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.
Welcome Back Collagen?
April 28th, 2009
Allure magazine has just reported the availability of a new injection material, Evolence. Manufactured by Ortho-McNeil-Janssen Pharmaceuticals, Inc., it received FDA approved almost a year ag0. Now available in the US, it gives another choice to patients requesting injectable wrinkle treatments. Other injection materials include hyaluronic acid (Restylane ®, Juvéderm ®), hydroxyapitite (Radiesse ®), autologous fat (fat from your own body), and other collagen products (Zyderm ®, Zyplast ®, Hylaform ®, Cosmoplast ®).
The Evolence collagen is sourced from porcine (pig) tendons. It is crosslinked using a patented technology using D-Ribose a natural sugar. Due to the genetic similarity between pig and human collagen and the crosslinking process, dermal allergy pre-testing is not necessary.
The search for the ideal injection material to improve facial wrinkles, augment facial bones, and enlarge lips has endured over a century long pursuit for plastic surgeons. The first material tried in the 19th century was paraffin or wax. The chemical induced inflammation and ruled out this material out of the question very early on. Interestingly, I recently saw a patient from Asia who had received such an injection in the 1990’s!
Women searching for larger breasts in the 1940’s and 1950’s received silicone injections. The reactions were so serious, it was banned in the US. Unfortunately, silicone breast injections continued elsewhere in the world for some time. In 1994, the FDA approved injectable silicone for detached retina treatment. The off-label (not approved) injection into the face has continued since that time. Sadly this practice has migrated outside the standards and medical protocol of physician’s offices. It can be found in home parties and offered at hotels where it is being injected by individuals without medical training. Poor results are common.
Collagen injections were first approved by the FDA in 1981. Since that time there has been a string of new collagen products, each trying to improve on the last. Problems including allergic reactions, visible material under the skin, and skin loss (necrosis) have plagued these products. Only widespread clinical use of Evolence will be able to confirm the reported risks and benefits for this product.
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