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Advances in Lip Augmentation:
Brian V. Heil, MD
One of the great challenges to plastic and cosmetic surgeons worldwide has been the search for safe, reliable, solutions to lip enhancement
Techniques may be separated into
two categories:
Temporary
Permanent
Temporary Techniques
• Involve the use of injectable fillers that may only last a few months
• Are painful, expensive, and must be repeated over and over to maintain the result
Permanent Techniques
• Involve the use of surgically placed implants inside the lips
• Have potential complications such as excessive scar tissue formation, which frequently results in a restricted unnatural smile.
PermaLip
• Soft, solid injection molded silicone that cannot rupture or deflate
• Tapered at both ends to allow for a more natural contouring of the implant to the lip
• Has a smooth surface that reduces scar tissue formation and prevents tissue ingrowth
Anatomy
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Anatomy
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• Four point block is administered to the facial sensory nerves • Lip block is performed directly to the substance of the lip along the plane of dissection with emphasis on the commissure.
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•The Patient’s peri-oral region is prepped
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• A 4 to 5 mm incision is made in each commisure, adding pressure to achieve hemostasis.
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• Using the curved Iris scissors ( with the wet dry border as your guide ) – dissect to midline deep in the submucosa, staying just superficial to the muscle. Repeat from
the opposite side and connect the two tunnels with the Iris scissors prior to inserting the Perma Tunneler.
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•The Perma Tunneler is then guided through the lip between the thumb and index finger.
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•Guiding the tunneler through the lip
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•The implant is grasped with a good purchase where tapering meets full thickness
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• The implant is pulled back through the dissected tunnel aided by Brown Adson forceps grasping the opposite end of the implant to
ensure it is not pulled completely through.
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•The implant is then worked from side to side to ensure proper positioning in the mid-line, with modifications to placement performed
through palpation
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•The process is then repeated for the lower lip.
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•The incisions are closed with one stitch in each commissure using an absorbable suture to grab deep tissue and performing an
interrupted figure-of-eight with eight knots.
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Pre Op 1 Day Post Op 1 Wk Post Op
3 Wk Post Op 3 Mo Post Op 6 Mo Post Op
Complications
• Infection – Less than 1%
• Capsular Contracture – Less than 1%
• Improper Sizing
• Improper Placement
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Lip Fullness Labral Height Maxillary Height Treatment
Type 0 Normal Normal Normal Augmentation
Type 1 Involutional Loss Normal Normal Augmentation
Type 2 Normal Long Normal Lip Lift
Type 3 Involutional Loss Long Normal Combination
Type 4 Congenital
Hypoplasia
Normal Normal Augmentation
Type 5 Congenital
Hypoplasia
Long Normal Combination
Classification System for the Perioral Region
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Type 0
Lip Fullness Labral Height Maxillary Height Treatment
Normal Normal Normal BLA
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Type 1
Lip Fullness Labral Height Maxillary Height Treatment
Involutional Loss Normal Normal BLA
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Type 2
Lip Fullness Labral Height Maxillary Height Treatment
Normal Long Normal LL
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Type 3
Lip Fullness Labral Height Maxillary Height Treatment
Involutional Loss Long Normal LL, BLA
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Type 4
Lip Fullness Labral Height Maxillary Height Treatment
Congenital
Hypoplasia
Normal Normal BLA
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Type 5
Lip Fullness Labral Height Maxillary Height Treatment
Congenital
Hypoplasia
Long Normal LL, BLA
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Type 0 Type 1 Type 2
Type 3 Type 4 Type 5
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Lip Lift
Designed to shorten the vertical distance between the base of the nose and the vermilion border of
the upper lip
Lip Lift
Traditional vs. Endonasal
One Week Post-Op Photo