A New ePTFE Soft Tissue Implant for Natural-Looking Augmentation of Lips and Wrinkles

BACKGROUND: Expanded polytetrafluoroethylene (ePTFE) implants have been used for augmentation of thinning lips and wrinkles due to aging for more than 10 years. The aesthetic results have often been excellent, but complications such as infection, extrusion, migration, shrinkage, and hardening have occurred in some patients. OBJECTIVE: To assess short-term results and complications in patients undergoing augmentation of the lips, nasolabial folds, and marionette lines with a newly designed ePTFE implant. METHODS: Thirty patients received 60 Advanta ePTFE implants for augmentation of the lips, nasolabial folds, or marionette lines. RESULTS: All patients received a natural-looking augmentation following 3-4 days of noticeable swelling. The only significant complications involved two upper lip implants that were removed for suspected infection. CONCLUSION: In a preliminary series, Advanta ePTFE implants provided effective, natural-looking augmentation of the lips and nasolabial folds with minimal complications.     

Granulomatous Foreign Body Reaction Against Hyaluronic Acid: Report of a Case After Lip Augmentation

BACKGROUND: Hyaluronic acid (HA) (Restylane and Hylaform) is becoming more widely used for cosmetic procedures such as lip augmentation and treatment of facial skin lines, as other products, mainly bovine collagen, have proved allergenic in many patients. OBJECTIVE: To report a case of a 48-year-old woman who developed discrete nodules in the lips after HA injection for lip augmentation. The histologic analysis revealed the presence of a granulomatous reaction surrounding a blue amorphous material with the tinctorial features of HA. CONCLUSION: To our knowledge, this is the third case of granulomatous body reaction against this substance, which was allegedly inert in humans. Although rare, this reaction can have important aesthetic implications, and the patients should be informed about their risks.     

3D Stereophotogrammetry Quantitative Lip Analysis

Background  Reduction in lip volume is a stigmata of the aging face. There are many lip augmentation techniques but very few studies analyzing how these techniques change the three-dimensional structure of the lips. Furthermore, there is no consensus about whether the lip position should be standardized to either the lips closed or parted. The aim of this study was first to obtain a three-dimensional quantitative analysis of the lips in adults and to look for sexual dimorphism and, second, to compare whether more consistent measurements of the oral region can be obtained with the mouth open compared with it closed. Methods  Seventy young Caucasian volunteers underwent lip dimension analysis using 3D stereophotogrammetry with lips parted and closed. Parameters measured for consistency of results were linear distances (e.g., mouth width, total lip height, upper lip height), surface distances (e.g., upper vermilion), areas (e.g., vermilion upper and lower lip, total vermilion), and volumes (upper and lower lip volume, total lip volume). Analysis also compared lip dimensions between male and female subjects. Results  Consistent and reproducible results were seen with the lips closed compared with lips apart. All lip parameters (distances, areas, and volumes) were larger in men than in women. The following measurements had significant differences between males and females: mouth width, upper lip height median, upper white lip height median, upper white lip height lateral, lower vermilion surface distance, and area of vermilion (p < 0.05). Conclusion  We present a novel technique for aesthetic assessment of the lips that is objective and achieves consistency with the lips in the closed position. Males have greater lip dimensions compared with females.     

The ��bikini lip reduction��: A detailed approach to hypertrophic lips

Excessively large lips represent an occasional but significant challenge in aesthetic surgery. Previously described techniques focus largely on the simple excision of a strip of tissue to reduce the lips, without specific attention to the resultant lip contour or to the volume relationship between the lips. The present paper describes a new technique for lip reduction, called the ‘bikini lip reduction’. This technique not only reduces the volume of the lips, but also restores an attractive labial contour, as well as an ideal volume relationship between the upper and lower lips. Because it is based on aesthetic analysis, this technique consistently yields both smaller and more aesthetically appealing lips. Simply stated, the bikini lip reduction consists of excision of a ‘bikini top’ (two cups and a middle strap) from the upper lip and a ‘bikini bottom’ (a triangle) from the lower lip. The aesthetic results and the patient satisfaction achieved through the bikini lip reduction technique have been very satisfactory.     

