So You Want Those Sexy Lips! - liplift / bullhorn lip-lift / gullwing lip-lift / lip suspension

In part 1 of this 2-part article, the different types of injectable fillers for the lips were discussed. There are also more permanent options such as lip implants and surgery.

AlloDerm is an implant material made from donated human cadaver skin and processed by the LifeCell Corporation. It comes in sheets and the tissue can be cut to any size or shape that the physician wants. Incisions are made in each corner of the lip and the implant is inserted. How much resorption that occurs with this implant over time is still questionable. There are some reports of it lasting up to two years and others that say less. Some patients complain that their lips feel hard in the area of the implant, however, this firmness usually resolves after a few months. Also, your own tissue integrates with the AlloDerm, so essentially, you can not have these implants removed. If you did, you could end up with tissue deformities. Some physicians do what’s called a dermal fat graft where the surgeon can use skin tissue from a facelift or tummy tuck. If that is not an option for you, skin tissue can be removed from your inner thigh area. That tissue is processed and then 3 cuts are made in the lip and the graft is inserted. How long this implant lasts also depends upon the individual person.

GORE Subcutaneous Augmentation Material (S.A.M.), is one of the synthetic implants, which can be used. The same company that created GORE-TEX fabrics, W.L. Gore @ Associates produces GORE S.A.M., which is a flat rubbery material that comes in different solid thicknesses, and also tiny thin strands that can be bundled on top of each other. Incisions are made in each corner of the lip and the implant is inserted. With the thicker strands, patients have complained of firmness and there have also been instances where the end of the implant breaks through the skin. Also Gore S.A.M. can roll up above the muscle of the lip and then would have to be removed. The tiny thin strands of Gore S.A.M. were developed to avoid firmness; however, they may not be as easy to remove as the thicker strands if the patient wanted them removed.

Another synthetic implant that is available is Softform, which is produced by Collagen Aesthetics. It comes in a round tube in different sizes, which is surgically inserted into the lips, similarly to Gore S.A.M. These tubes are hollow so normal tissue can grow through the tube to stabilize it. Because your own tissue grows into the center of the tube, it may be more difficult to remove than the Gore S.A.M., and some patients have complained of firmness in the area of the implant.

Advanta facial implant is a another option. Advanta is not tubular but has a soft central core which allows increased cellular interaction and vascularization. Patients may experience less rigid encapsulation resulting in a softer, more natural healing response. Because of the softness and tissue integration of the Advanta implant, many surgeons consider this to be a better alternative to Gore S.A.M. or Softform.

There are also lip-lift surgeries. Basically, there are three different types of lip-lift surgeries. Unfortunately, the area between the nose and cupid's bow area elongates as we age. We often develop a long sagging thin upper lip that covers most of the upper teeth when the lips are slightly parted. Corners of the top lip droop down and the bottom lip often starts to sag too, eventually showing the lower teeth, again when the lips are slightly parted. Today more and more surgeons are addressing this area of the face that is very important in maintaining our youthfulness.

The most common lip-lift procedure is called a bullhorn liplift. Removing skin under the nose and resuturing the skin back together creating a higher lip performs this procedure. The incisions are hidden along the base of the nose. This procedure shortens the distance between the top lip and the tip of the nose allowing for more upper tooth show when the lips are slightly parted. It also everts more of the upper lip vermilion, therefore creating more "poof" in the upper lip. Some plastic surgeons are also plicating (folding) or removing a strip of orbicularis oris muscle with skin while doing the upper lip lift. Then they are suturing the orbicularis oris muscle to the periosteum underneath the nose. Many, many more complications have been seen using this technique so it is not widely accepted or recommended. Severe stiffness and numbness can be experienced lasting for many months and in some cases can be permanent. With this suturing technique, you can be left with abnormal movement of the orbicularis oris muscle and nose, which can lead to bizarre looking movements of the upper lip during animation. It has been reported that muscle damage can occur from this suturing technique. The orbicularis oris is a sphincter muscle and it's natural and normal movement is restricted when it is sutured. Because of the complications from this technique, speech disturbances have also been seen. Most plastic surgeons will only do a skin only liplift which is the safest way to go. With the newer advanced techniques, beautiful results are seen with the skin only lip lift.

When patients are considering undergoing a procedure that involves a "new" technique or type of technology, they should further inquire if results supporting the safety and effectiveness of the procedure have been documented in a peer-reviewed journal or other reputable publication. If the plastic surgeon doing the procedure is the only one doing it, then there must be a reason for that.

Bullhorn lip-lifts can change the shape of your nose so this risk needs to be discussed with your surgeon. Also, some surgeons are now hiding their incisions within the nostril opening. While this technique may camouflage the scar, it can lead to negative cosmetic consequences with patients who have prominent nasal sills. The removal of the sills at the base of the nose can lead to enlarged nostril openings and a distorted nasal base. With the bullhorn lip-lift you also have a risk of scarring under the nose. With most people this scar fades but if you do not scar well or have a history of developing keloids then any of the lip-lift procedures are not for you. Over time, both the skin only and muscle lip lift can drop. If this occurs a revision liplift can be done.

Another lip-lift procedure that is done but is not as popular is called the Gullwing lip-lift often referred to as the vermilion lift. The incision is made all along the vermilion border at the junction where the pink part of the lip meets the flesh-colored part above your top lip. Then a strip of skin (the flesh-colored part) is removed and the lip sutured to the now higher skin. This also creates a reduced lip to nose ratio. However, scarring along the entire upper lip is a risk.

Corner lip-lifts are also done for people that have a sad look because the outer corners of their lips turn down. The incisions are made on the exact edge of the upper outer lips.

Another procedure that is usually intended for the lower lip is called the V-Y lip augmentation. One to three small V shaped incisions are made in the mucosa of the lip (the wet part inside the mouth) and then they are sutured in the shape of a Y. The top of the V is left open and heals thereby expanding your lip and creating elevation of the inner lining of the lip where the upper lips and lower lips would meet if you closed your mouth. This procedure addresses the increased bottom tooth show from a drooping lip that often develops as we age. When doing this procedure, surgeons are very careful to stay away from the musculature underneath the mucosa, so that they do not injure superficial nerves. If these nerves are injured you can develop permanent numbness. This is not uncommon!! Most surgeons have stopped using this procedure because of this risk and because the end result is so subtle.

As you can see, there are many available options for lip enhancement and rejuvenation. Don’t be afraid to ask your physician questions about any aspects of these procedures. Remember with any of these lip enhancement procedures there are risks and complications that may occur.

Back to Part 1
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