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Dr. Barry Eppley

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Posts Tagged ‘lip implants’

Case Study – Permalip Implant Lip Augmentation

Sunday, August 30th, 2015


Background: Lip augmentation is the historic location for injectable fillers since the early 1980s and remains as one of the top injectable filler sites even today. There are a wide variety of injectable fillers and manufacturers but the use of hyaluronic-acid (HA) based fillers is primarily used in the lips as they have the lowest risk of potential complications.  HA injectable fillers flow in the smoothest and the easiest and this makes them ideal for lip augmentation.

While injectable fillers for lip augmentation is highly effective and safe, it is not permanent. (I am excluding the use of silicone oil from this discussion since it is not FDA-approved for this use) This lack of permanency poses a long-term issue in terms of cost. Few women are going to spend $500 to $1,000 per year over their lifetime to maintain a lip augmentation result. It simply is too costly to do so for most women.

The concept of lip implants has been around for a long time and numerous types of lip implants have been tried. While effective in increasing the size of the lips they have posed numerous problems including hardness, irregularities, scar tissue, lip numbness, extrusion and difficulty with removal. This has given lip implants an historic poor reputation.

Permalip Implants Indianapolis Dr Barry EppleyWhile no permanent lip implant can be perfect as the lip is a very soft and distensible structure, the problem with past implants is that the materials used were too firm. No matter how it is engineered and designed, polytetrafluroethylene (Gore-tex) is too firm for the lips. A newer lip implant, Permalip, offers an improved material that is of a very soft flexible solid silicone material. Just by feel it seems more like a soft lip structure.

Case Study: This 42 year old female had various HA injectable filler materials placed into her lips for the past six years. While she liked her lip augmentation results, the cost of repeated treatments was becoming prohibitive. She sought a permanent lip augmentation result with implants.

Lip Implants result side view Dr Barry Eppley IndianapolisLip Implants result front view Dr Barry Eppley IndianapolisUnder local anesthesia in the office using infraorbital and mental nerve blocks with direct infiltration into the lips, Permalip implants were placed. A 4mm implant was placed in the  upper lip and a 3mm implant placed in the lower lip through small incisions placed just inside the corner of the mouth.

Indianapolis Permalip Implants Dr Barry EppleyPermalip implants offer the only permanent method of lip augmentation. Of all lip implants ever manufactured, their soft silicone composition is the best material and design offered to date. They are easy to place and, just as importantly, easy to remove should that be necessary. Because they have a smooth surface it is very important that the chosen length of the implant is at least as long as a measurement taken across the lip from one mouth corner to the other. If the implant is short of this distance it will become displaced with asymmetry of the implant between the two lip halfs.

Permalip Implant Size Options Dr Barry Eppley IndianapolisCurrently the largest Permalip implant is 5mms in size. This produces a very noticeable lip augmentation change but will not create dramatically large lips. The use of larger lip implants, even if they were available, would not be advised. When the ratio of the implant size to that of the natural lip exceeds more than 50% the rate of complications is bound to exponentially increase.

While lip implants offer a permanent method of lip augmentation, it is important that patients realize that they have the potential for complications like implants placed anywhere else in the body. The most common complications are palpability and implant asymmetry being at different tissue levels between the two lip halfs.


1) The only permanent FDA-approved method for lip augmentation are silicone implants. (Permalip)

2) Permalip implant are generally used in qualified patients who have tried other injectable methods and now seek a permanent lip augmentation solution.

3) It is important to remember that Permalip implants are implants that are placed in a flexible and sensitive body part with exposes them to certain risks.

Dr. Barry Eppley

Indianapolis, Indiana

The Perma Facial Implant For Lip Augmentation (PermaLip)

Saturday, June 7th, 2014


Lip Augmentation Dr Barry Eppley IndianpolisDespite that lip augmentation is sought by many women (and a few men), the perfect procedure to accomplish it remains elusive. A wide variety of treatment options exist to achieve bigger lips from injectable fillers and fat to surgical manipulations of the vermilion and skin excisions. Injectable fillers are by far the most common lip augmentation method because of their simplicity and immediate results. Their drawback is that no FDA-approved injectable filler is permanent and the treatments have to be repeated. Those filler materials that are permanent (silicone oil) is both non-FDA approved and has a propensity for nodules and foreign body reaction if improper injection techniques are used. (and sometimes even if they have been placed with good technique.

