Plastic surgery is extremely personal, and I depend on you to help me know what the best course of treatment will be. Sometimes plastic surgery is the best answer, and sometimes less is more appropriate.

Many plastic surgeons use Botox and Restylane in their practices. While non-surgical, these products are complementary to what we Plastic Surgeons do. For example:

Forehead Wrinkles and Frown Lines

Relaxing the frown lines and forehead wrinkles has always been a part of the Brow Lift procedure. If you have droopy eyebrows that are pushing skin onto your upper eyelids, deep wrinkles running across your forehead, or vertical lines between the eyebrows that make you look angry (frown lines), a brown lift might be for you. On the other hand, if you have the frown lines the forehead wrinkles, but the eyebrows and eyelids are fine, Botox, Dysport and Xeomin, may provide you with an equally attractive result.

Lower Face Wrinkles

Lower facial wrinkles include the Naso-Labial Folds (NLF’s), Marionette Lines (ML’s), lip lines and other wrinkles found on the lower face. These areas can be treated with a Facelift, when coexisting with lower facial skin laxity, but when found in isolation, a face lift is more than what is needed. Dermal fillers like Restylane, Juvederm, Perlane and Radiesse can pinpoint the treatment to exactly where it is needed, without the downtime associated with surgery.

Naso-Labial Folds (NLF’s)

The Naso-Labial Folds are the lines that extend from the sides of the nose down to the lips. They are the result of muscle attachments to the skin, and are deepened when we smile. The more firmly the muscle is attached, the deeper the resulting fold. Filling the NLF’s with Restylane, Juvederm, Perlane or Radiesse can reduce the appearance of folds without affecting the ability to smile. Unlike botox, dermal fillers do not inhibit motion.

Marionette Lines (ML’s)

The Marionette Lines are a continuation of the NLF’s, extending from the corners of the mouth down to the jaw line. These too are reinforced when we talk and smile broadly. Like the Naso-Labial Folds, the Marionette Lines respond well to fillers. The ML’s often require more volume than the NLF’s for what would seem to be wrinkles of similar depth.

Lip Lines

Lip lines are the fine lines that radiate out from the lips. Often referred to as Smoker’s Lines, the lines are formed when we pucker our lips. Lip lines allow lipstick to bleed, and can make maintaining a clean line at the edge of the lip difficult. By carefully filling in the edge of the lip, a smoothed contour can be formed, and less lipstick bleed occurs. This can be done with or without Lip Augmentation, or purposefully adding volume to the lips.

Facial Wrinkle Correction Before and After Photos

This segment focusses on dermal fillers, and shows numerous before and after pictures illustrating the areas more commonly treated with fillers like Restylane, Juvederm, Perlane and Radiesse. Wrinkle relaxers, like Botox, Dysport and Xeomin can complement results in facial wrinkle reduction, but were not used for the areas shown in these before and after pictures.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

Facial Wrinkle Correction Video Contents

This Facial Wrinkle Correction Video includes:

• Liquid Facelifts or Facial Wrinkle Reduction
• The effects of gravity and aging on the face.
• Who is a good candidate for wrinkle reduction treatments?
• Before and After Pictures of Dermal filler treatments
  • Before and After Pictures of Howdy Doody Line treatment
  • Before and After Pictures of Naso-Labial Fold treatment
  • Before and After Pictures of Facial Wrinkle treatment
  • Before and After Pictures of Acne Scar treatment
  • Before and After Pictures of Lip Augmentation
  • Before and After Pictures of Non-Surgical Rhinoplasty
• Dermal fillers used include
  • Restylane
  • Juvederm
  • Perlane
  • Radiesse
• Neuromodulators can also enhance the results of fillers. For example:
  • BOTOX Cosmetic
  • Dyport
  • Xeomin
• The best areas to treat with fillers
• Temporary vs. “Permanent” Correction

Who Am I?

