Lip augmentations is most commonly done by hyaluron-baed injectable fillers and has been so for over the past two decades. While very effective with immediate results they are not permanent and, as a result, some patient do develop filler fatigue. It is not the most pleasant facial site to inject so it is understandable why patients may eventually seek other more permanent options.
As a result, various materials and implants have been placed in the lips to try and achieve this permanent effect. Implants offer the most assured permanent result and such implants have a long and checkered history. The two most common lip implant materials have been ePTFE and silicone. The most effective lip implant material with the lowest rate of complications has been ultrasoft silicone lip implants. (aka Permamlip implants) They are easily introduced and, of equal importance, easily removed. They are well tolerated with a low rate of infection and feel about as natural as any implant in the lip can.
In the Online First section of the July 2022 issue of the American Journal of Cosmetic Surgery an article was published on this topic entitled ‘Optimizing the Lip Aesthetic Ratio Using Surgically Placed Silastic Implants for Lip Augmentation’. In this paper the author reviews his 10 year experience with silicone lip implants. (aka Permalip) An analysis of the aesthetic outcomes, complications, a method to chose lip implant size, and the use of injectable fillers both before and after lip implant placement are reviewed. Aesthetic outcomes and patient satisfaction were assessed by direct patient questioning and surgeon observation.
To no surprise the vast majority of patients were women that had used injectable fillers for lip augmentation prior to the lip implant surgery.
In 100 lip augmentation patients a total of 192 implants were placed. The vast majority were in both upper and lower lips placed simultaneously. Overall patient satisfaction was high (97%) with a complication rate of 8% with lip asymmetry by far the most common. Some of the patients (7%) had HA injectable fillers placed after the lip implant were done without complications in doing so.
What is most novel in this clinical paper is the author’s quantitative method of choosing implant size. Used was the well known golden ratio (1:1.62) as the metric of size of the upper and lower lip, followed by two-third incisor dental show.
What is also interesting is that most patients in this clinical series used lip implants of 4 and 5mms in size. This has been my experience as well as lip implants of a 3mm size barely makes any visible lip enhancement.
While lip implants create a very visible augmentation effect the resultant lip size or the location of the augmentation on the lip may not be completely satisfying for all patients. The author safely performed injectable filler placement secondarily by injecting superficial to the implant capsule and using a microcannula as opposed to a needle.
Like any lip augmentation procedure, lip implants are not perfect and are not ideal for everyone. The biggest challenge with their use is the symmetry of their placement across the side to side length of the lip. Since the lip is curved and not really a straight structure getting it ideally placed to match the curve of the lip can be challenging.
Dr. Barry Eppley