Lip Enhancement: More Is Not Always Better!

Cosmetic surgical and nonsurgical procedures to improve the lips are quite common.  The nonsurgical procedures include filler injections with Juvederm or Restylane, and superficial procedures like dermabrasion or laser resurfacing.  Neuromodulator (i.e., Botox) injections can sometimes be used sparingly in the lips, usually along with a filler.  But what I really want to discuss are surgical procedures to enhance or augment the lips.  In keeping with August’s blog post on the over-operated face, let’s explore the over-operated lip.  Reconstructive procedures after trauma or tumor removal are a different subject – again, for this post I’ll stick to the issue of over-operation in the realm of cosmetic surgery.

Cosmetic surgery of the lip can involve augmentation procedures or procedures to lift or shape the lift.  The goal of augmentation is to “re-inflate the balloon”, smoothing lip lines and restoring youthful volume.  During a facelift, SMAS tissue can be used for this, and there is usually not enough to “over-do” it.  A nice subtle result, using the patient’s own tissue, is the goal.  Filling with fat injection also works well, but can be overdone, as can filling with products like Juvederm and Restylane.  Lip augmentation with silicone is a very controversial procedure – although microdroplet silicone injection techniques have been done successfully by some practitioners, improper technique, overinjection, or improper silicone product can lead to disaster.

Why some patients (and their doctors) think that “more is better” when it comes to lip augmentation is a question that doesn’t have an easy answer.  Some people certainly have an altered self-image, but their doctor should have the aesthetic sense not to over-do a procedure that will make both the patient and the doctor look ridiculous.  For over-injected lips from off-the-shelf fillers like Juvederm and Restylane, an overdone result will simply go down with time.  It can be accelerated with injections of hyaluronidase if necessary.  Overdone fat injections are a difficult problem that usually requires surgical excision.  Corrective liposuction would seem like a possible solution for too much fat in the lips, but it doesn’t work.  Surgical implants such as Goretex implants can be removed or changed to smaller ones, but this procedure is frought with problems and I don’t recommend it.

Surgical procedures to re-shape the lips or provide an “auto-augmentation” can cause problems and significant scar tissue.  The “bullhorn lift” and similar procedures to lift the lip can be very effective, but there is an external scar, usually hidden beneath the nose.  Scars along the edge of the lips can heal with an odd appearance.  These lip lifts, unless they are combined with an augmentation procedure do not augment or “plump” the lips – they shorten the distance of the upper lip with the goal of producing a more aesthetic lip-teeth unit.  But if overdone, they’ll produce a short rigid upper lip with too much teeth showing.  Internal procedures to “auto-augment” the lip by rolling some of the internal lip lining outward tend to have more problems than benefit – they don’t really do what they advertise, and the scar tissue that forms can create stiff lips with altered movement.

With lip enhancement it’s best to stick with reliable and predictable procedures.  Augmentation with hyaluronic acid fillers (Juvederm and Restylane), fat injection, or other autologous tissue like SMAS.  A lip lift in the right candidate can also be an effective procedure with a discreet scar when placed under the nose.  Stay away from implants, and remember that more is not always better.

– Douglas J. Mackenzie, MD, FACS, Santa Barbara, California

Douglas J. Mackenzie M.D., F.A.C.S.

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