I am a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for almost 15 years. The development of injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they do allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

• Wrinkle filler & wrinkle relaxer information, including Before and After Pictures, on Dr. Mele’s main web site.
• Reducción de Arrugas y Cuidado de la Piel
• Five part series on Lip Augmentation

More Wrinkle Correction Videos

This is part 2 of 4 below are links to the rest of the series:

• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 1
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 2 (You are here)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 3 (Coming soon)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 4 (Coming soon)

San Francisco Bay Area – Leaders in Wrinkle Reduction

San Francisco Bay Area Plastic Surgery patients have always been at the forefront of facial wrinkle correction with fillers. It began in the 70′s with the local development of Collagen, and carries on today with its replacement, hyaluronic acid or HA.

Wrinkle Fillers – Restylane, Juvederm, Perlane & Radiesse

Like collagen, HA is a normal component of the skin, and is also found in our joints. HA dermal fillers are sold under many brands names, with the most popular being Restylane, Juvederm and Perlane. These clear gels allow for the correction of moderate to deep facial rhytids (lines) with minimal down time and quick improvement.

Wrinkle Relaxers – Botox, Dysport & Xeomin

Botulinum toxins have been used for years for the treatment of blepharospasm, a disabling chronic spasm of the muscles around the eyes causing functional blindness. For many years it was the plastic surgeons “secret” weapon, and used off-label, but a few years ago Allergan received approval for a new indication – the cosmetic treatment of frown lines. BOTOX Cosmetic was born. Others have followed with similar approval and results including Dysport and Xeomin.

Facial Wrinkle Correction Video

Today’s video is from a recent appearance on KRON‘s Body Beautiful during which I discuss how to use minimally invasive procedures to achieve maximum results. The discussion includes the use of fillers like Restylane, Juvederm, Perlane and Radiesse, and wrinkle relaxers, like Botox, Dysport and Xeomin. The (415) number in this video was for viewers to call during the live broadcast. If you have questions about dermal fillers or botox, give us a call at (925) 943-6353.

This Facial Wrinkle Correction Video includes:

• Liquid Facelifts
• Freshening up for special occasions
• Dermal fillers
  • Restylane
  • Juvederm
  • Perlane
  • Radiesse
• Neuromodulators
  • BOTOX Cosmetic
  • Dyport
  • Xeomin
• The best areas to treat with fillers
• The best areas to treat with neuromodulators
• Who is a good candidate for wrinkle reduction treatments?

As a Board Certified Plastic Surgeon in private practice in the San Francisco Bay Area city of Walnut Creek, California, for almost 15 years, the development of these injectable therapies has revolutionized the way facial rejuvenation is approached. While no substitute for real plastic surgery, they allow for real improvement in appearance of facial lines and wrinkles, in ways that were just not possible before.

More Wrinkle Correction Information

Information on facial wrinkle reduction is available in English and Español. Please follow the links below:

• Wrinkle filler & wrinkle relaxer information, including Before and After Pictures, on Dr. Mele’s main web site.
• Reducción de Arrugas y Cuidado de la Piel
• Five part series on Lip Augmentation

More Wrinkle Correction Videos

This is part 1 of 4 below are links to the rest of the series:

• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 1 (You are here)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 2
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 3 (Coming soon)
• Wrinkle Correction – Fillers, Botox and Plastic Surgery – Part 4 (Coming soon)

Silicone (Polydimethylsiloxane)

Silicone is used in many beauty aids. While most people equate silicone with breast implants, there is much more to how silicone is used. From contact lenses to shampoo (dimethicone) silicone is around us every day. Silicone drainage tubes can be life saving after brain injuries to prevent fluid on the brain and death. Silicone implants are used throughout the body to improve both form and function. Most silicone implants are solid. Injection of free silicone is different than using silicone implants. Free silicone injections are liquid, and unlike with breast implants, the liquid is not contained.