A lip implant, just like any other facial implant, would provide a stable and permanent lip augmentation effect. But the history of synthetic implants in the lip is very checkered with numerous materials and implant designs introduced and then eventually removed from the market (and often from the patient’s as well) due to a high rate of complications.

Permalip Implants Indianapolis Dr Barry EppleyIn the May 2014 issue of Plastic and Reconstructive Surgery Global journal, an article describing a newer lip implant was published entitled ‘Five Year Experience With Perma Facial Implant’.  This paper reports on the experience and long-term effects of the silicone lip implant known as PermaLip which is a very soft smooth solid elastomer tapered tube. The authors placed 832 lip implants on 420 consecutive patients.(91% female, 6% transgender and 3% men) with an average follow-up of over two years. The vast majority had both upper and lower lips done simutaneously. (98%) Of the three available implant thicknessess, the 4mms was most commonly used (78%). The largest 5mm diameter was only used for implant replacement when patients wanted more lip volume. Of the three implant lengths available, the 60mm and 65mm comprised almost 90% of the implants used. Of the 832 implants placed, the complication rate was 12% with malposition representing the majority of them. Infection, hematoma or extrusion was less than 1%. Equally relevantly, implant buckling or permanent loss of lip sensation was not seen in any patient.

While one may interpret that a 12% complication rate with a two-year follow-up of lip implants is high, it is not. (it is far less than that seen in breast augmentation for example) One must remember that this is an implant placed in the body which will always be more prone to complications than when one uses natural tissue. Since it is a smooth silicone tube, it is easily reversible which was a big drawback to previous lip implant materials and design.

Permalip Implant Size Options Dr Barry Eppley IndianapolisLike all implants, sizing and proper tissue positioning are the key factors in a low rate of complications for the PermaLip implant. For many patients, the largest 5mm size implant is too big for an initial augmentation, thus the popularity of the 4mm size. The hardest or trickiest part of the procedure is to get the implant is an even tissue plane across the whole lip and this is what accounts for implant malpositions. It is a problem that has always existed in lip implants. Because the lip is a curved structure and the implant instruments for placement are straight, it is not always easy to be in the same tissue plane from the side of the lip enter the instrument to the opposite side you exist from the corners of the mouth. This takes a bit of practice and and experience to keep the malposition rate low.

The Permalip implant is the best lip implant that I have seen in the past 25 years. It is nor perfect but it offers a simple and easily reversible method of lip augmentation for those women who are tired of repeat injectable filler treatments. Patient selection is critical as one has to have enough vermilion and lip tissue in which to place the implant with good soft tissue cover. Thus it is for patients who have very thin lip with little vermilion show unless they have had a prior or simultaneous subnasal or vermilion advancement lip procedure.

Dr. Barry Eppley

Indianapolis, Indiana



Postoperative Instructions for Lip Implants

Friday, September 27th, 2013


The use of implants for lip augmentation is a surgical procedure that adds permanent volume to the lips. It is done as an office procedure under local anesthesia if done alone or in the operating room under general anesthesia if it is included as part of a collection of other plastic surgery procedures. The implants are inserted through small incisions inside the corners of the mouth through the body of the lip form one corner to the other. The following is a list of after surgery care and considerations for the lip implant procedure.

1.  Lip implant surgery will cause some slight discomfort for the first 24 to 48 hours. Most patients find it can be relieved with mild pain relievers such as Alleve or Ibuprofen. The lips may be sensitive to touch and pressure (caused by activities such as drinking from a straw and kissing) for up to two weeks.

2.  There are no dressings applied after lip implant surgery. Antibiotic ointment can be applied to the corners of the mouth at the incision site to keep the area soft and supple.

3. You will experience swelling in the lips after surgery. Swelling typically takes three days to peak and then will begin to subside over the next two weeks. You may use ice packs to help reduce the swelling and provide comfort during the first day after surgery.

4. The incisions in the corners of your mouth can get wet with no concern for infection. You may shave (men), wash your face and perform oral hygiene (brushing your teeth, mouthwash) as normal.

5. The small incisions in the corners of your mouth will have sutures that need removed one week after surgery (unless you are from out of town). These sutures should be kept moist with antibiotic ointment, applied three times a day, to the corner of the mouth. If dissolvable sutures are used, it is normal for the corners of the mouth to get slightly red in color as those sutures dissolve, applying antibiotic ointment can help lessen this effect.

