Background: Lip augmentation is one of the more popular uses of injectable synthetic fillers and has been so for more than two decades. They offer an immediate and non-surgical method of lip augmentation that works fairly well when adequate vermilion height exists. But it does require periodic injections to maintain the effect and injections into the lips is not the most comfortable.
As a result the concept of a permanent form of lip augmentation has always been appealing and multiple methods have been used to achieve it. Permanent fillers (e.g., silicone), fat injections and dermal grafts have all been used with varying successes as augmentation materials. Autologous fat is the most convenient material and, while easy to harvest and inject, has a a very difficult time of surviving and maintaining volume in the mobile and delicate lip tissues.
Another form of fat for lip augmentation is the dermal-fat graft.While having been a type of graft that has a long history in plastic surgery it rarely is used today as it has largely been forgotten amongst other options. It also requires a graft harvest and a resultant scar in its wake which is also not appealing to many patients. But if the patient has an existing scar of adequate length the scar problem with the use iof a dermal-fat graft is negated.
Case Study: This female desired lip augmentation by the addition of volume but had already had fat injections which did not persist. She had good vermilion show and the upper lip was 2/3s the size of the lower lip. She wanted an autologous lip augmentation method and she had a long oblique and wide right lower abdominal scar from a prior surgery. She was having multiple other facial procedures so this was a convenient time for a dermal-fat graft technique.
Under general anesthesia the right lower abdominal scar was excised with a layer of fat maintained beneath it. The graft was prepared by removing the outer epithelial layer with sharp scissors.
Using a long curved alligators forceps and with an incision in each mouth corner a tunnel was made from one side of the lip to the other on both upper and lower lip. The graft was cut to the curved length of the lips and a thicker segment used for the smaller upper lip. Once the grafts were threaded into the lips a very important step is to stretch the lip out so the graft is not bunched up in the lip and lays smoothly inside the lip.
The graft ends are then trimmed at both sides of the incisions and the mucosa closed with dissolvable sutures.
When seen the next day after the surgery her lips were tremendously swollen as was expected. It will take about 3 weeks for all the swelling to subside. Unlike fat injections most of the dermal-fat graft can be expected to persist.
Case Highlights:
1) One form off autologous lip augmentation is with the use of dermal-fat grafts.
2) Dermal-fat grafts for the lips are a good alternative when the patient has failed prior fat injections, wants an autologous approach and has reasonable vermilion show.
3) Dermal-fat grafts are threaded into the lips using a curved grasping forceps.
Dr. Barry Eppley
World-Renowned Plastic Surgeon