* The following auto-generated transcript has not been proofread for grammar, spelling or accuracy.
“I had two patients this week that asked me about permanent lip augmentation and I wanted to comment on it, I’ve written a couple of papers about this and the medical literature I feel very strongly about it partly because of those papers I’ve had a number of patients referred over the years that have had permanent lip fillers and while permanent fillers have a role and I think they can be used in some areas very effectively. The use of silicon injection and Belo fillers are the fill the products that are approved in the United States all of their off label uses in the lips. I think they’re too dangerous in terms of long term outcomes and side effects to make them worth the benefit of not having to have to be re-treated.
Basically these long term fillers and there’s 53… 57 of them now available that are permanent injectable fillers in Europe so they are widely available there but not often use there and there’s a reason and that is that people can get granulomas which are inflammatory nodules that can be really permanent in the lips and they can be quiet traumatic, can make the lips hard and inflamed and very unnatural looking. I’ve had patients sent to me that they’ve have attempts of surgical excision I myself have done surgical excision of extreme nodules in the lips and so these inflammatory granulomas are really immune response to what the body perceives as a foreign body, a lot like if you were to get a thorn on your finger, it’s in your lips so we don’t have a lot of wiggle room in terms of how to looks and in fact I’ve got patients that have tremendously over volumized lips because those granulomas continue to form and they’re just not controlled.
Now there are treatments for them and again not encouraging people to do this because you can treat them but there are steroid injections and find a few another treatments that we can use to try to calm that inflammatory response down if you were an unfortunate patient decided to go with a long-term or permanent filler for you lips but I would tell most patients that are thinking of lip enhancement to avoid the injectable fillers that are permanent and again there’s only a couple of them in the US and I’m not picking on them because I do think there are role for those areas, for those products in certain areas where in the worst case scenario could be easily excised, the lips was not one of those areas. So my suggestion for people who want long-term volume enhancement are more vermillion so you see more of the red lip, the what we call the body of the lip or go to the surgical options and there’s really 3 that I think of it may or interrelated to one another. There’s the sub-nasal lip lift or the incisions, are carefully hidden underneath or in the nostril itself and underneath the columella, the little piece of skin between the two nostril and up on the ala lateral nasal wall, that allows us to lip with literally lift the lip up which gives more vermillion show and it gives it for the wrong term, it’s a simple procedure can be done in the office with local anesthesia, I’ve got video showing the procedure itself as well as before and after pictures and it looks very natural and gives a great long term lip enhancement.
There are other ways to do it that you can’t see the incision at all because inside the mouth and they’re basically using some of the principles of the surgery and in terms of plasty with Tom Labiaplasty if you will. One of them is the V to Y plasty or the W plasty where from underneath the lip we’ll make an incision in the shape of the V and then repair it in the shape of a Y which allows the lip to move forward and roll out and I’ve done combinations of the lip lift and V to Y plasty to get more fullness and more vermillion show and better really white lip to red lip ratio. In the ideal word you’re in the 1 to 3 or better rang in other words one part red lip to 3 or less of the white lip and as we age that white lip gets longer, no questions. Some nasal lip lift actually really dramatically improves those ratios, the V to Y plasty improves the amount of vermillion or red lips shows.
So those are long term solutions, can be able to see more of the vermillion the red part of your lip and I can’t stop, I can’t stop the discussion of this without mentioning the corner of the mouth lip because in many people right at the corner of the mouth as we age, there’ll be a tissue hanging over the edge here, extending into the marionette line and those patients are excellent candidates for what we call a corner of the mouth lip which involves a very small triangular incision of that redundant tissue that actually elevating the corner of the mouth and we’re really trading off a deep line that’s the curvature of the so-called Marionette line or the crease in the corner for a small and very difficult to identify linear scar that is diagonal and in the lip lines and it’s an excellent trade off because it’s very hard to see that scar and really gets rid of the sagging or downturn mouth, I guess it’s the best way to describe it.
So for people really looking for the longer turn options I really advice avoiding permanent lip fillers and going to these surgical options, sub-nasal lip lift the corner of the mouth lip, the V to Y advancement. I’m not a big fan although I’ve seen in certain cases that’s a good indication with direct lip advancement which involves making an incision right along the border of the lip in taking out some of the white lip, I don’t like that because that area, the lip roll area, they’re so sacrasing, we don’t want to do that unless it’s a trauma case or some other special condition, I would stay with this sub nasal lift lip.
If you have any other questions about permanent lip enhancement or long lasting lip enhancement including those fillers that we don’t advice but the surgical options in particular don’t hesitate to write, you can send pictures of your lips that don’t identify you so you can share them with other people and my thoughts on them and send those to DrMaas.com, you can visit my website @DrMaas.com or MaasClinic.com to find out more information, see before and after pictures and learn a little bit more about these procedures that can really help you stay looking your best, this is Corey S. Maas MDTM.”
