Lip Augmentation:
Lip augmentation procedures increase the size of the lips to make them fuller and more attractive. The procedure is used to help women and men of all ages. The upper or lower lip may be treated singly, or both upper and lower lips may augmented at the same time.

Lip augmentations have become increasingly popular in recent years. Some types of lip augmentation involve the insertion of natural or synthetic materials. Other surgical techniques bring tissue from the inside of the lip to the outside. Some of these procedures are permanent, while others provide only temporary results.

If you're considering lip augmentation, the following information will provide you with a good introduction to the different lip augmentation procedures. For more detailed information about how this procedure may help you, we recommend that you consult a facial surgeon who is board certified or has completed a residency program that includes instruction in this procedure.

Injections involve filling the lip with a soft substance to create a fuller appearance. Collagen and fat are the most widely used injectable substances.

Prepared from the collagen found in cow skin, collagen injections are used to temporarily augment the lips. Although it is purified, this collagen may cause allergic reactions in some people. For that reason, a sensitivity test should be performed before the actual lip augmentation procedure.

Collagen is injected into the lip with small needles. Because the body slowly absorbs the collagen, the results generally last between one and three months. The procedure may be repeated as needed.

Fat injections are also placed in the lips with small needles. The fat used is harvested from another area of the body -- most often the abdomen or the thighs -- and is purified before it is injected into the lips. An advantage to this procedure is that there is no possibility of an allergic reaction. As with collagen injections, results are temporary. The procedure is often performed more than once to achieve desired results.

Another injectable material, Artecoll, augments the natural tissue to create long lasting results. It is mainly composed of tiny synthetic “beads” (polymethyl methacrylate) that stay in the lips, and raise them. Only a few doctors in the U.S. have been trained in this procedure.

Another injectable, Autologen, is collagen extracted from the patient’s own skin, often from excess skin removed in a facelift. The results are relatively long lasting, and there is no risk of an allergic reaction.

Dermalogen is extracted from the skin of a human donor, and is inserted in the lip just like collagen. The donor material is screened and processed to avoid the spread of disease. The effects are temporary, and are similar to the effects of collagen injections.

There are three different substances commonly used in grafting.

AlloDerm is a popular human-donor grafting material that is screened and processed to minimize the spread of disease. The standards by which it is processed are strict. (The risk of infection is only about 2%.)

Under a local anesthesia, the material is inserted through incisions made in the inside corners of the mouth. Stitches are used to close the incisions. The material is often absorbed, so that the results are only temporary, lasting from 6 months to a year.

SoftForm has recently replaced another lip implant material, Gore-Tex, because it has been shown to produce better results with fewer complications. SoftForm does not shrink and is never absorbed into the body. It also remains in place because scar tissue forms on both ends. This allows it to easily be removed if it becomes infected.
To insert SoftForm, a small incision is made in the inside of the lip. The material is then made into the shape of a small tube and it is inserted with an insertion trochar (needle). For the upper lip, this process is repeated three times, to implant three separate pieces in the lip. In the lower lip, two pieces are usually used.

Fat grafting produces lasting results in approximately half of the people who try it. Although it is possible that the body will reabsorb it, many people choose fat grafting because they are most comfortable with using the fat from their own body to enhance their lips. The fat is harvested from another area of the body, often the abdomen. It is then prepared and inserted with a needle into the lip from more than one point.

Local flaps bring material from inside the mouth outside to enhance the lips. Results are temporary. An incision may be made inside the mouth to push the tissue inside the mouth upward, and outward, into the lip, sometimes in conjunction with grafting. Or, an incision may be along the upper lip line. In this case, skin above the lip is removed, and the lip is then stitched along the line of the incision.

Ideal Candidate:
In general, the best candidates for lip augmentation are:
   :: Men and women of all ages.
   :: In good physical health.
   :: Psychologically stable.
   :: Informed about the healing process.
   :: Accepting of any limitations, as discussed with surgeon.
   :: Free of allergies to the implant material used.
   :: Realistic in their expectations for the outcome.

Chin Augmentation:
The chin is just as important in the profile as is the nose. Often in association with rhinoplasty and sometimes just by itself, the profile of the chin can be changed. If the chin protrudes, it can be reduced by drilling away some of the bone under the chin pad or if the teeth do not fit properly, by moving the entire jawbone backwards, thereby improving the occlusion of the teeth and the appearance of the chin. If the chin does not protrude sufficiently to create an aesthetic profile, it can be built up with a small, hard silicone rubber implant. The implant can be placed through a small incision underneath the chin or through an incision inside the mouth. Both techniques have advantages and disadvantages. It is our experience that implants placed from below the chin have a lower infection rate and cause much less discomfort than those placed through the mouth. The major risks with a chin implant are infection, extrusion of the implant, or some displacement of the implant. In fact, in as many as 5% of cases, the implant slips and needs to be removed or adjusted. Interestingly, when the implant is removed, it often leaves some scar tissue and a very improved profile. Another occasional complication with the insertion of chin implants is injury to the nerve that supplies sensation, that is feeling, to the lower lip. This nerve comes out of the bone close to the area where the chin implant must sit. It is sometimes injured, and while there is always some spontaneous recovery, that recovery is never complete.

The chin implant does not take long to insert. When performed alone, it can be done in the office, and when done with a rhinoplasty it is performed at the same time. There will be three small bandage strips over your chin; these come off four days after surgery, the same time that the rhinoplasty dressing comes off. No further dressing is necessary. The small scar under your chin generally heals well, and because of its placement under the chin, is not easily seen.

Cheek Augmentation:
Whether you want heightened and well-formed cheekbones like the ones you had when you were young, or you’ve never had well-defined cheekbones, cheek implants may produce a dramatic change. For many people, cheek implants can provide new facial contours and dimensions to bring facial features into better balance.

Cheek implants are made in various shapes and sizes. They are made out of both solid and semi-solid materials that have been used successfully for years. If you're considering cheek implants, the following information will provide you with a good introduction to the procedure.

When cheek implant surgery is performed in conjunction with other facial procedures, the implants may be inserted through the incisions used for that procedure. If cheek implant surgery is performed by itself, incisions are either made at the top of the upper lip, near the gums, or on the outer cheek, slightly below the lower eyelid. The implant of the size and shape that the surgeon has selected is then inserted through these incisions into a pocket created in the tissue. In some cases, a small titanium screw is used to attach the implant and the bone. The implants are placed on or below the cheekbones and the incisions are closed with sutures that the body absorbs. At the conclusion of the surgery the skin is dressed to reduce swelling.