Permanent Lip Lift, Augmentation and Reshaping

If you’ve ever had lip injections, you know that it takes a certain fortitude to get through it. The process is painful, the results are temporary, and not all injections are created equal. In order to make the process worth it, the filler must either be injected in exactly the right place for the desired natural effect, or else a ton of it must be used to fill the lip entirely. In the latter case, the end result is often less than optimal: Lots of frog, not enough Princess.

In order to get a more natural look, the lips must roll out rather than push forward. This usually means injecting into the edge of the lip in just the right angle. The slight roll outward then makes the lip look taller without leaving it heavy and without lifting away from the teeth (aka, frog effect). If properly done, this technique can be very successful, with a very natural look; but it is temporary, and for some patients it is also not enough to meet their aesthetic goals.

PERMANENT FILLER

As a surgeon, I am used to providing permanent results for my patients. That was one of the things that drew me to my profession in the first place- a real fix for the problem. While lip augmentation is a fantastic procedure with high patient satisfaction, until recently there were few options for permanent results, and none were very good.

There are countless filler materials on the market today, all with subtle variations in their profile and durability. For the most part however, they are generally all temporary, requiring repeat treatment at least two to three times a year. Variations in type of filler, person administering it, and other factors can also lead to some unpredictability or inconsistency of the results. For a more permanent solution, the options have always been either fat or silicone, both of which are fraught with issues.

Fat transfer, while a great idea in general, leaves a lot to be desired at this point in medical history. Fat is easy to harvest, and easy to place, but very hard to control. While the fat can get moved, it usually loses some of its blood supply in the process, and then has a very hard time staying alive. As it dies, it shrinks slowly, waiting for the body’s cleanup crew to come get all the pieces out of the way. This means that even though it looks like it is there to stay, some of it is actually being slowly removed before your very eyes. The end result is that many fat grafts do not last, at least not in any amounts that would make that procedure definitive.

Liquid silicone, on the other hand, is completely permanent- for better or worse. The particles get into the tissues and stay there forever. Placement can be controlled depending on the injector’s experience, but once in, the stuff cannot be removed without taking out the tissue that holds it. That means that if it’s not looking right, or if there are any complications, the piece of lip holding the silicone must come out with the silicone itself. Liquid silicone complications are often unpredictable, can become chronic, and sometimes ends up unfixable. (see my article on the high cost of free silicone)

THE SURGICAL LIP LIFT

Drawing from the theory of lip rolling, the question then becomes: can you roll the lip out permanently without injections? Yes you can.

As a plastic surgeon, tissue rearrangement is the basis of most of what I do. If properly executed, aesthetic procedures can truly mold the skin, fat, muscle, and sometimes bone. Shapes can be achieved, and results will last. The drawback is that this requires surgery, and surgery usually means scars. But with appropriate insight and planning, surgery can be extremely safe and scars as inconspicuous as needed.

The lip lift procedure involves taking out a strip of skin from right under the nose and then pulling the lip up to meet it. This results in a taller lip that is stretched upward instead of inflated outward. There is no filler material used, and therefore no risk of the injection getting to the wrong place and causing complications. The distance between the nose and the lip also shortens, which creates a more feminine and youthful look; and because the surgeon can control the change in height, the peaks of the upper lip (aka, cupid’s bow) can be emphasized as needed to solve the problem of a flat upper lip line. The best part of the procedure? It takes less than an hour, can be performed under local anesthesia, and is completely permanent.

Not many surgeons perform lip lifts. This is a relatively new technique and requires a good knowledge of anatomy. The lip muscles are right under the skin, and they must be spared and carefully managed. Extreme pulling can lead to bad or wide scars, or an overly shortened upper lip. But the biggest issue is that most lip lifters only address the upper lip, creating an imbalance often seen in filler use. When the upper lip is thicker than the lower lip, the mouth looks upside down, and this just doesn’t seem right.

As an artist and designer, I have always believed that balance is key. The lips come in a set, and as a set they work best if they match. As a team, they work best if they fit the rest of the face. In planning your procedure, consult with fully trained and credentialed surgeons, and make sure to discuss issues of symmetry and shape. Also, consider that not every part of the same lip requires the same lifting. Just like a good suit, the way it wears is only as good as its tailoring.

LIP SERVICE

Considering that lips are such a symbol of femininity and carry such weight in terms of how you present yourself to the world, it makes sense that there is so much focus on them these days. As a surgeon, I feel maximal satisfaction with safe, controllable procedures that have lasting effects. The lip lift has finally provided me with a tool that can do for lips what has been so successful for breasts: offer patients a transformative experience and a celebration of femininity across the board. That deserves a big fat kiss.