Q: Is Silicone a Liquid or a Solid? A: Yes

Silicone is extremely flexible in its use. At body temperature, silicone can be made with a wide range viscosities: liquid like water, cohesive like honey, soft solid like Jello, more firm like rubber or hard like a rock. The fact that silicone is extremely well tolerated by the human body, makes it an excellent substance for implantation; however, only silicone meant for medical use should be used, and only by a qualified professional should be consulted.

How is Silicone Used

As a Board Certified San Francisco Bay Area Plastic Surgeon, I use silicone implants every day in my Walnut Creek Plastic Surgery practice. In California, silicone implants are used to augment the breast, cheeks, chin, nose and many other areas.

Silicone Facial Implants – Chin Implants, Cheek Implants, Nasal Implants

Silicone Facial implants are made of a soft solid silicone. Since they are solid, they cannot leak. They are used routinely for Cheek Augmentation, Chin Augmentation and Nose Augmentation. Since silicone facial implants are used to augment boney prominences, the fact that they are firm is an advantage. They can be molded into specialized shapes and sizes, depending on the amount and location of augmentation desired. The smooth surface does not adhere to normal tissue, so it needs to be meticulously placed. The smooth surface also allows for easy removal, should removal ever become necessary. Solid silicone facial implants are firm but flexible. For larger augmentations, silicone facial implants may not be firm enough.

An example: for small to moderate chin augmentation, silicone chin implants work great. For larger chin augmentations, I prefer Medpore®, which is made from porous high-density polyethylene. It is much firmer, and since it is porous, it allows in-growth. In-growth can help stabilize the Medpore® chin implant, and further decrease the already small risk of infection. These are decisions best made during your presonal consultation with a Board Certified Plastic Surgeon. This allows an open, honest discussion of the pros and cons of each option with a trained expert who has the experience to back-up your specific surgery.

Silicone Breast Implants

All breast implants have a silicone shell, even saline filled breast implants. When we say silicone breast implants we are talking about what is inside. Silicone breast implants have a solid outer shell, and a center filled with a cohesive silicone gel. Some older silicone breast implants were filled with a thin liquid, which would migrate if the shell ever broke. Currently, the cohesiveness varies from a very thick gel that likes to stay together (Allergan Natrelle® and Mentor Memory Gel® breast implants – currently available) to a solid with the consistency of Jello® (Gummy bear, Allergan Natrelle 410′s and Mentor Cohesive III Implants – Not yet FDA approved). These gummy bear implants can be made with various asymmetrical shapes, because they are thick enough to retain their shape.

Free Silicone Injections – Buyer Beware

The San Francisco Bay Area is a great place to be a plastic surgeon. We have an educated population that is interested and aware of many of the latest options in plastic surgery. Unfortunately, new doesn’t mean better, and sometimes new isn’t even new. Silicone injections are a great example. Even San Francisco plastic surgeons are still looking for the perfect injectable to fill wrinkles and augment the face without surgery. A well tolerated, stable substance, free from allergy, that will last a hundred years and remain soft remains elusive. There was a time when silicone was felt to be that substance.

Silicone is well tolerated, and can be made thick enough to prevent migration. The augmentation obtained is better than Restylane®, Juvederm®, Perlane®, Radiesse® or any other available dermal filler. It can remain soft for many years. Unfortunately, the body will form scar around free silicone, and this scar can continue to develop over years into a hard disfiguring mass.

Free Silicone in the Lips

Silicone has been used for lips. Initial results are great; however, the long term results are not predictable. Lisa Rinna, famous for her silicone augmented lips, recently had to have surgery to excise the silicone from her lips.

Free Silicone in the Buttocks

Silicone has been used for buttock augmentation. At first it looks great, but with time, it becomes hard and can cause visual disfigurement. Since medical grade silicone is not available in the United Stated, reports surface every year of an unqualified injector offering cheap buttock enhancement using silicone purchased at the local hardware store.

