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Frequently Asked Questions
LIP AUGMENTATION
- How many techniques are there to augment the lips?
- Lip implants:
- Gore-Tex
- Softform
- AlloDerm
- Dermis grafts
- Tendon Grafts
- Implant capsules
- Injectables:
- Collagen
- Dermalogen
- Fat grafting
- NewFill
- Restylane
- Cymetra - Micronized AlloDerm™
- Hylaform
- Fascian
- Bioformacryl
and many more...
- Other Procedures:
- vermilion border lift
- under the nose lift
- scarification
- lip roll
- etc.
- What types of injectables are out there and what are the differences?
Most of what is out there in injectables is temporary. Collagen, which has been the leader, usually lasts only 3 months and requires a skin/allergy test. Fascian™ lasts a little longer although not by much. In theory, Fascian™ sounds wonderful - it is made up of fascia lata, strips of the tough covering that surrounds the outer thigh muscle. It is harvested from cadavers. It should last longer than collagen although I have not had the chance to test it out myself. But I hear too many reports of lumpiness and inflammation and unfortunately -- high prices, considering it is cheaper to purchase than collagen.
Cymetra Micronized AlloDerm™ isn't exactly getting rave reviews either. Everyone I have spoken to says that Cymetra lasts only a short time and costs them an arm and a leg. AlloDerm allograft (dermis graft) itself, being that the injectable is somewhat "broken down" already. But then I hear from the company that it is supposed to be layered over a 2 year period for best benefits. Well who has 2 years and a second mortgage to spare for that?
The benefit of an injectable is the volume it can give the lips. The "poutiness" is much more defined compared to the implants which gives a more subtle, defined lip. Only downfall - which is a big one - is that most injectables are not permanent.
There are a few injectables that are permanent, such as Artecoll™, Argiform™, Metacril, Bioformacryl, etc.. Artecoll™ is made from PMMA (polymethyl methacrylate) The Artecoll™ is formulated into microspheres (extremely small round bits) and blended with 0.3% lidocaine for comfort and collagen (3.5%) as well. The collagen is broken down by the body yet the PMMA microspheres are left behind to be encapsulated by the body's own collagen. These microspheres are "networked" together by your body's collagen structure therefore creating augmentation.
Argiform™ and other polyacrylamide implants are made from a polymer that holds moisture. This type of product has been used in medicine and also in agriculture for decades.
- Are there any permanent options in lip augmentation?
There are permanent and reversible options like Gore-Tex™, which I have, and Softform soft tissue augmentation implants (or the newer second generation version... UltraSoft. These implants are made from (ePTFE) (expanded polytetrafluoro-ethylene). It is a white tubular type of "rubbery" material - the same thing used in Gore-Tex™ boots and rain jackets, but of course a sterile medical grade. It has been used for decades in the body for all sorts of applications. These are the most popular and probably the only approved standard synthetic implants are considered "permanent".
- How is lip augmentation with lip implants performed?
The surgery is not at all complex nor does it take a substantial amount of time to perform. The surgeon, after making the necessary 4 incisions at each corner of the mouth, "threads" the Gore-Tex, Softform or dermis strip through either lip and cuts the implant to the size the patient's individual lip needs to be augmented. The corners of the strip are then rounded with small, intricate cuts to ensure proper healing and little to no friction to the inside of the lip. The incision areas are then sutured with a thin, dissolving suture material. There is usually only the smallest amount of blood, miniscule actually, during the procedure due to the injections of Lidocaine and epinephrine. The patient may have a drop or two inside of their mouth mixed with the patient's excess saliva that may appear to be a lot of blood - it isn't.
- Where are the incisions made?
In a lip augmentation procedure with Gore-Tex, UltraSoft, Softform or dermis, the incisions are made on the very corners of the lip on each side resulting in 4 small incisions and little or no scarring. The lips tend to heal quit fast as long as you don't disrupt them or keep touching them.
- What should I expect post-operatively?
You should expect to be very "full lipped" post-operatively. You may have difficulty drinking or eating without spilling as well. there will be pain, especially to pressure. You may feel numb in the lips for several days from the swelling putting pressure on the nerves in your lips. You should be thankful for this, because when the numbness dissipates you will feel more pain. Your pain relievers prescribed by your doctor should alleviate this pain.
You will have your stitches removed in about 7 days. And it hurts a little bit so beware. The swelling will be apparent, but you had the surgery for augmentation, didn't you? The swelling will subside, probably more than you would like it to.
- Is it quite painful? Is there much bruising?
It takes about a week for most of the swelling to subside, although it will be sensitive to light to medium pressure for about 3 weeks. There is really not much bruising with average cases, although it should be looked upon as individual. Some are prone to bruising more than others. Some doctors recommend a pharmaceutical grade Arnica montana product called "SinEcch", Bromelain, Vitamin K, A etc. These two products are thought to decrease both bruising and swelling in all procedures and in most cases have shown a significant decrease in both complaints. but please do not consume anything other than what your surgeon advises.
- Will I have to pre-medicate for dental work?
It is quite possible that you will have to pre-medicate to prevent infection in the cavity where the lip implant (or any implant for that matter) is located.
