Lip Augmentation ("Cheiloplasty")

Author: Dr. Bryce J Cowan BSc MSc MD PhD FRCSC
Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver, BC

Lip augmentation or "cheiloplasty" is a commonly requested cosmetic procedure. Many women are now seeking the "Paris" or full lip look so common amongst the Hollywood elite. In all lips, there are areas of natural fullness. The attractive upper lip is centrally full with slightly less volume toward the lateral edge of the mouth. The white roll above the red lip ("vermillion") tends to also be more prominent centrally than laterally. Attention to restoration of these features provides in vogue sexy lips.

PROCEDURE LOCATION

CONTRAINDICATIONS (some may be relative)

1. Allergy or sensitivity to product or carrier molecules in proposed filler (pre-testing may be required in select cases)
2. Areas of inflammatory or infectious skin conditions (i.e. active acne or cold sores)
3. Women who are pregnant or breastfeeding
4. Association with laser treatment, chemical peels or dermabrasion
5. Unrealistic expectations

PREPARATION

Prior to any cosmetic surgical procedure patients should avoid anti-inflammatory drugs (Aspirin®, Motrin®, Ibuprophen, Advil®, etc.) for two weeks prior to their treatment due to unwanted effects on the body's blood clotting system. Failure to do so may lead to increased bleeding during the procedure, hematomas (blood clots), or unnecessary post-operative bruising. If you require painkillers on a regular basis for arthritic pain or headaches, the use of Tylenol ES® will not affect bleeding. The use of herbal supplements or traditional medicines should be discussed with your physician pre-operatively to see if they will affect your surgery.

All medical conditions and medications must be disclosed to your surgeon pre-operatively. Medical conditions such as high blood pressure must be well controlled before all cosmetic procedures where bleeding and hematomas are a risk.

A variety of choices in augmentation mediums must take place pre-operatively with the cosmetic patient. First, the precise lip location and quantity of augmentation desired; and second, the type of implant (temporary or permanent; synthetic or natural - listed below). These components of the clinical decision should be discussed with your clinician or surgeon pre-operatively so that the pros and cons of these various choices can be discussed in detail.

Autologous Fillers	Biologic Fillers	Synthetic Fillers
Fat SMAS and FatDermis Dermal fat grafts Autologen® (collagen from patient's own skin)	Restylane® Perlane® Juvederm® CosmoDerm® CosmoPlast® Cymetra®	Artecoll® Artefill® Gore S.A.M® (subcutaneous augmentation material) Radiance®

* All products listed above have been used for lip augmentation and may not be the filler medium of choice in all cases.

Fat grafting of the lip ("lipo-sculpturing" or "structural fat grafting") is one of the best methods of maintaining a permanent full and soft lip. It is also widely used as it is well tolerated.

THE PROCEDURE

Lip augmentation or rejuvenation with Restylane®, Juvederm®, or other temporary soft tissue filler is performed by a smooth threading injection below the muscle of the lip to camouflage the filler. Superficial filling below the smooth outer surface of the lip may result in discoloration. Typically Restylane volumes of 0.5 to 1.0 cc per lip provide excellent results. Often, the addition of a larger molecule and more permanent fillers along the lip margin (like Perlane®) allows for greater definition of the lips white roll. This provides better visual effect in more comprehensive lip rejuvenation.

Structural fat grafting of the lip requires harvesting of fat from another site (usually the belly, thighs, or "love-handles"). The harvest site and treatment sites are anesthetized using a combination of local anesthetics and nerve blocks. Fat is removed from the donor site using a specialized harvesting cannula attached to a suction syringe. The fat is processed by simple centrifugation prior to re-injection with fine cannulas. Approximately 1.0 cc of fat is use to rejuvenate the white roll above the lip and 1.5 to 3 cc of fat is often used to fill the body of the upper lip. Nearly twice that volume is often used on the body of the lower lip. Traditional, injection techniques placed fat cells within the lip muscle to provide the augmentation required. Today, through refinements in this technique, we place fat between the muscles in the lip and the red lip vermillion. This placement location provides a beautiful roll of the red lip and unparalleled volume that looks and feels normal in repose and with facial animation. Best of all, it lasts.

POST-AUGMENTATION CARE

Immediately following lip augmentation you are recommended to avoid unnecessary and excessive facial expressions. Treatment of the lips with cool ice packs (20 minutes on and 20 minutes off) can reduce post-operative swelling and discomfort. Oral antihistamines (i.e. Claritin) can also reduce unwanted post-injection symptoms. Lip swelling can also occur over the first 3-5 days following treatment and any bruising can last one to two weeks.

For two weeks following injections you should only have very brief exposures of the treated areas to sunlight or excessive heat. You should also avoid handling or massaging the treated area. Make up and standard skin care is resumed the day after treatment.

THE RECOVERY

The use of temporary fillers for lip augmentation can be very desirable as there is little to no down time. Final lip shape and volume should be seen at 3-5 days post treatment assuming there is little residual bruising.

Swelling and bruising are expected after the injection of fat. Your surgeon will often overfill ("overcorrect") the lips when structural fat grafting as your body absorbs some of the fat with the rest remaining to provide a long lasting result. The typical convalescence following lip augmentation is 2-3 weeks.

Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. Bruising and swelling of the lips and around the mouth can occur with these procedures and swelling can slightly more marked within 3-4 days after the augmentation. Remember that this is a normal part of recovery and disappears within weeks.

POTENTIAL COMPLICATIONS

Any cosmetic procedure carries risks. Although these risks are uncommon, it is important that they are discussed between the patient and physician. Some potential risks are listed in the table below. For a more detailed discussion on expected results, recovery, and specific complications, please see your individual physician or surgeon.

Intra-operative	Early Post-operative	Late Post-operative
Drug (anesthetic) reactions Bleeding Hypersensitivity reactions	Itching Bleeding Hematoma (blood collection) Infection Sterile abscess Numbness Fat necrosis (volume loss) Rejection (Extrusion/Exposure/Infection)	Small irregularities Asymmetry (between sides) Implant volume loss Persistent sensory change Granulomas Skin colour change (irreversible)

WHAT TO EXPECT

Patient satisfaction with this procedure is extremely high.

The rejuvenation or augmentation provided by Restylane®, Juvederm® and similar temporary fillers typically lasts between 4-8 months. After repeat treatments, patients can see a more sustained correction lasting closer to 8 to 12 months.

COST

Lip augmentation surgery is not covered under the Canadian Medical Services Plan and the final cost for such procedures will be at the discretion of the physician or surgeon performing the procedure. Costs will vary based on the filling medium used.

DISCLAIMER

This website does not cover all medical knowledge related to lip augmentation nor does it deal with all possible risks and complications of treatments to the lips. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and clinician that must occur prior to any cosmetic procedure.