Use of expanded polytetrafluoroethylene in aesthetic surgery of the face

Aesthetic surgery procedures and materials available to improve the appearance of various subunits of the face have been evolving for the past several decades. Initially, techniques such as direct excision or placement of autogenous tissue grafts (e.g., fat, fascia, tendon, and dermal fat grafts) were used. Additional options became available with the development of silicone, injectable collagen, and ePTFE. These options for facial augmentation can be done rapidly in an office setting and as an outpatient. An important aspect of treatment is discussing clearly all pertinent options with the patient, and recommending the appropriate option based on the patient's anatomic findings and personal needs. For example, patients desiring lip augmentation but unsure about the result may be best treated with collagen injection, which gives temporary results and lets the patient consider a long-term result provided by ePTFE or autogenous grafts. Use of ePTFE in facial aesthetic surgery gradually has increased over the past two decades. Its use in augmentation of lips, nasolabial creases, and nose is becoming an important treatment modality for aesthetic surgeons.     

A new classification of lip zones to customize injectable lip augmentation

OBJECTIVES: To present a new classification of 15 anatomical lip zones used to direct placement of injectable fillers during lip augmentation and to evaluate the new classification's ability to customize lip contour and size. METHODS: Study participants were consecutive patients presenting to a facial plastic and reconstructive surgery practice for injectable lip augmentation with a nonanimal-sourced stabilized hyaluronic acid (Restylane; Medicis Aesthetic Inc, Scottsdale, Arizona). A nonrandomized, prospective case series. RESULTS: A total of 137 treatments were performed on lips of 66 patients. The mean (SD) satisfaction score was 4.5 (0.6) on an integral scale of 1 (dissatisfied) to 5 (most satisfied). The mean (SD) persistence until lips returned to preoperative appearance based on patient subjective evaluation was 4.9 (1.5) months. Patients were free of adverse effects. CONCLUSIONS: Using a new classification of lip anatomical zones to direct the injection of a nonanimal-sourced stabilized hyaluronic acid has increased my ability to better control lip shape and size in lip augmentation. This technique was met with high patient satisfaction and no adverse effects. Persistence of injected nonanimal-sourced stabilized hyaluronic acid was similar to that seen in other studies.     

Lip Rejuvenation

BACKGROUND . The management of the senile lip remains a dilemma. Allogenic fillers often feel unnatural, lip resurfacing is not adequate, and fat transfers may disappear.
OBJECTIVE . To develop a more reliable step-by-step approach to lip augmentation.
METHOD . Lips were divided into types: (1) the simple senile lip that had lost its fullness—treated with fat augmentation; (2) the lip with rhagades—treated with fat augmentation and laser resurfacing; and (3) the duckbill lip—treated with lip advancement, fat augmentation, and laser resurfacing. Tattooing to increase the degree of redness was performed on all types of lips.
RESULT . If there had been a previously full lip, it was possible to rejuvenate the lip by simple augmentation with autologous fat transfer. The average number of fat transfer sessions to generate this pleasing lip was two to three. The lip with rhagades required fat filling, with laser resurfacing to achieve a new contour. The duckbill lip required a lip advancement along with lipofilling and laser resurfacing. All types benefited from lip tattooing.
CONCLUSIONS . It was possible with fat augmentation and/or laser resurfacing to generate a pleasing lip in type 1 and 2 lips. Lip type 3 required a lip advancement along with fat augmentation and laser resurfacing. Lip tattooing accentuated all the lip types.     

Lip Augmentation with Liquid Silicone

Background. Many fillers have been used to augment the lips. One of these that has provided long-term satisfactory results is liquid silicone.
Objective. To demonstrate the efficacy and safety of lip augmentation with liquid silicone.
Method. Following a discussion of the benefits and risks of the procedure and the benefits and risks of alternatives and after answering all of the patients' questions, an informed consent form was signed. After obtaining anesthesia with a regional nerve block of the infraorbital and mental nerves, 0.25 to 0.5 cc of liquid silicone (1,000 centistokes) was injected using the microdroplet technique into the vermilion border of both the upper and lower lips. Depending on the desire of the patient, the procedure was repeated monthly. The augmentation of the lips was documented with histology, micrometry, and digital photography.
Results. Lip augmentation was achieved gradually during the months following liquid silicone injections into the vermilion border of the lips in the 608 patients studied. Most of the patients requested a second and third injection session. The results were most dramatic in the patients with type I and type II lips and less satisfactory in patients with type III lips. Bruising occurred in the majority of the patients. Eleven patients (2%) developed small palpable granulomas. These granulomas either required no treatment, responded to steroid injections, or were excised.
Conclusion. The use of liquid silicone remains an effective method of lip augmentation. It returns the adolescent vermilion curl to the lips.     

