Background: Lip augmentation is a very common office-based cosmetic procedure that is done by commercially-available injectable fillers. Despite the immediate and dramatic effects of injectable fillers in the lips, their results are not permanent. These lip treatments must be repeated if the results are to be maintained. There are some patients who tire of these repeated treatments (known as ‘filler fatigue’) or can not get the lip results they want with injections alone.
The lip (vermilion) advancement is a permanent alternative to lip injections. Fuller or larger lips are evident when more of the vertical height of the vermilion (pink portion of the lips) is seen. Injections accomplish this by pushing from the inside out. Lip advancements achieve this by moving the border of the vermilion further out through skin removal.
Case Study: This female had received injectable fillers into her lips for years. She tired of the discomfort and cost of the repeated injection sessions. While her lips could not be construed as thin to begin with, she sought a very full lip look. She felt that even the injections did not get them large enough. In these before surgery pictures, the lines (mounds) of her existing fillers can be seen around her lips.
At the time of the procedure, the position of the desired new edge of the vermilion was initially lined with a marker. Since the upper lip is usually smaller than the lower lip in most patients, the upper lip line is about 4 to 5mms above the existing vermilion edge and about 3mms below the lower lip vermilion edge. Dental blocks (infraorbital nerve upper and mental nerve lower) were initially performed. This provided anesthesia so that a next set of injections could be done directly along the line of the lip cutouts for absolute comfort and control of any bleeding during the procedure. The previously marked skin was removed along the upper and lower lips as marked. A two-layer closure was then done. For patients that live close, I use very fine 7-0 sutures to be removed a week later. For faraway patients, fine dissolveable 6-0 plain sutures are used. Antibiotic ointment is the only dressing. Some significant lip swelling will initially be seen, accentuated by the previous injection of the local anesthetic.There are no dietary or oral hygiene restrictions. Lipstick may be applied after one week.
Case Highlights:
1) Permanent lip augmentation can only be achieved with a lip or vermilion advancement. Vermilion advancements are the surgical alternative to injectable filler fatigue.
2) How much vermilion any particular patient wants increased is marked before surgery with their approval. Like drawing lip liner, the exact result can be known before surgery.
3) Lip advancements should be reserved for those patients who have previously tried injectable fillers or have very thin lips that do not respond well to injections.
Dr. Barry Eppley
Indianapolis