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LIPS

Background

In nearly all cultures, aesthetic ideals for women, and to a lesser extent men, include full-bodied lips. Artistic images abound from the Egyptian Queen Nefertiti to Michaelangelo’s David to the fashion and film idols of today, not only in Western culture, but in all cultures; the implied message: full lips are beautiful.

Many people are not blessed with such fullness to their lips. Though for women, lipliner can accentuate the lip size to a certain extent, only so much can be "drawn on" without looking grotesque as the lipstick extends onto the skin outside of the vermilion or red part of the lip.

There have been many different approaches to enhancing lips. They include bovine collagen injections, fat injections, implantation of the patient’s own fascia, implantation of strips of Gortex (SoftForm), or implantation of strips of human connective tissue (AlloDerm). New injectable filler materials enter the Plastic Surgery market every year to attempt to meet the need for not only filling wrinkles and scars, but also enhancing lips. With age, the upper lip can elongate, and there is a procedure to shorten or “lift” the upper lip that makes it appear more youthful. No one technique is applicable to every person’s desires or specific anatomy. Dr. Creasman will discuss the specific approach he would recommend at the time of the consultation.

The Consultation

Dr. Creasman takes a thorough medical history, including medication and allergy history. If you have an allergy to beef products, you should avoid bovine collagen. Dr. Creasman does not currently inject collagen or other fillers, but would be able to refer you to a qualified specialist in the area.

After examining your features and discussing with you what your expectations are for lip enhancement, the doctor will typically draw a sketch of your lips and the degree of enhancement he can provide. It is also a good idea to bring in pictures of lips you find attractive in order to communicate to Dr. Creasman what your expectations are for your surgery. There are physical limitations as to just how much enhancement can be achieved with any approach, and you will need to understand your limitations in order to have a realistic outlook for your result. 

After deciding on just what approach he recommends, Dr. Creasman will then go over the risks of that particular procedure with you, along with the details of the recovery process.

Risks of Lip Procedures

Each different approach has its own set of risks. The most common approach that Dr. Creasman uses to enlarge lips is to implant AlloDerm. AlloDerm is an allograft, which means it is tissue obtained from a human donor. Like kidneys, hearts, corneas, individuals or their families also donate skin. With AlloDerm, the skin is processed under rigorous FDA standards to minimize the transmission of disease. First, the outer layer of tissue or epidermis is removed, along with all of the cells in the dermis. The remaining tissue is the collagen framework, which provides strength to the skin. There are no components left to cause rejection or inflammation that can result with unprocessed tissue transplants. Patients often ask whether the material is safe. It is processed in such a way that pathological agents such as HIV, Hepatitis, and others are screened against in the donation phase; but in addition, the tissue is so prepared as to remove the possibility of AIDS transmission. The tissue is freeze-dried for transport, and once it is opened during the procedure, it must be reconstituted in saline, and is then bathed in an antibiotic solution. We therefore make every effort to minimize infectious transmission. It is normal for there to be a 2% or so risk of infection with any operation of this type, however. This would most likely be an infection from your normal skin and/or mouth bacteria, not an infection from the donor. Removal of AlloDerm after the first month is quite difficult, because of the fact that it is incorporated into the host tissue, and complications including scarring might result.

After implantation, the AlloDerm gradually becomes part of your own tissue, and feels like your own tissue. This takes time, and in the interval between implantation and complete incorporation (usually lasting 2-3 months), the grafted area can feel firm and in the lips this can interfere with speech, kissing, and eating. The AlloDerm may be quite noticeable to others as well as yourself. The lips often feel numb for a 6-8 week period, and this may even last as long as a year. Usually by 8 weeks, most patients appear quite normal, but there may be some loss of volume for up to 6 months. The scars used to implant the material are typically inconspicuous. In rare cases, resorption of the graft occurs and the person loses the effect of the augmentation. This is less likely with AlloDerm than with any other tissue material, including the patient’s own tissue.

Fat grafting is a very unpredictable medium for enhancement of lips, but is preferred by some patients who do not wish anything implanted other than their own tissue. Though in approximately 50% of patients it works well and is long-lasting, it cannot be predicted in whom it will work. The advantage of fat grafting is that many people have concerns about accepting either tissue from another person, tissue from a cow, or having plastic implanted into their lips. The disadvantage is that fat grafting is time-consuming, expensive, and involves a donor site scar and removal of fat from another location in the body (although the scars are imperceptible, and most of us do not have a problem finding excess fat to donate!). Swelling and bruising are greater with fat grafting, and the recovery is longer and generally more painful. If the fat dies in the process of grafting, it can turn hard, and may feel lumpy within the lip. The greatest risk of fat grafting is disappointment with the result with resorption of the fat over the first few months. If it appears to have taken by 6-8 weeks, it will probably hold up over the long-term, but again this is not predictable.

