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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