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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 nerve 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

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