Lip Enhancement

Today the FoxNews website had an article speculating whether Paris Hilton got her lips enhanced recently while in Australia. As is typical with these stories, a couple New York and Beverly Hills plastic surgeons were quoted, and based on the recent photos, opined in the affirmative. So that prompted me to write this…

Lip Enhancement, or Lip Augmentation, is the second most common procedure that plastic surgeons perform behind breast augmentation. There are certainly some very common concerns I hear when I see patients interested in improving their lips. But before I go into that I’ll start with the basics. Lips can be enhanced to correct the effects of aging, or just provide sexier lips to someone whose lips may be thinner than they would like. Let’s discuss the aging lip first…

As a person ages, their lips, along with the rest of their facial tissues, tend to atrophy, or shrink. The deflation from the plump lips of their youth causes the lips to lose the crisp edge between the skin and vermilion (the red part), roll inward, and to develop lines and wrinkles radiating outward. The philtral columns are the two ridges going up from the upper lip towards the nose – they tend to flatten with age. As you can imagine, besides aging, smoking and sun exposure also play a roll in the aging lip.

The most common, and as a stand-alone procedure, the most effective, way of improving the aging lip is by adding a filler – something that will re-inflate the deflated lip. This will restore volume, smooth lip lines, and if done with an artistic eye, give better and more youthful definition to the edges of the lip and philtral columns. Other procedures may be considered as well, such as lasering or peels, but filling the lips is usually the best tool for restoring youthful lips. So what are they filled with?

There are basically two broad categories of fillers: off-the-shelf products and autologous (your own) tissue. The most common off-the-shelf products are Juvederm and Restylane. In my opinion, these outshine the other products for reliability, ease of injection, lower risk, and the fact that they’re not permanent. That’s right, in my opinion the fact that the product is not permanent is an advantage when considering lip augmentation. A permanent implant, whether an injectable (silicone) or an implant (PTFE), can cause a myriad of problems as the patient ages and the surrounding tissues change, and can be difficult or impossible to remove.

As far as autologous fillers go, the main sources are your own fat, harvested elsewhere and injected into the lips, or a fascial graft, which is tissue harvested from elsewhere and threaded through the lips via tiny incisions. These are obviously more involved procedures than injecting a syringe of Juvederm. They can be done under local anesthesia, but often are done under general, and often as an adjunct to another procedure like a facelift. In fact, during a facelift I’ll often use the SMAS layer of tissue from the cheek as graft material for the lip, since I have it exposed and elevated already. This compliments a facelift nicely, as a facelift alone does nothing for the lips.

For a younger person who just wants bigger, sexier lips, the off-the-shelf products are by far the most common. These are quick office procedures, although they do need an anesthetic block to numb the lips as otherwise it would be extremely painful. Some swelling and occasionally some bruising may happen, but the pain tends to be minimal after the anesthetic wears off. Juvederm can last up to a year or more, but sometimes just a few months.

The biggest concern I hear, which tends to be more of a concern the older the patient, is going too big. I constantly hear “I don’t want to have duck lips”, or “I don’t want to look like ____” (fill in the blank with any number of balloon-lipped celebrities). A syringe of Juvederm in a young woman, or even two in an older woman is not going to look ridiculous as long as it is injected skillfully. The overdone celebrities either had too much to begin with, or more likely, they did a little and liked it and went back for more…and more.

Paris looks good, but I would have liked a little more definition of the philtral columns and the cupid’s bow contour of her upper lip. Maybe she’ll come up to Santa Barbara the next time she needs her lips done…

Douglas J. Mackenzie, M.D.