric Surgery San Francisco – Part 4 of 4 (You are here.)

Who Gets Post-Bariatric Plastic Surgery?

When we lose weight, there is often enough elasticity in the skin to maintain our shape. With the massive weight loss seen after Bariatric Surgery, and often after pregnancy, the skin is stretched beyond its ability to recoil. Skin can change from form-fitting to redundant, causing bulges in the same places that the fat used to. Skin can change from an unnoticed covering, to an organ that moves with its own momentum, making exercise uncomfortable. When this happens, a board certified plastic surgeon can help.

Cosmetic or Reconstructive? The Answer is Yes.

A lot of time is spent trying to pigeon hole plastic surgery into cosmetic and reconstructive procedures. The truth is all plastic surgery is a mixture of cosmetic and reconstructive elements. The classification is less absolute and more yin and yang. Everything I do is a mixture of both cosmetic and reconstructive surgery, and for post bariatric plastic surgery it is easy to understand.

Post bariatric plastic surgery removes excess skin and tightens the skin that remains. Yes is it cosmetic. Excess skin is not life threatening, and the cosmetic appearance is improved when skin no longer overflows the waist band. However, excess skin can also be painful. It can develop rashes in the folds which can lead to sores and life threatening infections. Correcting or preventing these types of problems is reconstructive.

The following segment focuses on the interplay between weight, exercise and plastic surgery. The 800 number appearing on the video was only for the live show. To contact my office for additional information, please use the form on the lower left side of this web page, or give us a call at (925) 943-6353.

Questions answered in this segment of Body Beautiful include:

• Who has more surgery? Men or Women?
• How does age, weight and weight loss effect plastic surgery?
• Does plastic surgery replace exercise?
• How much weight should I loose before plastic surgery?
• Once the weight is lost, how long should I wait before plastic surgery?

Post-Bariatric Surgery (Plastic Surgery after Massive Weight Loss) Links:

Post Bariatric Surgery San Francisco – Part 1 of 4
Post Bariatric Surgery San Francisco – Part 2 of 4
Post Bariatric Surgery San Francisco – Part 3 of 4 (You are here.)
Post Bariatric Surgery San Francisco – Part 4 of 4

Where did all this skin come from?

After weight loss, the problem is no longer excess fat, but excess skin. Rolls of skin that bind at the waist. Redundant skin that drapes on the inner thighs. Flaps of skin that keep moving after the arm has stopped waving. Loose skin that can no longer support the breast and keep it on the chest.

The skin is an amazing organ. It is our greatest barrier to the outside world. It keeps us warm. It cools us down. It protects us from the elements and infection. When we gain weight, it grows, and continues to protect us. When we lose weight, it can shrink too, but there are limits. With weight gain, the skin can be stretched too far, and it cannot shrink back to its original size.

Post-Bariatric Plastic Surgery

Post-Bariatric Plastic Surgery can help. As a member of The American Society of Bariatric Plastic Surgeons, I am able to assist my patients in their transition to a happier, healthier lifestyle. By removing excess skin, an tailoring what remains, I can help complete the transformation in ways that weight loss alone cannot.

Below is part two of a discussion about post weight loss plastic surgery that originally aired on KRON4’s Body Beautiful.

This segment shows before and after pictures for liposuction, mini-tummy-tuck and tummy tuck. While most tummy tuck have only a horizontal scar that runs below the bikini line, I have included a fleur-de-leis tummy tuck. This type of tummy tuck is most often used after massive weight loss. A fleur-de-leis tummy tuck has a vertical incision in the midline in addition to the lower incision, which is used to further reduce the excess skin left after massive weight loss.

Please note, the 800 number appearing on the video is only for the live show. For more information, or to schedule a consultation appointment, please call me at (925) 943-6353, or contact me via the form on the lower left side of this web page.

This Body Beautiful segment includes:

• Before and after pictures of:
  • Liposuction
  • Mini Tummy Tuck
  • Tummy Tuck
  • Fleur-de-Leis Tummy Tuck (with a vertical scar)
• Rejuvenation and tightening of the abdominal wall.
• The indictions for post-bariatric surgery.
• Scar treatment for keloid, hypertrophic and healing scars.

Post-Bariatric Surgery (Plastic Surgery after Massive Weight Loss) Links:

Post Bariatric Surgery San Francisco – Part 1 of 4
Post Bariatric Surgery San Francisco – Part 2 of 4 (You are here.)
Post Bariatric Surgery San Francisco – Part 3 of 4
Post Bariatric Surgery San Francisco – Part 4 of 4

What is Post-Bariatric Surgery?

Post bariatric plastic surgery is a collection of modified cosmetic plastic surgery procedures designed to remove and tailor the excess skin that weight loss leaves behind. While removing extra skin also means removing extra weight, the real strength of these procedures tightening the skin to reveal your new shape.

In my San Francisco post-bariatric plastic surgery practice, I use modified cosmetic plastic surgery procedures and specialized procedures to achieve optimal results. All post-bariatric plastic surgery requires careful, in-office, consultations and planning. Safety and predictability are paramount.

Video presentations for most post-bariatric procedures can be viewed by clicking on the list below. The back and buttock lifts have many variations, and are best discussed on an individual basis. More video presentations on cosmetic plastic surgery after massive weight loss, can be viewed on the post-bariatric page of DrMele.com.