Utilization of the depressor anguli oris musculocutaneous flap for lip reconstruction

The authors describe the anatomic aspects and surgical technique of the depressor anguli oris musculocutaneous flap for reconstruction of the upper and lower lips. Twenty patients were submitted to surgical treatment, 19 for carcinoma and for upper lip scar deformity. In all patients the repair was performed with the depressor anguli oris musculocutaneous island flap. At the follow-up, lip function was satisfactory in 19 patients and unsatisfactory in 1 patient. The aesthetic results were considered satisfactory in all patients. The depressor anguli oris musculocutaneous island flap is safe for upper and lower lip reconstruction, with good functional and aesthetic results, and can be added as a new flap for lip reconstruction.     

Permanent lip augmentation with serial fat grafting

A simple technique for lip augmentation with autologous fat is presented. Local anesthesia is injected into those areas used for fat harvesting and the perioral areas that are to receive the grafts. The fat is taken with a large needle and syringe, washed over meshed gauze, placed into the syringe, and injected into the lip tissue. Multiple passes with a small needle deposit the strained fat in horizontal tunnels within the lips. Subsequent injections are performed at a minimum of 3 months. Lip swelling is short lived and permanent lip augmentation occurs when patients undergo two to three grafting procedures.     

改良Black术式修复完全性双侧唇裂畸形

目的 探讨采用改良Black术式修复先天完全性双侧唇裂畸形效果.方法 应用改良的Black术式修复先天完全性双侧唇裂畸形36例,其中前唇组织特别短小者19例,皮肤、唇珠组织不足,均采用裂隙侧唇组织修复.结果 术后随访全部受术者3个月至3年,前唇部唇高正常,两侧唇高对称,唇珠丰满,唇弓静态及动态自然,上唇无明显过长、过紧,唇珠与红唇颜色无差异,切口瘢痕不明显,效果满意.结论 改良术式弥补了Black术式修复双侧完全性唇裂前唇组织特别短小的患者时,出现中央唇高不足、唇珠不够丰满的缺陷,使修复的上唇功能及美容效果更佳,值得临床推广.     

改良Black术式修复完全性双侧唇裂畸形

目的 探讨采用改良Black术式修复先天完全性双侧唇裂畸形效果.方法 应用改良的Black术式修复先天完全性双侧唇裂畸形36例,其中前唇组织特别短小者19例,皮肤、唇珠组织不足,均采用裂隙侧唇组织修复.结果 术后随访全部受术者3个月至3年,前唇部唇高正常,两侧唇高对称,唇珠丰满,唇弓静态及动态自然,上唇无明显过长、过紧,唇珠与红唇颜色无差异,切口瘢痕不明显,效果满意.结论 改良术式弥补了Black术式修复双侧完全性唇裂前唇组织特别短小的患者时,出现中央唇高不足、唇珠不够丰满的缺陷,使修复的上唇功能及美容效果更佳,值得临床推广.     

改良Black术式修复完全性双侧唇裂畸形

目的 探讨采用改良Black术式修复先天完全性双侧唇裂畸形效果.方法 应用改良的Black术式修复先天完全性双侧唇裂畸形36例,其中前唇组织特别短小者19例,皮肤、唇珠组织不足,均采用裂隙侧唇组织修复.结果 术后随访全部受术者3个月至3年,前唇部唇高正常,两侧唇高对称,唇珠丰满,唇弓静态及动态自然,上唇无明显过长、过紧,唇珠与红唇颜色无差异,切口瘢痕不明显,效果满意.结论 改良术式弥补了Black术式修复双侧完全性唇裂前唇组织特别短小的患者时,出现中央唇高不足、唇珠不够丰满的缺陷,使修复的上唇功能及美容效果更佳,值得临床推广.     

Quantitative analysis of lip appearance after V-Y lip augmentation

OBJECTIVE: To quantitatively analyze the changes in the 3-dimensional appearance of the lips after V-Y lip advancement for lip augmentation. DESIGN: A retrospective single-blinded study of patients who had a V-Y lip augmentation from January 1999 to December 2001. Standardized anterior and lateral preoperative and postoperative digital photographs of patients were analyzed using digital imaging software to quantify postoperative changes. RESULTS: There were statistically significant increases in the vertical height of the upper red lip (75%) and in the area of the upper red lip (66%). The upper and lower lip projection increased by approximately 40%. The vertical distance from the apex to the trough of Cupid's bow increased by 56.7%. CONCLUSIONS: The V-Y lip advancement for lip augmentation increases the parameters that characterize the fullness of the upper lip and enhances the vermilion "pout" and projection of the upper and lower lip. It also increases the curvature of Cupid's bow.     