It is thought by some surgeons that plaque and bacteria is set "free" during dental work, even a routine cleaning, and will enter into the blood stream via minute lacerations in the mouth. The bacteria searches for weaknesses in your body to "latch itself onto" and may do so, causing an infection. Besides, $12. USD isn't much to spend on the salvation of your $2,000.-$4,000. USD lip implants.
However, this is controversial and some surgeons believe that there same type of bacteria is released during flossing. I have personally never had a problem after the initial healing period - although I did have an infection which required removal with my first set. Ironically my dentist may have caused the infection by irritating my newly implant Gore-Tex with his overly large, bacteria-coated - yet gloved - hand in my mouth.
- When will I be able to see the results?
The results are immediate. Your lips will be quite large and swollen and you will see a difference in the swelling as it subsides in the first week post-operatively. The swelling will more than likely subside more than you would like as you will become accustomed to their enormous size and think that your lips are small in comparison. You should take photos before and after to compare and look back on your "old" lips' size. After viewing the before and after photos you should be able to appreciate a change in the lip volume.
- What are the risks of lip augmentation?
There are not too many risks associated with lip augmentation in comparison to other elective procedures, but there are enough to pay attention and have concern. It typically depends on the chosen implant or filler. Let's start with Gore-Tex™... There can be infection and irritation if the ends of the implant are too long for the cavity or not rounded, if needed. The good thing is that it is reversible and can be readily removed. UltraSoft™ is more hollow and has thinner walls than its predecessor, Softform™, allowing your own tissues to "grow into" the implant like the others but resulting in a softer feel. If an infection arises, this may make it a little more difficult to remove. Dermalogen, AlloDerm, and other forms of tissue-grafts or derivatives supposedly are absorbed within your body with no after-effects. New injectable fillers, that may be approved for the U.S. like Restylane™, and Hylaform™ supposedly have no side effects. Artecoll™ is yet another, as is a hopeful Argiform™ hydrophilic polyacrylamide (hydrogel). Although safety studies must be performed for polacrylamide products due to the residual unpolymerized acrylamide.
The (ePTFE) (expanded polytetrafluoro-ethylene) implants are hollow allowing your tissues to "grow into" the implant. This can make it difficult to remove unless an infection is present. There may be shifting of either implant or deformity from excess scar tissue arising from an infection or the hands of an unskilled doctor. Or quite possibly from your body attempting to reject the foreign material. There may be permanent discolorations from the bruising. Possible hematomas resulting in additional surgeries and excessive scarring from delayed healing or trauma. There also may be changes in your smile, numbness, palpability, stiffness, etc.
- What is Arnica montana or Bromelain, I have heard that these homeopathics reduce swelling and bruising? Which is the best kind to take?
Also known as: Mountain Tobacco, Mountain Arnica, Common Arnica, Leopard's Bane and Sneezewort
plant family: Asteraceae
type: Herbaceous perennial
parts used: Roots and flowers
description: Arnica montana or Leopard's Bane is a perennial herb, growing close to the ground. The leaves form a flat rosette, from the center of which rises a flower stalk, 1 to 2 feet high, bearing orange-yellow flowers. The rhizome is dark brown, cylindrical, usually curved, and bears brittle wiry rootlets on the under surface.
habitat: Indigenous to Central Europe, in woods and mountain pastures, although it has been found in England and Southern Scotland.
warning: This herb should NEVER be taken in raw form. This plant, like many medicinal plants if ingested, can cause intestinal bleeding, abdominal cramping and sickness. Homeopathy is the medicinal use of tinctures and suspensions using herbs and other plants and should never be consumed without proper preparation. Only respectable homeopathic remedies and tinctures should be consumed.
Arnica montana has been used in Europe for centuries to treat swelling, soreness and bruising. This product is often misunderstood when confused with ingesting the arnica plant in its raw form. When properly prepared, Arnica may significantly decrease healing time or the appearance of such. There are many formulations from different companies although many "under the tongue" brands can be considered mild and ineffective for more traumatic planned traumas such as plastic surgery. There is however a stronger formulation that many plastic surgeons do recommend for their patients. although many patients do use weaker formulations available and standard healthfood stores.
One such product is SinEcch. SinEcch may speed healing after a "planned trauma" like plastic surgery. It has also been used before undergoing medical operations such as hernia repair, intestinal disorders and more. SinEcch may significantly reduce both bruising and swelling for most patients gently and safely. Of course not all patients will respond the same or receive the benefits of SinEcch.
"SinEcch is a set of 12 capsules on a blister card with the instructions when to take each dose printed right on the card. The dosage regimen is custom designed to match the level of bruising and swelling which most patients experience in the most common plastic surgery procedures."
from the plant of the: Pineapple
also known as: Ananas, Nanas, Pina
plant family: Bromeliaceae
type: herbaceous perennial
parts used: mostly in the stems of pineapples, but some fruit is used as well.
description: 2 1/2 to 5 ft. high with a spread of 3 to 4 ft. The plant is like a thick stem with a rosette of wide, waxy leaves. These pointed green, red, and white/off white striped leaves are approximately 18 - 70 inches long and graced with a spiny needle-like tip. The plant produces a sweet to tangy and sometimes sour fruit that is yellow to white in color. The unpeeled fruit is brownish with a hard, spiky covering and a large green sprout from it crown. The fruit is shaped like a coffee can with rounded ends and is about 10-12 inches long usually when considered prime and may even weigh up to 10 lbs.
habitat: Indigenous to southern Brazil and Paraguay, The fruit is now grown all over in green houses and in the fields of Spain, Guatemala, Hawaii and more. The pineapple is a tropical plant and thrives in hot, humid places. Although it can survive cold snaps, it is not recommended for the more northern areas if intended to be grown outdoors.