Post Bariatric Procedures

• Breast Augmentation
• Breast Lifts
• Breast Reduction
• Gynecomastia Reduction
• Face Lifts
• Liposuction
• Arm Lifts (Brachioplasty)
• Thigh Lifts
• Tummy Tucks (Abdominoplasty)
• Back Lifts
• Buttocks Lifts
• Lower Body Lifts

I have had the opportunity to discuss post weight loss surgery on KRON4’s Body Beautiful. Since the show is broadcast live, it allows you to call in with your questions during the show, and get them answered. Below is part 1 of 4 videos. You can find more videos on post-bariatric surgery (plastic surgery after massive weight loss) posted on the San Francisco Plastic Surgery Blog, or they may be viewed on my YouTube channel.

The 800 number appearing on the video was only for the live show. To contact my office for additional information, or to schedule a private consultation appointment, please call (925) 943-6353, or use the contact form on the lower left side of this web page.

After bariatric surgery, it is best to wait a year to allow your weight loss to stabilize. The body has time to adjust to its new physiological state, and the skin can tighten to the best of its ability. Post bariatric plastic surgery can then be tailored to the areas where the excess skin remains.

This video describes:

• The differences between post-bariatric and other cosmetic plastic surgery procedures.
• Why it is important to wait a year after bariatric surgery before having cosmetic plastic surgery.
• Where stretch marks can be removed on the body.
• How many pounds can be removed with liposuction.

Post-Bariatric Surgery (Plastic Surgery after Massive Weight Loss) Links:

Post Bariatric Surgery San Francisco – Part 1 of 4 (You are here.)
Post Bariatric Surgery San Francisco – Part 2 of 4
Post Bariatric Surgery San Francisco – Part 3 of 4
Post Bariatric Surgery San Francisco – Part 4 of 4

Breast augmentation revision surgery may be elective, and may be performed to increase or decrease the size of your breast implants. Increasing breast implant size is one of the most common, and simplest forms of breast implant revision.

Breast implant revision surgery may be needed to replace a deflated implant or to revise the scar around the implant (capsular contracture). The major US breast implant manufacturers offer lifetime replacement of their breast implants if a breast implant deflation occurs. They also provide financial support if the breast implant leaks occur within ten years of the primary breast augmentation.

You will find videos on breast augmentation and breast augmentation revision surgery posted on the San Francisco Plastic Surgery Blog. They can be viewed here or on my YouTube channel. Please remember, the 800 number appearing on the video was only for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.

This video comes from a segment of KRON’s Body Beautiful. You can hear:

• What is Breast Augmentation Revision surgery?
• Who needs Breast Implant Revision surgery?
• Do your silicone breast implants or saline breast implants come with a warranty?
• Is there an expiration date on my breast implants?
• Before and after pictures of Breast Implant Deflation Replacement Surgery?
• Can breast implant asymmetry be improved?
• How does Capsular Contracture present?
• Can breast surgery be performed for a diabetic (a person with diabetes)?

If you are considering Breast Implant Revision Surgery in the San Francisco Bay Area, a Board Certified Plastic Surgeon can help. This first step is a consultation appointment so that existing problems can be defined and achievable goals can be set.

Breast Implant Revision Links

Breast Implant Revision – Part 1

Breast Implant Revision – Part 2

Breast Implant Revision – Part 3

Breast Implant Revision – Part 4: (You are here.)

Thanks for visiting the San Francisco Plastic Surgery Blog.

Many times there is no complication, and the primary motivation for breast augmentation revision surgery is to change the size of the implants. Perhaps the most common breast implant revision surgery is to replace breast implants with a larger pair. This is the reason I place so much emphasis on defining the goal size for breast augmentation before surgery. Even so, minds and goals can change with time.

Other times breast implant revision surgery is less volitional, and may be due to gravity (requiring a breast lift), breast implant failure (breast implant deflation or breast implant rupture) or capsular contracture (tightening of the nature scar that surrounds the implant causing movement or firmness of the breast implants).

Other videos on this subject have been posted on the San Francisco Plastic Surgery Blog and they can be viewed here (see bottom of article for links) or on my YouTube channel. When you are watching this video, please note, the 800 number on the video was for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.

On this episode of KRON’s Body Beautiful you can learn:

• What are the main reasons for Breast Augmentation Revision surgery
• Do breast implants wear out?
• What is the capsule around the breast implants?
• What is Capsular Contracture?
• How long is the Breast Implant Warranty?
• How many Breast Augmentations are performed each year?
• How is Breast Implant Revision Surgery performed?
• What is the recovery like after Breast Augmentation Revision?

Breast Augmentation Revision Surgery requires a careful analysis of the existing problem, a thoughtful discussion about the good (and bad) aspects of all available treatments, the ability to adapt the plan to any new findings found during surgery, and a careful recovery, to speed you return to daily life. The first step is a private consultation with a Board Certified Plastic Surgeon.

Promised Links

Breast Implant Revision – Part 1

Breast Implant Revision – Part 2

Breast Implant Revision – Part 3 (You are here.)

Breast Implant Revision – Part 4

Thanks for visiting the San Francisco Plastic Surgery Blog.