Evaluation of Lip Augmentation with Gore-Tex Facial Implant

Although numerous materials, including autogenous, homogeneous, and alloplastic materials, have been used for lip augmentation with varying degrees of success, no ideal one has been found to achieve a soft and long-lasting result. Gore-Tex implant has been successfully used in cardiovascular surgery. So far, it has not been used much in lip augmentation. In this study, a Gore-Tex SAM facial implant (1.8 mm in diameter) was used for lip augmentation in 23 lips of 17 female patients. In 10 consecutive lips with three segments of the implant each, a computer-assisted imaging system was used to scrutinize the results. The results have shown that the three segments of the implant enhanced the lip projection with about 0.98 mm in mean (p < 0.01) and the exposed vermillion width with about 1.94 mm (p < 0.01) in the over 6 months follow-ups. No major complications, only some minor ones, were seen. For lip augmentation, we find that only minor changes can be achieved with three segments of the Gore-Tex facial implant. We feel that it is safe and believe it gives a permanent result which is not the case with collagen injection and usually not the case with lipofilling despite reinjections. Furthermore, we consider the implant quite expensive at present.     

Synthetic soft tissue substitutes: 2001.

The human face ages in a predictable fashion. Well-described changes in the lip and perioral region include progressive deepening of the nasolabial folds and atrophy of the lips. Conventional face lifting and endoscopic and resurfacing techniques do not adequately address many of these changes. As such, soft tissue filler materials are often used. This article outlines the history of soft tissue augmentation and discusses the risks and benefits of current synthetic materials.     

New Technique for Correction of the Microform Cleft Lip Using Trans/Intraoral Approach

The traditional method of treating microform cleft lip with nose deformity uses upper lip external incision, finally leading to a small scar on the upper lip. Hereafter, we present a new method for the correction of microform cleft lip using trans/intraoral approach. The new surgical technique is characterized as (1) using trans/intraoral approach and no incisions on the skin of the upper lip, (2) reconstruction of the “cross” muscular structure using the abnormal muscular insertions at the base of nasal columella and the nasal alar to restore nose deformity, and (3) repair of the lip deformity using two small Z-plasties to get the aesthetic and functional outcome. Thirty patients with microform cleft lip were repaired with our technique, and good functional and aesthetic results of repaired noses and upper lips were obtained in most cases.     

Lip Augmentation with AlloDerm Acellular Allogenic Dermal Graft and Fat Autograft: A Comparison with Autologous Fat Injection Alone

Many surgical options exist for lip augmentation, none of which consistently provide safe, lasting, and predictable volume gains. We describe and evaluate the use of AlloDerm acellular allogenic dermal graft in combination with fat autograft and compare the postoperative results with those of autologous fat injection alone. Analysis of the preoperative and 1- and 3-month postoperative photographs was done using digital imaging software. Outcome measures included vermilion show and horizontal lip projection from the soft tissue pogonion–subnasale plane. A 61% mean increase in vermilion show was observed in lips augmented with AlloDerm/fat injection, in comparison to a mean increase of 13% in lips augmented with fat injection alone. Lip projection demonstrated a mean increase of 1 mm in AlloDerm/fat lips at 3 months. Postoperatively, no evidence of resorption was seen in lips augmented with AlloDerm/fat between the 1- and the 3-month follow-ups, however, a 9% decrease in vermilion show occurred in lips augmented with fat injection over the same period. No complications occurred in either group. We conclude that AlloDerm in conjunction with autologous fat injection constitutes a safe, reliable, and lasting method of lip augmentation providing increased vermilion show compared to that with autologous fat injection alone.     

Surgical vermillion augmentation: Different possibilities

In 1981 the author described a surgical technique to augment thin lips: a double YV mucosal plasty. Satisfactory and lasting results are achieved with this technique, mainly in young patients. Today, the author sometimes uses a fascia temporalis graft for lip augmentation. In patients over 40 he recommends that the temporalis fascia craft be combined with the double YV mucosal plasty.