Lips: Lip Enhancement

Lip Anatomy

The lips provide one of the more attractive features of our face and contribute to a significant component of our overall facial beauty. Fullness and voluptuousness of the lower and upper lips suggests a sensual, youthful, and attractive appearance. Anatomically, the lips are a combination of deep-layered muscles (orbicularis oris muscle) and superficial lining of a moist mucosal layer. The upper lip has the characteristic “cupids bow” as an integral part of the normal appearance of the lips. Generally, when applying lipstick women will enhance the fullness of the lips and accentuate the voluptuousness, thereby emphasizing the youthfulness of the lips.

Aesthetic Disharmony

There are a number of factors that contribute to aesthetic mal-proportion or unattractiveness of the lips. Heredity is a contributing factor. Some individuals are simply born with thin lips. Also with time, the lips become thinner and less voluptuous. This aging process is a significant factor. Atrophy and thinning, as well as lengthening of the lips simply occurs with time. Additionally, wrinkling in and around the lips causes the lips to become less discreet and appear more thin and aged. Commonly, smokers will exacerbate, worsen, and induce wrinkling in and around the lips due to the constant piercing of the lips day after day. Women are often complaining of lipstick “bleeding” into the lip wrinkles due to the prominence of the folds.

Lip Enhancement

Many patients desire to improve the wrinkling in and around the lips or to resolve the unattractive appearance. Many individuals simply desire a more “pouty” and voluptuous appearance. Lip enhancement restores the youthfulness of the lips and provides significant improvement in overall facial attractiveness.

Collagen

Over the years a number of substances have been utilized to improve the appearance of the upper and lower lips. Collagen is one of the more common and traditional treatment options. Generally there are two types of collagen; Dermalogen comes from a cadaveric source and Isolagen comes from one’s own cells. Collagen is a very simple material that is easily injected with a small needle into the soft tissues of the lips or other areas. Collagen essentially is temporary and only treats lips for a reasonable period of time, perhaps six to twelve weeks only. Nonetheless, collagen provides significant improvement and is somewhat dynamic.

Patients who choose Bovine or Dermalogen must undergo skin testing to assess allergy to the collagen. In those not allergic, collagen is easily injected directly into the lip to provide a fuller appearance. There are several types of collagen such as Zyderm and Zyplast. Zyplast is longer lasting and sometimes lasts up to three months. These are excellent options in the event of a near-term social event where lip enhancement is desired.

Dermalogen is a collagen that comes from cadaveric sources. Clinical trials have been undergoing scrutiny since 1998. Dermalogen (Collagenesis, Beverly, MA) is a suspension of collagen fibbers obtained from human tissue or cadaveric source. Additional material in the Dermalogen is an elastin substance, as well as an important ground substance (glycosaminoglycans). The tissue undergoes a very rigorous sterilization protocol that renders the human tissue suspension devoid of any possible infectious potential. Dermalogen is injected in a similar fashion as Zyplast and Zyderm, utilizing a 30-gauge needle.

A third collagen option is Isolagen. Skin from your own tissue, specifically dermis, is harvested from behind the ear and sent off to a lab for cultivation. Collagen is grown and sent back to the physician’s office where it is then injected into the lip for augmentation. Nonetheless, Isolagen is somewhat more expensive and takes more time due to the harvesting, cultivation, and injection process. Isolagen does tend to last a reasonable period of time, however, in the lip area absorption is still a concern due to the lip’s dynamic movements.

Alloderm

AlloDerm is a reasonably satisfactory alternative for lip enhancement. Essentially like Dermalogen, AlloDerm is taken from the dermis of cadavers and is processed in a rigorous fashion. Implantation is safe. The benefits of AlloDerm include a very soft pliable texture which can easily be threaded through the lips. There are minimal irregularities or lumpiness to the lip area after implantation and there is minimal ability to palpate or feel the AlloDerm in the lips. Long-term benefits are somewhat unknown. Many reports suggest six months to a year benefit, sometimes longer.

Softform and Ultra-soft

Softform and Ultra-soft lip enhancement has become one of the major therapies of choice for lip augmentation in recent years. Some specific changes to the alloplastic material have improved the overall satisfaction of this implant. Soft-form and Ultra-soft are very pliable and are constructed in a tube fashion that allows one’s tissue to grow within the implant and help its stability and aesthetic contour. The reaction or infection rate is quite low and the satisfaction rate is reasonably high.

Restylane

Restylane is an exciting new injectable that was FDA approved in January of 2004. It is made of a non-animal stabilized hyaluronic acid. The hyaluronic acid is identical to the hyaluronic acid found in the body; therefore it is completely biodegradable and integrates naturally into the tissue to allow important nutrients to pass through the injection sites. Restylane adds volume as an inherent gel lifts the skin. Concurrently, hyaluronic acid attracts and binds to water molecules, which adds more volume. The overall satisfaction is significantly high and the take rate ranges from three to twelve months. Many individuals have significant improvement remaining beyond a year.

Lip Enhancement - Before	Lip Enhancement - After