March 20th, 2013 Dr. Mele
Lisa Rinna has had a very successful Hollywood career which she credits, in part, to her large, Augmented Lips. When it comes to a beautiful face, the lips are second only to the eyes. Subconsciously, we associate fuller lips with youth and fertility. Larger lips are a big contributor to the “glow” of a pregnant woman’s face. As we age, so do our lips, and gradually they become thinner and thinner. Lip augmentation can be an integral part of facial rejuvenation.
Lisa Rinna is putting her lip troubles behind her.
Lip Augmentation with Silicone Injections
Lisa Rinna had been very forthcoming with the fact that her lips were enhanced with injectable silicone. Liquid silicone injections are problematic, and her honesty has helped other young women avoid the same fate. Right after silicone injections everything looks great, but with time, the body creates scar tissue around the globs of silicone. The result is palpable, and often visual, lumps and lip distortions. Lisa does not regret her decision, but 20 years after the Silicone Injections, her lips were a lumpy mess. She underwent surgery to remove as much of the silicone and scar as possible. Here is the story in her own words:
“Here’s the story: 25 years ago, I had my lips injected with silicone. Stupid thing to do at 24. I saw ‘Beaches.’ Remember that movie ‘Beaches’? I did it with my best girlfriend, so she and I go and we get our lips done. Fine. I have it like that for my whole career, right? So then cut to a couple of years ago, I have a doctor remove as much as they possibly can because it got to the point where they were yucky. You know, they get hard. It’s gross. They are now whatever that was after they took out as much of the silicone as they could.”
Surgical Correction after Silicone Injections to the Lips
Lucky for Lisa, her lips still look fine. Twenty-five years ago, the risks of silicone injections were not as clear cut, and the only approved injectable was Collagen, which was hard and completely gone in a month or two. Today, we have much better alternatives. Lip Augmentation can be performed with injectable HA’s like Restylane and Juvederm in a few minutes in the office. The results do need to be maintained; however, the results are full and soft, something that has not been possible previously without surgery. How long the results last is variable. Average results are 4-6 months and if you decide you not longer need it, after the plateau phase, the lips gradually return to their original size.
Permanent Lip Augmentation
Since lips thin as we age, there are no Permanent Lip Fillers. Even the perfectly sized lips will need a little maintenance to counteract the normal aging process. Inserting permanent fillers, like silicone, promotes the formation of chronic scars and foreign body reactions like granulomas. HA fillers are made from Hyaluronic Acid (HA), a normal component of skin and joints. Unlike free silicone injections, our bodies recognize HA as a normal component of the skin, and we have natural hyaluronidase, an enzyme that can clean up HA.
Lip Augmentation Before and After Pictures
Lip Augmentation Before and After Photos: Lip enhancement performed with HA filler.
Lip Enhancement Consultations
If you are considering Lip Augmentation, especially if it is your first time, consider a brand name HA filler like Restylane or Juvederm. They can give a soft natural result, which is easy to maintain. Swelling is minimal, and with ice and elevation, the appearance is normal in 24-48 hours. Longer lasting alternatives are available, but they require a longer recovery, and are best when the goal size is well known.
Other Lip Enlargement Resources
Other articles on lip augmentation are available on the San Francisco Plastic Surgery Blog and my main web site. Here are the links:
August 3rd, 2012 Dr. Mele
Gilt City Restylane and Perlane Offer – Summer 2012
For the next two weeks, Dr. Joseph Mele, the makers of Restylane and Perlane and Gilt City San Francisco have teamed up to save you some summer cash.
Facial Wrinkles in Need of Correction?
If you’ve been considering smoothing the lines around the mouth, or enhancing the size of your lips, now is the time to do it. Right now, our Walnut Creek Plastic Surgery office is accepting Gilt City vouchers for Restylane and Perlane. If you are already familiar with facial wrinkle fillers, you can take advantage of this offer too. Here’s how it works…
Restylane and Perlane Discount Coupons
Go to Gilt City before August 16, 2012, and purchase a voucher good for $100 dollars off any 1 ml Restylane treatment for only $49. If you need more volume, $300 coupons, used for any 2 ml Restylane treatment, can be purchased for only $149. Vouchers are valid 24 hours after purchase, and must be used by September 30, 2012. Vouchers are transferable, and can be combined. Some restrictions apply, see Gilt City Restylane voucher’s web page for full details.
How to Redeem Your Restylane Vouchers
Your Restylane voucher will arrive via e-mail in 24 hours. Print your coupon, you will need to bring it with you to your appointment. Schedule your appointment with Dr. Mele by calling (925) 943-6353. You can use the voucher toward treatment on the day of your consultation.
What if I’ve never had Restylane, Perlane or other HA fillers (Juvederm)?
If you never had correction of facial rhytids or lip augmentation with an HA filler, you will need to be evaluated prior to your first treatment. An in-person consultation is required to determine if treatment is right for you. If you are eligible, treatment can be administered that day. Although uncommon, in the event that you are not eligible for treatment with Restylane or Perlane, Gilt City will provide a refund.
April 3rd, 2011 Dr. Mele
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.
March 16th, 2010 Dr. Mele
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:
March 12th, 2010 Dr. Mele
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:
March 8th, 2010 Dr. Mele
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 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
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.
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:
March 4th, 2010 Dr. Mele
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.
To learn more click on the links below:
February 28th, 2010 Dr. Mele
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?
- 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: