ASPS: Lip Augmentation Moves Toward Permanent Plumping

SAN FRANCISCO, Oct. 11 -- Plastic surgeons believe the perfect pouty lip is attainable, but not quite yet.

Not all lip augmentation fillers are created equal and some may leave lumpy lips, but the field is getting closer to the "perfect product," pronounced Miles Graivier, M.D., of North Atlanta Plastic Surgery.

He and a panel of lip augmentation experts, speaking at the American Society of Plastic Surgeons meeting here, discussed techniques, fillers and implants including a permanent saline-filled implant introduced here.

The saline implant, called FulFil, is approved only for use as a nasal splint. Dr. Graivier here reported performing the first off-label lip implantations in the U.S. over the past two weeks.

The saline implant is placed surgically in the top or bottom lip and consists of a Teflon and silicon outer shell with a valve that self-seals once the fill tube is removed.

It has the advantage of being softer and conforming to the lip as it moves better than previous "almost cylindrical shaped implants," such as Gortex implants, Dr. Graivier said. But like Gortex implants, its volume does not change dramatically over time as with aloderm or dermal fat grafts, which are particularly unpredictable in patients older than 55, he said.

"It's something that has a lot of interesting potential," said Dr. Graivier, who is a consultant and on the medical advisory board of Juva Medical, which makes the product. He said the company is seeking an extended application for the implant and working on a similar implant that is adjustable through the skin with a needle postoperatively.

Lip augmentation fillers have also improved with several new products in the past few years.

Dr. Graivier said that the hyaluronic acid filler Restylane is the gold standard for plumping the inner body of the lip. Hyaluronic acid is a component of connective tissues and rarely causes allergic reactions. The hyaluronic acid products carry little risk of clumping or nodule formation because they typically last less than a year, he said.

Dr. Graivier also discussed hyaluronic acid lip filler called Juvederm Ultra that he expects to be available in the plastic surgery community soon. Human or animal collagen can be used but is expensive.

"The hyaluronic acid products are good, but some longer lasting products can be used also along the vermillion-cutaneous junction, the edge of the lip," Dr. Graivier said.

Semi-permanent fillers are best around the mouth and along the edge of the lip, he said, but are less safe for use in the body of the lip. When semi-permanent or permanent fillers like Radiesse (microspheres of calcium hydro-xylapatite suspended in an aqueous gel carrier) and Artefill (a mixture of bovine collagen and polymethyl-methacrylate microspheres) are used on the inner lip, they have a higher complication rate, he said.

Visible lumps and clumping of the filler material may occur at a rate of 2% to 12%, he said. However, this can be "fairly easily treated with aggressive massage and steroid injection and even excision if necessary," Dr. Graivier said.

"I don't recommend using these products in the bottom lip unless it's a very experienced injector who's doing the procedure," he said.

Artefill is contraindicated for lip augmentation, according to the American Society of Plastic Surgeons.

Radial lip lines, or "smoker's lines," are best handled with hyaluronic acid, Dr. Graivier said. For short-term, "ready-to-wear" plumping in this area, a hyaluronic acid called Hylaform (made from rooster combs) causes the least swelling along with a human recombinant collagen product called CosmoDerm.

Overall, "I think that there's nothing perfect yet," he concluded, "although we are making progress with the fillers that are available as well as these new lip implants that are moving us along the lines of getting a reliable lip augmentation and rejuvenation."