6. Your lips will feel a little tight when you open your mouth widely. That will take several weeks to a month to return to normal. You may stretch open your mouth and lips as much as feels comfortable. You may eat whatever you like.  Focus on liquids and soft foods for the first few days after surgery.

7. You may experience some bruising after surgery. Taking Arnica Montana tablets prior to your surgery may help to prevent bruising. In addition, topical Arnica gel may be applied after surgery to help reduce any bruising that may occur.

8. There are no physical restrictions after lip implant surgery. You may return to work and resume physical activities such as working out as soon as you feel comfortable.

9. You may begin driving again as soon as you are off pain medications, can react normally and feel comfortable doing so.

10. If any lip redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery – Lip Implants

Thursday, September 26th, 2013


These explanations are intended to improve your understanding of the lip implant procedure that has been discussed with you. Please read them carefully and understand that this list includes many, but not all of the different outcomes from this surgery. Please feel free to ask Dr. Eppley any further questions regarding your surgery.


Augmentation of the lips can be done by a variety of synthetic or fat injectable fillers to increase the size of the pink part of the lip. (vermilion)  Other lip augmentation procedures include lip lifts and lip advancements. How the results achieved by injection and lift techniques compares to that of an implant should be thoroughly understood before surgery.


The goal of lip implants is to permanently increase the size of the lips.(increase vermilion show)


The limitations of lip implants is the size of the lips that can be achieved. Lip implants range in sizes from 3 to 5mm diameter at their thickest central section. The effect of the implant in increasing lip size (vermilion show) is also controlled by how much visible vermilion one initially has.


Expected outcomes of placing lip implants include the following: temporary bruising and swelling of the lips and temporary lip numbness. All lip implant procedures will create some temporary stiffness on lip movement and mouth opening.


Significant complications from lip implant surgery are very rare but could include infection. More likely complications could include aesthetic deformities such as asymmetry and irregularities of the implants and lip size and shape and under vs. overcorrection of the desired lip size achieved. Any of these risks may require revisional surgery for improvement.


Should additional surgery be required to adjust the position or size of the implants, this will generate additional costs.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Male Lip Implant Augmentation

Saturday, December 8th, 2012

Background: Lip augmentation is a popular procedure that is most commonly done with the use of injectable fillers. Any of the family of hyaluronic-acid based fillers offers an immediate improvement in which the material can be placed in a variety of lip locations to create both increased size and/or enhancement of various lip features. Its only downside is that it is temporary and must be repeated for the effects to be maintained.

The overwhelming number of lip augmentations is done in women with only an occasional man ever having the procedure. The reasons for this is the obvious preference for fuller and larger lips in women from a fashion and beauty perspective. While fuller lips in men can also be attractive, it is not a primary facial feature that necessarily makes for a strong masculine appearance. The other reasons lip augmentations are done a lot less in men is that they, in general, are less tolerant of the injectable experience.

Lip implants offer a permanent option for lip augmentation. Over the years, a variety of implant types have been available for subcutaneous tissue implantation, all of which have been different forms of polytetrafluorethylene materials. All of these materials have been withdrawn from the market with mixed clinical results. Permalip (Surgisil, Plano, Texas) is a relatively new implant designed for the lips made of a very soft (low durometer) formed silicone material. Because of its very smooth surface and tapered design, it is easily reversible should that be desired in the future.

Case Study: This 45 year-old male was undergoing a variety of procedures for facial enhancement and was interested in doing a permanent lip augmentation at the same time. Options discussed included fat injections, a lip lift, an internal mucosal advancement and silicone lip implants. He wanted the simplest but the most reliable method that would ensure a sustained augmentation effect.

At the completion of his other facial procedures, both the upper and lower lips were infiltrated with a lidocaine solution that contained epinephrine. Small 5mms incision were inside the corners of both sides of the mouth in the mucosa and scissors used to make an intramuscular tunnel to the midline in both the upper and lower lips. A fine curved grasping instrument was then passed from one side of the lip to the other through the incisions and a 5mm implant was placed in the upper lip and a 3mm implant in the lower lip. Both implants were 65mms long. The incisions were closed with small dissolveable sutures.

After surgery he did develop the typical significant lip swelling that is typical from implant passage through the lips. Some bruising occurred on the left upper lip but in other lip quadrants. His lip achieved their final size at 3 weeks after surgery which remained unchanged three months later.

