The Aesthetic Surgery of the Lips

 Disturbing Aesthetic Deformities of the Lips

The deformities of the lips appear due to the ageing and necrosis of the connective tissue of the face. Therefore lips get thinner with age. This process, which is most of the times accompanied by the appearance of wrinkles, can be especially prominent on the upper lips. The wrinkles are the most prominent around the corner of the upper lip, but usually wrinkles appear beyond the border of the lip and the skin. ladies have used lipsticks as a protection against the ageing of the lips (i.e. they try to appear more feminine, aesthetic and younger by using lipsticks), but wrinkles make this protective method impossible, because lipstick will run over these vertical wrinkles.

Shaping the Lips with Injectable Implants (Lip Filling)

 Special Aspects

We should consider what has been mentioned in the chapter on wrinkle filling, but there are some special aspect that have to be considered in this chapter.

We have to be even more careful in the treatment of the lips than at other areas. Lips are more in sight than the other parts of the face, and they are more sensitive towards fine deformities. For example a haematoma after an injection treatment can be more frightening on the lips than elsewhere on the face.

We have already described the injectable fillers that are available, in the chapter on injectable wrinkle filling (cf. previous chapter). We should only use the ones for lip correction, which can be finely dosed with a thin needle (as lips can be deformed as a result of the haematoma after the injection), and which do not contain ingredients that can be felt (eg. Artecoll.). Similarly rough ingredients are Goretex, or derma stripes.

Therefore we have to select the injectable fillers according to these criteria. Fortunately, there are several implants suitable for injecting.

The procedure may induce the development of lip herpes, so we have to call the patient’s attention to this in time, as it can be avoided by taking preventive drugs. (If there was no lip herpes yet, prevention is not necessary for the patient.)

The Injection of the Lips and the Wrinkles at the Corner of the Lips

Preparation

Normally lidocain spray together with a mild sedative provides sufficient sedation. If the patient is over-sensitive, infiltration anaeasthesia or sedation can be employed. for the injection we should apply a very thin (27 G), 13-23 mm long needle.

The treatment of the wrinkles

(We recommend to start the treatment with the vertical wrinkles at the border of the lip and the skin. We can lift the furrows with the so called linear threading technique, i.e. the filler is introduced in the dermis through the needle sticked in the length of the furrow, developing small threads. The length of each small thread should be 2-3 mm, and they should be introduced at a distance of 2-3 mm from each other. After the introduction of avery thread, we apply a soft massage in order to distribute the filler evenly, and so that a unified thread can develop from the small threads.

We should stick the needle at an angle of 33 degrees to the skin, in the length of furrow. The opening of the needle should be towards the skin, and the filler should be introduced at a depth of 1-3 mm to the mid-deep layer of the dermis. While introducing the implant, we should gradually pull back the needle. It is important to stop the injection before reaching the surface in order to avoid the dropping out or the superficial dosing of the filler.

The lips can become softly tumescent directly after the injection (2-3 min.), which will disappear within 24-48 hours, so the patient has to be informed that the final result will be smaller. The duration of the filling of the wrinkles can vary according to the injected filler.

In the case of durable injectable fillers, a further correction may be necessary after a while, because the number of the elements of the connective tissue reduces with time. (It is natural that we cannot stop the process of ageing with this procedure.)

Lip filling

We start the filling of the lips at the border of the lips and the skin on the upper lip lengthwise. We introduce the 22-23 mm long, 27 G needle 3-4 mm at the edge of the mouth, medially from the corner of the mouth, directed to the middle of the lips. The filler is injected while pulling back the needle. In the course of the treatment we have to control if it has reached the right place. A mild massage of the skin follows the injection.

The lower lip is filled in the same way. The reason for the complaint is the thinning of the upper lip and the prominence of the wrinkles at the edge of the mouth, therefore we should start the filling at the upper lips, and then, if it is necessary we continue the procedure on the lower lips. 

It is important to inject the filler deeper than 1 mm in the case of the lips.

We should bear in mind that the injection causes a tumescence on the lips. Apart from the effect of the injected implant, the pricking of the needle also causes tumescence. Therefore the patient has to be informed that the result directly after the procedure is not equivalent with the final result. (It looks thicker.)

We have to endeavour to inject the same amount of fillers in both sides of the lips. The lips may seem asymmetric or extremely tumescent (especially in the case a haematoma developed), although the injection was carried out correctly. This asymmetry must never be corrected immediately! It can be corrected if the lips are asymmetric after 5 days. After the injection we can apply cooling in order to reduce the tumescence. It is advisable to carry out the treatment in 2 steps, with a difference of 5 days, which helps the socialisation of the patient.

Shaping the lips

Apart from the filling of the wrinkles, we have the chance to shape the lips in the course of the injection treatment. Naturally each procedure makes the lips thicker. We can increase the fullness of the lips with several injections. The lips can be made prim by introducing the needle at the border of the lip and the skin (always at a 2-3 mm depth below the lips), and inject the filler while pulling out the needle. If we inject in the middle third of the lip, the lips will seem more round, and if we inject in the lateral thirds, the lips will seem wider.

An alternative procedure to fill the lips

The injection can be made from the mucous membrane, from the inner side of the lips. Thus the lip will rise from the teeth, but keep its original form. We ask the patient to lie down and open his mouth slightly. We should watch the point where his mouth meets the teeth. The injection should be done 3 mm under this point by introducing the needle several times, injecting small doses each time. The danger of this method is the injection of too big doses, or injecting to the wrong place, then the patient may bite his lips, which get cicatrised and sensitive.

Emphasizing again:

• • the patient has to be informed about the expected result
• • the tumescence will reduce within a few days, and then the final result will be visible
• • the filler must not be injected superficially
• • we should apply the linear thread technique, and not a pearl-like injection
• • the deformity should not be over-corrected, we had better carry out a supplementary procedure after 2 weeks, if necessary
• • we should apply a slight massage

The filling of the lips will be less effective with absorptive fillers, than the filling of wrinkles or furrows. Usually the patient asks for the repetition of the procedure sooner than expected, but this period may vary individually.