A Lip Lift is a procedure wherein the distance from the base of the nose to the “cupid’s bow” of the upper lip is surgically shortened. This makes a patient with a long upper lip look younger. It involves placement of a scar that lies just beneath the base of the nose. This usually results in a very inconspicuous scar. It can result in a more “toothy” smile, but this is usually considered salutary.

Before Your Procedure

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist that may interfere with the safety of their surgery. Specifically, any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery. In particular, any outbreak of herpetic infection (cold sores) should be reported to our office.

A prescription for pain medication and a lip ointment is given to you at the preop visit, so that you have your necessary medications when you return home from the operation.  Dr. Creasman recommends the use of homeopathic pills to minimize swelling and bruising.  This is available for purchase in our office.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 - 6 months after your procedure.

You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks have been explained here, but are also discussed at the consultation.

This is a preoperative checklist to follow prior to your lip augmentation procedure:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation. 
2. Pick up an infant toothbrush and Listerine Mouthwash for use after surgery. Prepare a solution of one tbsp. table salt in one quart of water and chill in refrigerator. This is to rinse your mouth out after surgery.
3. Stock up on Coca Cola Classic. It may help with any nausea you might feel after your anesthetic.
4. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
5. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
6. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms. IT IS IMPORTANT THAT YOU REPORT ANY HISTORY OR CURRENT OUTBREAK OF COLD SORES ON YOUR LIPS.
7. Wear a non-pullover shirt to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
8. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be free of jewelry for your safety.
9. Take any prescribed medications as directed.
10. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
11. Avoid smoking for six hours prior to surgery.
12. Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards. Floss and brush your teeth thoroughly the morning of surgery, and rinse with Listerine Mouth Wash.

You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transportation in the event that you cannot find an escort. It is mandatory to have someone stay with you for at least 24 hours after surgery, for your comfort and safety.

The Operation

Lip augmentation is typically done under a local anesthetic, with intravenous sedation. After marking the outline of where the graft or implant is to be placed, anesthetic blocks are placed, but you will feel no pain during the injections. In the case of grafting, small incisions are made near the corners of the mouth, and slightly inside the mouth to avoid visibility of the scars. A tunnel is created across the face of the vermilion or red skin of the lip, just beneath the skin surface, and from the junction of the skin and vermilion down to the visible bottom of the lip (called the wet-dry line). The AlloDerm is prepared as described above and threaded through the tunnel and secured to the corners. Self-absorbing type stitches are used to close the incisions. Dr. Creasman almost always prefers to augment both the upper and lower lips; even though patients may want to augment just the upper lip, it is aesthetically more attractive for the lower lip to be fuller than the upper lip.. When they are the same size it gives an unnatural appearance.

In the case of fat grafts, the fat is harvested usually from the abdomen. It is prepared using a proprietary method, but this essentially separates the fat from any other debris such as local anesthetic, present during the harvesting process. The fat is then injected from multiple entry points using a specially designed injection needle.

Lip lifts are done by excising skin beneath the base of the nose in a special pattern. The wounds are closed. Dressings are applied.

The Post-Operative Period

Ice cold compresses should be continuously applied for 48 hours. Talking and chewing should be kept to an absolute minimum to also reduce swelling. Homeopathic pills reduce the swelling and bruising. Pain medication controls the pain in most patients. It is important to keep the lips lubricated with the ointment to reduce your discomfort.

On the second or third day after surgery, you will be seen in the office by either Dr. Creasman or his nurse for a wound check. You should then be able to return to work in less than a week, but swelling continues as mentioned above, for 6 weeks or more. Any removable sutures are taken out on the fifth day after surgery.

The final result cannot be appreciated for 2 - 3 months. You may not feel completely normal for even longer. The length of the recovery is directly proportional to the amount of material placed in your lips. In patients desiring dramatically larger augmentation, the recovery is longer and the risks of complications are greater. Subtle enhancement is accompanied by a shorter, smoother recovery. Dr. Creasman’s goal is to provide a natural, long-lasting enhancement of your lips.