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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘permalip 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

Case Study: Labiomental Fold Reduction with Implant

Friday, January 11th, 2013


Background: The chin is composed of various tissues that simplistically is a ball of soft tissue sitting on top of a prominent bony ledge. At the top of this ball is a horizontal groove or indentation that sits between the lower lip and chin about 2/3s the way up from the very bottom of the chin bone. Known as the labiomental fold, sulcus or groove, it is a natural feature of most chins. It is caused by the underlying attachments of the mentalis muscle as it comes superiorly and inserts into the underside of the skin below the lower lip. It forms an angle between the lower lip and a line tangent to the superior convexity of the chin and is purported to be most aesthetic at around +/- 130 degrees.

Unlike the nasolabial fold which deepens with aging, the labiomental fold is a fixed structure that is established early in life and does not change thereafter. The depth of the labiomental fold is affected by numerous factors and can become excessively deep when the lower jaw is shorter. When the lower teeth are retropositioned (class II malocclusion), the lower lip folds under the upper teeth making the labiomental fold deeper.  When the lower teeth protrude beyond the upper teeth (class III malocclusion), the fold is flattened or non-existant. Short of these jaw deficiencies, the depth of the labiomental fold is genetically determined and appears to be a function of the size of the entire chin pad more than anything else.

The labiomental fold is not a very common aesthetic facial concern. But occasionally requests are made to treat a deep one. The most common treatment method is by injection and it can be augmented like any other facial fold. It requires smaller volumes of injectable fillers than other facial sites and any of the commercially available fillers can be used. Synthetic fillers can last up to a year in the fold. Fat injections can also be used but there is no documentation that it persists any longer.

Case Study: This 48 year-old male was going to undergo multiple aesthetic procedures including rhinoplasty, submentoplasty and lip and nasolabial augmentation with implants. He also wanted an implant to lessen his labiomental fold as well. He has always felt it was too deep.

Under general anesthesia, he had all of his implants placed first to decrease infection risk. Using Permalip silicone implants a 4mm x 65mm implant was placed in the upper lip and a 3mm x 60mm implant in the lower lip. For the labiomental fold, small stab incisions were made at each end. A 5mm diameter Permalip implant was slide into place right under the skin and the ends trimmed off as only about 35mm of length was needed.

There was no bruising in the chin from the labiomental fold implant placement and the incisions healed inconspicuously. There was a moderate reduction in the depth of the fold that was maintained.

Labiomental fold reduction can be achieved permanently with the placement of a subcutaneous implant. Most reductions are modest in nature and deeper V-shaped folds respond less significantly than those that are more shallow with a rounder indentation.

Case Highlights:

1)      The labiomental fold is natural line between the lip and chin whose depth is genetically determined.

2)      Injection therapies provide an immediate but temporary improvement in lessening the depth of the fold. Synthetic implants provide a permanent result.

3)      Soft silicone tube-shaped implants (Permalip) can be easily placed to soften the labiomental fold under local anesthesia.

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   

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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