The Liquid Facelift - Wrinkle Fillers: Restylane, Perlane, Juvederm, Radiesse; and Neuromodulators: BOTOX Cosmetic, Dysport and Xeomin.

The Liquid Facelift is a quick way to reduce the signs of facial aging. Technically not a facelift, the term liquid facelift refers to use of volume restoring injectables like Restylane, Perlane, Juvederm and Radiesse. These products can fill unwanted wrinkles and enhance facial features that are desired.

Filling Unwanted Wrinkles

Dermal Fillers are a class of pharmaceuticals designed to plump sagging skin. Unwanted facial wrinkles, like those found around the mouth, can be carefully filled to significantly reduce their appearance. The treatments are performed right in the office, and the downtime is minimal.

Dermal Fillers are administered with a fine needle, and come complete with local anesthetic inside. The most common unwanted side-effects are temporary and include swelling and bruising. Icing after treatments can help reduce both. A few days prior to your treatment, it is important to avoid medication that thins the blood like: aspirin, ibuprofen, naprosyn, vitamin E, fish oil and many natural supplements. This will reduce your risk of bruising. If you are planning to do some wrinkle reduction for a special occasion, do not delay. Ideally you should have the treatment done several weeks in advance. If you bruise, you will have plenty of time to recover, but your results will last for months.

Enhance Facial Features

Sometimes the goal is not to disguise, but to augment. Restylane, Perlane, Juvederm and Radiesse can be used to increase the size of some of the face’s most desirable features. Hyaluronic based fillers like Restylane, Perlane, Juvederm, can be used to enhance the lips. While Radiesse can be used to enhance the cheek bones and chin. If you are considering facial augmentation with cheek or chin implants, dermal fillers can provide a way to try it out on a temporary basis.

Maintaining the Result You Want

If you want to maintain the results, it is necessary to touch up the areas from time to time. For most patients, touch-ups require less volume than the initial treatment. This is because we are adding volume before the previous correction has completely resorbed, and because these product promote your face to produce collagen in the areas of injection. Even after treatment, the face continues to age. Dermal fillers cannot provide permanent results. The amount of wrinkle reduction, and the time it will last for you, may vary.

2011 Holiday Discounts on Selected Dermal Fillers and Neuromodulators

For the month of December several promotional specials are being offered in our San Francisco Bay Area, Walnut Creek plastic surgery office:

• Any HA filler, buy two get one free includes: Restylane, Juvederm, and Perlane. All product must be administered by December 31, 2011.
• Up to $65 rebate with each syringe purchased. (May be combined with above!)
  • Perlane – $65 rebate on each 1.0 cc syringe (maximum of 6 cc’s)
  • Restylane – $50 rebate on each 1.0 cc syringe (minimum of 2 cc’s & maximum of 6 cc’s)
• $50 rebate on BOTOX Cosmetic and Dysport treatments of $200 or more.

Liquid Facelift Appointments

If you are interested in learning more about the liquid facelift and facial wrinkle fillers, or you want to know more about neuromodulators like Botox, Dysport and Xeomin, please give our San Francisco Bay Area Plastic Surgery office a call at (925) 943-6353, and schedule a personal consultation appointment. More information is also available on our web site under face: facial wrinkles (minimally invasive) or on DrMele.com under skin.

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.

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)

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)
• Lip Advancement (Vermilion Advancement)