Free Silicone for Breast Augmentation

Free silicone was used for breast augmentation, as was fat injection, until they were replaced by a much more effective and safer alternative – breast implants. Breast implants use a solid silicone shell to contain the silicone inside. A thicker, more cohesive gel is used inside to help prevent migration, but even this should be removed if the implant breaks. Since the center is highly cohesive, it acts as a unit rather than a liquid, so it can be hard to tell if a silicone filled breast implant has leaked. This is why the FDA recommends women who have silicone gel breast implants obtain an MRI at three years and then every two years after having breast augmentation surgery.

“New” Silicone Injections

Research is on-going to find the perfect formulation for silicone injections. The latest attempts are looking into silicone with increased viscosity to help prevent migration and reduce the scar reaction. Since it often takes years for the scar around free silicone to develop into a noticeable mass, the results are still pending. One problem is that the thicker gel is much more difficult to inject without resorting to something like a caulking gun. Until the known problems are solved, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery and the FDA do not approve of the use of silicone injections outside of clinical trials.

Allergan, the manufacture of Juvéderm XC and Vivité, is giving away a free Vivite Defining Lip Plumper to patients receiving a Juvederm XC injectable filler treatment.

Juvederm is now available as Juvederm XC with Lidocaine added for comfort. All qualifying patients receiving Juvederm between now and September 30, 2010, are eligible to receive a free Vivite Defining Lip Plumper (a $45 value).

If you are not familiar with Juvederm, it is an HA filler similar to Restylane and Perlane. This year, all three were reformulated with Lidocaine (a local anesthetic). This significantly decreases injection site discomfort compared to the HA products without Lidocaine. HA is a filler used to attenuate the appearance of moderate to deep facial wrinkles. The most frequently treated areas are the nasolabial and marionette lines, which can give the appearance of parenthesis around the mouth. (Thus the clever logo at the top of this article.) Juvederm is also used for lip augmentation, to add volume to lips.

If you have wanted to try Juvederm, or you are ready for a refresher, now is a great time to schedule a consultation appointment. Just give us a call at (925) 943-6353. Juvederm treatments must be completed by September 30, 2010 to qualify for the Vivite Defining Lip Plumper give away.

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)
• Rhytidectomy (Facelift) San Francisco – Part 2 of 4
• Rhytidectomy (Facelift) San Francisco – Part 3 of 4
• Rhytidectomy (Facelift) San Francisco – Part 4 of 4

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.*

3) We will help you complete the rebate form.

4) Go online to register for the program. (www.latisse1year.com)

5) Mail the form and receipts to Allergan.

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.

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.

The Top Five Non-Surgical Procedures

• *Botox injections (BOTOX Cosmetic® & Dysport®) – 2,557,068 procedures
• *Hyaluronic Acid Fillers (Restylane®, Perlane®, Juvederm®…) – 1,313,038 procedures
• Laser Hair Removal – 1,280,031 procedures
• Microdermabrasion – 621,943 procedures
• *Chemical Peels – 529,285 procedures

The Top Five Surgical Procedures

• *Breast Augmentation – 311,957 procedures
• *Liposuction – 283,735 procedures
• *Eyelid Surgery (Blepharoplasty) – 149.943 procedures
• *Rhinoplasty (Nasal Surgery) – 138,258 procedures
• *Tummy Tucks (Abdominoplasty) – 127,923 procedures

The Top Five Surgical Procedures for Women

• *Breast Augmentation
• *Liposuction
• *Eyelid Surgery (Blepharoplasty)
• *Tummy Tucks (Abdominoplasty)
• *Breast Reduction

The Top Five Surgical Procedures for Men

• *Liposuction
• *Rhinoplasty (Nasal Surgery)
• *Eyelid Surgery (Blepharoplasty)
• *Breast Reduction (Gynecomastia Reduction)
• Hair Transplantation

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.

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:

• 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
• Local flaps (V-Y advancement)
• Lip Advancement (Vermilion Advancement) (You are here.)

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:

• 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
• Local flaps (V-Y advancement) (You are here.)
• Lip Advancement (Vermilion Advancement)

• 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)