Cosmetic medicine and cosmetic surgery of the lips

TREATMENT OF THE LIPS

The volume increase of the lips can be achieved through several medical and/or surgical procedures which consist in using:

Injectable filling materials (fillers).
Solid implants (threads).
Tissue grafts (autologous and non-autologous tissues).
Local flaps.

The choice of the kind of procedure (medical or surgical) and of the material to be used depends upon the cosmetic result that one wants to achieve and the decision is made in tune with the patient at the end of a meticulous specialist examination.

1. INJECTABLE FILLING MATERIALS (FILLERS)

Fillers are filling materials that are injected into the lips (vermilion) or along the border of the mouth through very thin needles; they allow the shape and the volume of the lips to be contoured.
The treatment is usually performed in a health centre without anaesthetic and lasts few minutes; apart from slight puffiness during the first 24-48 hours, it does not cause any visible after-effect preventing the patient from immediately resuming his/her daily activities.
The filling materials can be:

Absorbable.
Semi-permanent.
Permanent.

Absorbable materials: Absorbable fillers have the advantage of being easily tolerated by the body but provide a temporary volume increase (from 4 to 12 months).
The absorbable materials are essentially two: collagen and hyaluronic acid.
These substances are proteins occurring naturally in our skin and represent the main structural component of connective tissues. After being injected, collagen and hyaluronic acid are gradually metabolized and, then, absorbed within a time lapse varying from few weeks to 12 months. The absorption time depends on the volume of the microparticles and on the intramolecular bonds that the pharmaceutical companies manage to synthesize.
The most common commercial products containing hyaluronic acid are: "Restylane", "Perlane", "Juvederm", "Hylaform", "Vital", "Restylane subQ", while those containing collagen are: "Zyderm" and "Zyplast" (both of bovine origin), "Cosmoderm" and "Cosmoplast" (which are more recent and safer because they are both of non-bovine origin).

Semi-permanent materials: Semi-permanent fillers have the advantage of providing a more durable result (from 12 to 36 months) but, though in exceptional circumstances, may induce foreign-body reactions (granulomas).
Semi-permanent materials are essentially three: polylactic acid, collagen combined with polymethyl methacrylate or hyaluronic acid combined with acrylic hydrogel.
Semi-permanent materials are made up of a component that is absorbable within few months and of a permanent component.
The most common commercial products are: "New fill" or "Sculptra", "Artecoll", "Dermalive" and "Reviderm intra".

Permanent materials: Permanent fillers have the advantage of providing a permanent result but, sometimes, they can induce a rejection reaction that is not easy to control and correct.
Permanent materials are derivatives of polymers with alkyl-imidic bonds and polyacrylamide and are made up of non-absorbable molecules.
The silicone as an injectable gel is a permanent filler whose use was forbidden by the Italian law in the early 90s because of the numerous side effects it can cause.
At present, the most common products allowed for sale are: "Bioalcamid" and "Aquamid".

Fig.1

Atrophic and thin lips.

Fig.2

Result.

2. SOLID IMPLANTS (THREADS)

Solid implants are threads of non-absorbable material that are inserted into the lips (vermilion) or along the border of the mouth in order to increase the lip volume and contour permanently.
The treatment is usually performed in a health centre under local anaesthetic and lasts few minutes; apart from slight puffiness during the first 24-48 hours, it does not cause any visible after-effect preventing the patients from immediately resuming their daily activities.
The threads used for lip filling are derivatives of ePTFE (expanded Polytetrafluoroethylene), a material obtained by laboratory synthesis which has proven to be excellent in reconstructive surgery and cosmetic surgery because it is easily assimilated by tissues, is biologically inert and has few side effects.
The most common commercial products are: "Gore-Tex", "Advanta", "Softform" e "Ultrasoft".

3. TISSUE GRAFTS (AUTOLOGOUS AND NON-AUTOLOGOUS TISSUES)

Tissue grafts are transfers of cells taken from a part of the body and implanted in the lips in order to increase their volume and contour permanently. The treatment is usually performed under local anaesthetic and in outpatient care; it lasts about half an hour and, apart from slight puffiness during the first 24-48 hours, does not cause any visible after-effect preventing the patients from immediately resuming their daily activities.
Normally, the tissues used for lip filling are autologous (that is, taken from the body of the patient and thus perfectly tolerated) and are made up of fat (lipofilling), derma or muscle.
Non-autologous tissue is seldom used and, on the market, it is known as "Alloderm".
The lipofilling technique consists in taking small quantities of fat by means of a thin needle or a cannula; this fat is then injected into the area to be treated.
Instead, the derma or muscle graft is made by surgically taking and repositioning the tissue in the lips through two small incisions at the corners of the mouth.

4. LOCAL FLAPS

To increase the lip volume and contour permanently, it is also possible to use local flaps, making incisions (W-, V- or Y-shaped) in the internal part of the mouth and transferring a flap of local tissue to the external part of the lips.
This treatment has the advantage of using local tissue and, therefore, of avoiding problems of rejection or absorption that might emerge with some of these implants.
The treatment is usually performed under local anaesthetic in outpatient care and lasts about two hours.
Slight oedema and puffiness in the treated region will appear immediately after the operation and will persist for about one week.
The cosmetic result achievable by this kind of treatment is definitive and very natural.

If you wish to take this subject further, we advise you to visit the cosmetic surgery of the lips , where you will find the answers to the most frequent questions asked by the patients.

COSMETIC SURGERY

COSMETIC MEDICINE

Chirurgia-plastica-estetica.it
Prof. Mario Dini
Chairman and Director of Plastic Surgery Dept. - University of Florence

Prof. Mario Dini - Chairman and Director of Plastic Surgery Dept. - University of Florence
Via G. Capponi, 26 - Firenze - CAP 50121 - Tel. 055 244950 - Fax. 055 2345089

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