Case Highlights:

1)      Lip augmentation in men is uncommon and they are less likely to choose temporary injectable fillers.

2)      Silicone implants (PermaLip) offers a permanent option for lip augmentation when one has tried and/or does not prefer injectable fillers.

3)      Silicone implants slide easily into place through small incisions at the corners of the mouth and are available in sizes of 3, 4 and 5mms diameters with lengths from 55mm to 65mms. Men will almost always need the longest lengths.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery Product Review: PermaLip Implants

Friday, May 18th, 2012

Lip augmentation is one of the most popular minimally-invasive cosmetic procedures of the face. Done almost exclusively with injectable fillers, it produces instantaneous augmentation of the vermilion-cutaneous junction or the lip body proper. Of last year’s nearly 2 million injectable filler treatments performed in the U.S., a significant percent of them was for lip enhancement.

 While there is a wide variety of injectable filler options, those fillers that are comprised of hyaluronic acid compositions work best in the supple and sensitive lip tissues. The immediate and usually satisfying results of injectable lip augmentation  is why its drawbacks are tolerated. Lip injections have to be repeated for maintenance at a frequency based on the absorption of the material. With most hyaluron-based fillers, that can be expected to be anywhere from 3 to 9 months. In addition, there is some level of discomfort with injections which makes each treatment session a tolerated but not a pleasant experience.

The alternative to lip augmentation by temporary-lasting injections is through the use of synthetic implants. There has been a history of a variety of synthetic materials used as lip implants since the mid-1990s, most of which have gone out of favor. The most common material has been that of PTFE or Gore-Tex. Initially used as a multi-strand implant, it developed an unacceptable level of complications such as stiffness, bunching, nodules and lip distortion with movements. Another PTFE material, known as Advanta which is a dual-porosity soft tube, had better clinical results but is now no longer commercially available. I had used it for over a decade and had very good clinical results with it with few negative experiences.

The newest synthetic lip implant is that of PermaLip. (SurgiSil, Plano Texas) Composed of a very soft silicone elastomer materal that is shaped like a tube with tapered ends, it offers a very supple and flexible implant that feels quite natural. It is a smooth non-porous implant that can never rupture or deflate. It is available in thicknesses up to 5mms and lengths of 6.5cm. The typical distance from one mouth corner to the other is usually around 7 cms or less.

The surgical technique to place the PermaLip implant can be done in the office under local anesthesia. Through small incisions placed just inside the mouth corners, the implant is slide into place using a small instrument. One of the biggest problems to overcome in the placing of lip implants is even placement at the right level in the lip from one side to the other. The technique for placing PermaLip implants largely overcomes the problem of lip asymmetry. One will experience some lip swelling for a week or so and occasionally some lip bruising may occur.

The physical features of this lip implant is what is most appealing to me. Its smooth surface means that it easily be reversed should one so desire. That has been the biggest problem with synthetic lip implants in the past, they were difficult to remove.

The success of any lip implant is both material and technique-based. It is important to place the implant in an intramuscular position and not immediately subcutaneous or submucosal. It is also important to not stress the lip tissues by placing too big of an implant. While PermaLip has sizes up to 5mms, a small (3mm) or medium (4mm) size is best for most patients. The implant volume/tissue ratio is important. A moderate lip size increase that has long-term success is better than a large lip size result that develops complications.

Dr. Barry Eppley

Indianapolis, Indiana   

Common Questions about Lip Augmentation and Lip Lifts

Tuesday, January 19th, 2010

1.      What is the difference between lip enhancement and lip augmentation?

Most people, including plastic surgeons, often use these lip terms interchangeably. While one could argue no matter what you call it, the idea is to make the lip look better… which usually means fuller. However, there are some subtle differences between lip augmentation and enhancement. Lip augmentation adds or restores fullness to the lips. This can be done with either temporary injectable fillers or permanent materials. Enhancement procedures do not really add fullness, although they do make the lip look bigger. These are  skin removal procedures that change the position and shape of the vermilion, thus enhancing the appearance of the lip.


