Fuller lips continue to be a desired cosmetic enhancement. Most commonly, the upper lip is augmented in an effort to increase its naturally smaller proportion to that of the lower lip. Injectable fillers continue to be the most common method of lip augmentation due to immediate result and lack of recovery.

Lip augmentation with injectable fillers, however, is not a permanent solution. Repeat treatments must be done to maintain the results. The frequency of repetitive injections will depend on the duration of the injectable filler used. At best, however, the longest lip filler will last in the range of 9 to 12 months. Many are of much shorter duration.

As an alternative, there is a permanent lip augmentation material. Because it is an implant, it is not injectable and must be surgically placed. This material, known as Advanta, is a modification of what most people know as Gore-Tex which is essentially a form of Teflon. Known as expanded polytetrafluoroethylene (ePTFE), this material is very soft, flexible, and compressible, much like a marshmellow. It does allow some tissue growth through its dual porosity composition but its most important characteristic to patients is its soft feel.

Advanta is easy to place as it comes preloaded on a trocar (big needle) and is available in a wide range of sizes from very small (2.5mms) to quite large  (8mms) in both circular and oval cross-sectional shapes.

They can easily be placed in the office under local anesthesia with infraorbital enrve blocks followed by direct lip infiltration. Going through a  small incision in the mouth corners, the trocar is carefully thread from one side of the mouth to the other. The biggest problem is to be sure that the implant is placed at the same tissue depth on both sides of the lip lest there be some asymmetry. I have found the best way to avoid this problem is to use a split-implant technique. By using a third central incision in the central vermilion of the upper lip, the implant can be thread half-way, cut, and then thread through the other side. This is also a good way to avoid the potential for a tight upper lip when one piece implant is used across the entire lip.

In my Indianapolis plastic surgery practice, I have used Advanta lip implants for years without an infection or extruding problems. I have seen occasional differing implant depths in the lip which is reflective of a placement technique issue. I have not seen that with a split-implant method.

Advanta lip implants is a very good material that works well in the lips as well as other facial areas. However, I do not employ it as a primary lip augmentation procedure. Patients must have a previous history of successful injectable filler treatments and be motivated to have a permanent implant in their lip. While that thought may seem disturbing to some, I have yet to have to remove a lip implant yet. While I am sure there will eventually be one that has to be removed, it is fair to say that the track history of Advanta in the lip is quite good provided the implant is not oversized and the placement technique is good.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

Improving the size and shape of the lips is a frequent cosmetic request and a very commonly performed aesthetic procedure done in the office. While the vast majority of lip enhancements are done by injectable fillers, and most patients are only aware of this approach, there are other less common but equally effective options.

Injectable fillers are the most common lip enhancement method and the hyalurons such as Restylane and Juvaderm are usually used. The longevity of hyaluron fillers, while touted differently amongst manufacturers, is in the range of 4 to 6 months. While longer-lasting injectable fillers exist, such as Radiesse and Aretfill, these contain particles which may be prone to lumpiness and foreign-body reactions. Because of their predictability and safety, with very few complications, hyaluron lip enhancement is the current gold standard.

There other other types of non-injectable lip fillers. Over the years, many collagen-based implants have been tried, such as Alloderm and Fascian. Unfortunately, while conceptually appealing, their longevity has not been shown to be any greater than the hyaluron fillers. But they are more expensive and cause much more lip trauma to place. As a result, they have fallen into disuse.

Despite the frequent touting of your own fat as an injectable filler, and reports of great longevity and possible permanency, most plastic surgeons have not had that experience. Fat in the lip is simply unpredictable. I will still use it…..when I am performing other procedures in the operating room where the use of fat is ‘easier’ than in the office and there is little to lose by doing so. I suspect that repeat fat injections over time do consistently work but that is fairly traumatic for a patient to go through.

Permanent lip augmentation can be done by synthetic implants known as Advanta. These very soft implants are threaded into the lips, corner to corner, by a metal trocar under local anesthesia. They are non-resorbable, fairly soft, and the volume added is permanent. They can definitely be felt in the lips but I have not had a patient yet who has reported that as a problem. I use Advanta when the patient is ‘qualified’, meaning they have tried injectable fillers first and want to move on to something permanent.

More surgical lip enhancement is known as vermilion advancements or subnasal lip lifts. While these are highly effective are making the lip bigger, they have a trade-off of permanent scars. A patient must be very willing to make this trade-off and accepting of fine-line scars. I use these in patients that have very thin lips and a very flat cupid’s bow and have ‘failed’ lip enhancement by fillers. (meaning it does not look good or do what the patient expected. Lip lifts are often most effective in the older patient whose lips (which were not big to start with) have shrunken with age.

As you can see, lip enhancement has lots of options. All work well at achieving larger lips….but not every enhancement procedure is for every patient.

Dr Barry Eppley
http://www.eppleyplasticsurgery.com
http://www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis

As of today, there are seven commercially-available injectable fillers, from the original Restylane (hyaluronic acid) to the most recent ArteFill (plastic microspheres). While these all produce wonderful and instantaneous results in the filling of facial lines, wrinkles, and lips, the lifespan of their effect is limited to montsh and, at best, certainly less than one year. Some injected patients ultimately tire of the injection process and desire a more permanent solution to their facial problems, even if it requires surgery to do so. Once a patient reaches this ‘qualified’ level, there is a permanent filling solution (Advanta Facial Implants) for the selected areas of the lips, nasolabial folds, marionette lines, and the glabellar furrows. (the famous 11s between the eyebrows) Because they are not new and are produced by a company whose main revenues come from vascular grafts (http://www.atriummed.com/) , these permanent facial implants have not caught a lot of press and most patients are completely unaware of them. I have used them for the past 5 years with great success and very few problems. For the right patient who desires to move on from temporary fillers and can accept having a permanent implant under their skin, these type implants are a good treatmenmt option to consider.

Advanta Facial Implants represent a major advance in PTFE (Gore-tex) implant technology. Advanta is the first “next generation” PTFE implant material to feature innovative biocompatible architecture combining a soft central core with a controlled cellular penetration outer layer. This unique one-piece construction offers patients a softer, more aesthetic and more comfortable implant with a more natural look and feel. The soft central core allows increased cellular interaction and vascularization, with reduced inflammation. Patients may experience less rigid encapsulation or “walling off”, resulting in a softer, more natural healing response. This controlled cellular penetration also enhances implant stabilization and may help reduce the risk of migration and extrusion.

These implants can be placed under local anesthesia in the office. They are threaded into place by a tiny incision on each end of the treated area. Through an attached needle, they are threaded into placed, the ends trimmed, and one small stitch placed to close the small entry and exit holes. There are numerous different sizes available in either a round or oval form. Like temporary injectable fillers, the result is instantaneous. Unlike temporary injectable fillers, there will be some swelling and bruising for a few days after the procedure.

Dr Barry Eppley
www.eppleyplasticsurgery.com
www.ologyspa.com
Clarian North Medical Center, Carmel, Indiana
Clarian West Medical Center, Avon, Indiana
Indianapolis