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