2.      What is the best injectable filler for lip augmentation?

There are nearly a dozen injectable filler materials but not all are appropriate for the lips. The lips are unique in that they are not covered with skin but a thinner and more sensitive tissue. (vermilion) In addition, the lips must remain very flexible and soft. For this reason, the best injectable filler for the lips is either collagen-based or composed of hyaluronic acid derivatives. (e.g., Restylane, Juvaderm) Fillers that contain particles, resorbable or permanent, are more likely to cause reactivity and delayed reaction problems.



3.      Are there any permanent options for making my lips bigger?

The desire for a permanent lip ‘filler’ is a common one and there are some options. There is no easy injectable method, however, for lip augmentation that is absolutely permanent. None off-the-shelf injectables are permanent. At best, some may last as long as nine to twelve months.


Fat is often injected into the lips because it is your own tissue and particularly if one is in the operating room for other procedures anyway. The downside to fat injections into the lips is that its survival is unpredictable. I have seen some patients in my Indianapolis plastic surgery practice who have done really well with it while many others have gone on to near complete resorption. It’s worth a try if you are already in the operating room but any long-term retention should be thought of as a bonus, not an absolute. It is not a procedure that can be done in the office.


Implants have been tried over the years in the lips as a permanent filler, of which Gore-Tex (polytetrafluoroethylene) is the most commonly used. Different variations and designs of this material have been used over the years. The best one that I have used is Advanta, which is a very soft and spongy tube of various diameters. When well placed deep in the lip, it can be a very reliable and effective method for permanent lip enlargement.


4.      I have very thin lips that have no shape. I have tried injectable fillers but they didn’t work. Is there anything I can do?


Injectable fillers work when there is sufficient vermilion or lip tissue to expand. In very thin lips, fillers can often make for an unnatural ‘duckbill’ look because there is not enough vermilion to expand out naturally. Unless the filler is done in small amounts, the lips can assume an unusual bloated appearance.


One option for very thin lips is to treat the underlying problem, not enough vermilion exposure. This can be done through two types of skin excisional or removal procedures. The vermilion advancement is done by removing a strip of skin directly along and above the lip line and moving the vermilion upward (upper lip) or downward. (lower lip) For the upper lip, the cut out of skin can be done so that the cupid’s bow is more accentuated with a more defined shape. The vermilion advancement has the advantages of being able to affect the entire lip, from corner to corner, and being truly permanent. Its disadvantage is that it creates a fine line scar at the junction of the lip and skin.


The other vermilion changing procedure is the lip lift, also known as the ‘bullhorn’ lip procedure.In an effort to avoid a lip scar, the skin removal is done right under the nose placing the scar in the hidden crease between the lip and the nose. By removing skin in this area, the vermilion of the lip below is pulled up increasing its pout. The disadvantages of the lip lift is that it affects only the central part of the lip and it will lose some percent of the created lip fullness after surgery. (due to gravity)


5.      Can lip procedures be done in the office?


Any type of lip procedure, injection, implant, or surgery, can easily be done in the office. The lips can very effectively be numbed by the injection of local anesthetics, just like in the dental office. For patients who are anxious about those type of injections, oral sedation medications can be provided which will definitely alleviate any apprehension that one may have. If you take sedation, you will need someone to drive you home.


Injection procedures take about 15 minutes to perform. The placement of lip implants takes about 30 minutes. Lip lifts or lip advancements will take about 60 to 90 minutes to perform.


6.      Is there much pain and swelling after lip augmentation procedures?

Depending upon the technique used, the amount of swelling and discomfort afterwards changes. Injectable fillers result in no pain and very little swelling after. Lip implants cause considerable swelling for a week or so and have some mild discomfort from fullness and stiffness. Lip lifts and advancements cause much less swelling than implants and virtually no pain.

Recovery from lip procedures is essentially ‘social’, meaning how you look. There are no restrictions of any activities including eating and drinking.

Dr. Barry Eppley

Indianapolis, Indiana



Advanta (ePTFE) Implants for Lip Augmentation

Tuesday, August 18th, 2009

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

Indianapolis, Indiana

Lip Enhancement Options

Sunday, February 3rd, 2008

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 Permalip. These very soft silicone 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 Permalip 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

Indianapolis, Indiana

Advanta Facial Implants – An Alternative To Injectable Fillers

Friday, November 2nd, 2007

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, 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. The greatest advantage to this type of subcutaneous facial implant is that they provide a permanent treatment for soft tissue folds and deficiences, primarily of the nasolabial folds and the lips.

Dr Barry Eppley


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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