Bromelain is an anti-inflammatory formula containing the proteolytic enzyme from the stems of pineapples. Proteolytic enzymes are capable of dissolving proteins. It is most often used after sports injuries, to relive edema and after surgical procedures to help with swelling.
ALWAYS ASK YOUR SURGEON FIRST BEFORE TAKING ANY MEDICATION.
*Enhancement Media has NO financial ties to Alpine Pharmaceuticals, SinEcch, or any other product and merely suggests it for your convenience and post-operative ease.*
- I have heard that the risk of infection is quite high, is this true?
The reason the risk of infection is high is the site incision and location of the procedure. The mouth is a very dirty place on the body and harbors bacteria growth. It is a prime habitat for bacteria as it is warm, moist and frequently is given food by its host (you).
Especially if you go to the dentist you can disrupt even more bacteria and it may "latch itself onto" your body's weak areas, possibly infecting it. Your mobile tissues take longer to heal than those of which are not mobile. You move your lips quite often, hardly giving them a chance to heal. That is also why it is of utmost importance for your doctor to smooth any edges of an implant prohibiting the implant from irritating the wound from the inside.
If you keep your mouth clean, rinsing regularly with Listerine and not "pick at" the incision sites, your wounds will have less of a chance of becoming infected.
- How are lip implants comparable with injectables?
Injectables wear off but give wonderful, instantaneous results. Injectables are cheaper, but more expensive in the long run. Implants give results which are long lasting yet are more invasive than a regular shot for an injectable. It's really your call. If you would like permanent, yet reversible results, get the implants. If it is very full, pouty mouth, get the injectables - but be prepared to spend a lot of money on touch ups and maintenance.
- Is lip augmentation reversible?
Lip augmentation with most injectables is temporary so, yes, figuratively - it is reversible. Lip augmentation with the Gore-Tex and Softform implant is reversible. The Gore-Tex implant's surface may be porous but it is relatively easy to remove, especially in the event of an infection. The Artecoll is reported to be quite difficult in removing - it is approved in Canada, UK and Europe for Acne pock correction not soft tissue augmentation. At least not yet. Some products re reversible - some are not - like silicone. Once you get it, it's there forever.
- Will my significant other be able to feel it when we kiss?
It really depends on whether or not you had very thin lips beforehand. If you had very thin lips and had an implant placed into a tight space it is quite possible for he or she to be able to feel the implant. But! the good thing is, you get used to it, very quickly. You will be able to feel it as it is in your body.
It is quite possible that your significant other will feel it - but if you discuss this with your surgeon he can better explain it to you.
- Will the movement of my lips be hindered or look "odd" when animated?
It is quite possible that you will notice a difference in your smile, how you speak and sensation after a lip enhancement procedure. Especially during the healing stage. Lip implants can feel very stiff and immobile - it takes some getting used to.
My bottom lip implant sometimes stretches oddly (in my opinion) across my top teeth (I have a slight overbite) if I do a "fake" smile or half smile. I notice this and smile naturally rather than look strange. Smile big! You can't expect not to have a change in this area - your lips sit atop the orbicularis oris muscle and also move with the use of direct labial tractor muscles. Not to mention the contraction of levator labii superioris alaeque nasi, the levator labii superioris, and/or the zygomaticus minora wil aso lift the upper lip and set it into motion. If this isn't enough, the depressor labii inferioris and/or platysma par labialis will also cause movement. Plus there are many other facial muscles which may inadvertently animate the lips - no wonder this surgery is delicate and causes discomfort even when you try not to move. The muscles of the lips move involuntary as well, any change to this area be it surgical or injectable is bound to change or affect its movements either slightly or hinder them severely.
- What is the best lip implant or procedure for me? Which do you recommend?
This is a choice only you can make. I get asked this all the time and so many factors are involved. Number one is the fact that you must be evaluated by a physician - I am not a physician and do not know your needs as an individual. The material or product that you may want may not be available in the United States, much less your area. new and improved products are developed all the time, it is only a matter of waiting for that material. Impatience is a factor. If you had to wait 2 years for an expensive product that you KNOW will work and be like you want - or take a cheap route that is risky - most people live in the now and take the chance.
I personally got the best product at the time and it has served me well until I am ready to take it out and get something better. But I am still waiting because one is not approved, the other is not available in the states and is still very new. Plus I am weight options - I think long term instead of short and quite frankly one of the steps in my "lip plan" is very permanent.
Remember to think ahead, and go for what is safe and proven - not some whim. The choice is yours and you must make it.
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