By Michael Sundine, MD

Full lips have gained increasing attention in the media. More and more patients are interested in having full lips as seen in celebrities like Angelina Jolie. Dr. Sundine has had a long standing interest in the aesthetics of lips. His interest in lip aesthetics started with his treatment of patients with cleft lip deformities and other craniofacial deformities. The nuances and precision involved in these repairs have lead Dr. Sundine to a deep appreciation of the beauty of lips.

There are many techniques that are available for lip augmentation. The techniques can be categorized as using local flaps, use of native tissue (palmaris longus tendon, SMAS grafts, temporoparietal fascia), cadaver dermis (Alloderm), injectable fillers, and the use of alloplastic (nonbiological) materials.

Lip flaps may allow for good lip augmentation but the scarring can may the lips very stiff and they may also be insensate. These techniques are probably better employed in reconstructive patients such as those who have a cleft lip deformity.

SMAS grafts provide a very nice graft material consisting of the patient’s own tissue that is well vascularized and provides for a nice augmentation of the lips. However, the use of the SMAS is somewhat limited to patient’s who are undergoing a facelift procedure. In patients who have a preexisting scar, dermal-fat grafts from around the scar may be used to augment the lips, but this technique is less applicable for patients who desire pure aesthetic lip augmentation.

The palmaris longus tendon can be similarly used as a SMAS graft but is more acceptable for reconstructive patients who require lip augmentation. Patients must be willing to accept a scar on the palm side of their forearm. Similarly, for use of the temporoparietal fascia patients must be willing to accept a scar (usually well hidden) in their temporal hairline.

Cadaver dermis has been also used for lip augmentation. The problem with this material is that it has typically melted away over several months and may need to be repeated.

The use of Gore-tex threads have been used for lip augmentation. They have been fraught with problems such as extrusion, lip stiffness, and foreign body reactions such that they are no longer widely used for lip augmentation.

The use of injectable fillers has been widely used for lip augmentation. The material used was initially bovine or human collagen. Collagen has been replaced by other hyaluronic acid fillers such as Restylane and Juvederm. Radiesse (a hydroxyapetite or calcium phosphate filler) is no longer used for lip augmentation because it tends to form hard masses within the lips. The difficulty with injectable fillers is that the augmentation tends to be very short-lived and may last only three months of time. Over time the maintenance of this improved appearance can become quite expensive.

An exciting new tool for lip augmentation has been the development of a permanent soft silicone lip implant (Surgisil). The implant is easily placed and can be performed in the office under local anesthesia. The lip implant is soft and not easily felt in the lip. There are several different lengths and diameters available to meet each patient’s individual needs. The implant is easily removed and can also be upgraded if the patient desires. Dr. Sundine has performed a video discussion on lip augmentation that can be viewed at the following connection.