Lip Sculpting
October 16th, 2009
I find that a significant part of doing cosmetic surgery is sculpture. Whether I am removing (liposuction), adding (breast enlargement) or rearranging (face lift), the quality of the result and achieving a natural appearance is the direct result of sculpture. Lip enlargement using injectable materials is no different. I first start out with mental image of what normal lips look like. The lips are then sculpted with the injections to look like normal lips. Just this past week, I did three lip injections to minimize wrinkles and give the face a more youthful appearance. All of my patients have a nice improvement in their appearance, no hint of the “sausage lips” look, that seems to be popular in Hollywood.
I have noticed that many injectionists must think lips look like sausages! Jimmy Dean fills cylindrical tubes with meat to create this shape. I do not find this look to be attractive. Nobody’s lips look like sausages except the ones which have been injected! Lips have a subtle curve know as a “Cupid’s Bow.” This complex curve is created by the mirror image of the upper lip meeting the lower lip. The Cupid’s Bow shape is most apparent along the upper lip where the red lip meets the flesh-colored skin also known as the vermillion border.
Lips injected with fat, collagen or hyaluronic acid will look like sausages if they are injected evenly along their length. It is a simple matter of physics. To maintain a normal appearance, they must be injected differentially, maintaining relative fullness of the central upper lip compared to the lateral upper lip. The lower lip should be the mirror image of the upper lip. The lower lip should be fuller lateral to a central relative thinness. You might think of the lips like gears which mesh. Full on top meshes with thin on the bottom and thin on top meshes with full on the bottom.
Three other things to remember. First, the lower lip is almost always fuller than the upper. Julia Robert’s lips are an exception to this rule. In other words, they are not normal. Seeking this appearance will give you unnatural looking lips. Second, lips naturally taper toward the corners of the mouth. Injections here distort this natural shape. Finally, lip enlargement can be accomplished with about 2 ml or cc. This equates to two syringes of most products. Injecting more than 2 ml, increases the risk of getting an unatural appearance (or sausage lips) and more importantly, the risk of terrible scarring from skin necrosis or skin death.
In other words, there is more to creating a naturally pouty lip than most people might appreciate.
Media Hype: Exploding Implants
October 15th, 2009
Most normal physical activities do not break breast implants. However, extreme high speed sporting accidents can exert excess pressure, resulting in implant failure. This is a very rare occurence. More commonly the accident just breaks the scar tissue around the implant. The recent report of a woman breaking her implant while doing a stunt for reality TV proves this point. Warning – this video clip contains harsh language. I think she just broke the scar tissue as it is impossible to tell immediately if the implant broke. Her response is to the change in her breast which was hard before the fall and became softer after the impact. Breaking the scar tissue from the outside is called closed capsulotomy.
I know I have mentioned it before, but all breast implants break or fail eventually. This is no surprise, as all man made implant eventually fail. Why? Because stresses are repeatedly placed on the materials which lead to stress fatigue. Take a piece of wire and bend it back and forth many times. You will first notice the wire becomes warm in the area that it is bending. Keep bending it back and forth and it will eventually break. This is the same process which goes on in the body. Whether it is a heart valve, hip implant, pace maker or breast implant, this process continually goes on within the body and it eventually fails.
Of course, the length of time that it takes for an implant failure to occur is variable. The length of time that an implant lasts, is inversely related to the focus of the stress. In the specific case of breast implants, they can develop a crease or fold once they are implanted. This crease (like the wire) if it persists will result in implant failure. Obviously localized stresses decrease the life expectancy of an implant. I generally tell patients breast implant failure is rare within ten years, but starts to increase between ten to twenty years after surgery.
The implications of various types of broken implant does varies. Heart valves and pace maker failures can lead to serious or fatal consequences. Joint replacement failures usually result in pain and a decreased ability to use the involved limb until corrective surgery is done. Fortunately, breast implant failure does not lead to any immediate functional problems. Saline implants, to their advantage, result only in possible embarrassment when they deflate. They also might interfere with mammograms more than when they are fully inflated. Implants filled with silicone gel will eventually lead to changes in the natural scar tissue around the implant when they break. These changes show up as firmness, tightness, tenderness, swelling, changes in breast shape or hard lump adjacent to the implant. Silicone gel can become extravasated into the surrounding breast tissue in the extreme cases. For these reasons, the FDA recommends patients with silicone gel implants undergo MRI studies every other year after surgery, in an effort to detect silicone gel implant failure early. Early detection allows corrective surgery to be carried out before these clinical changes occur.
One other caveat needs to be mentioned. I hope it is obvious to everyone that when the breast is penetrated with a needle or scalpel during surgery, the implant can be damaged or broken. I have seen this on two occasions. Fortunately both implants were saline implants. Simply replacing the implants in these cases was all that was necessary. Silicone gel implants damaged in this way might have required more surgery and they may have left the patient with mammogram changes.
Finally, mammograms should never be avoided for fear of breaking a breast implant. Even though considerable pressure seems to be applied to the breast implant, it is very, very difficult to actually break an implant in this way. It happens only very rarely.
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