Lip Service

By staff November 1, 2004

Sarasota resident Vainca Bauman admits she's been self-conscious about her thin upper lip ever since she wore braces as a child. "I always envied the even-ness of most people's lips," she says.

The 45-year-old fashion consultant had been reading about artificial lip fillers for years when she finally marched into the office of Dr. John Fezza at Center for Sight and pleaded for a product called Restylane. It wasn't even approved by the Food and Drug Administration yet.

When it did gain approval earlier this year, Bauman was first in line. Now she's ardent about the results. "I'm also a smoker, so I had those wrinkles around my mouth," she continues. "Those are gone." And she admits, "It's very addictive."

No wonder lip augmentation rose 21 percent last year. The American Society for Aesthetic Plastic Surgery says nearly 900,000 patients turned to soft tissue fillers to restore fullness to some part of their face. Statistics do not yet single out how many of those procedures were targeted to lips, but, "Interest in my patients has tripled over the last five years," says Sarasota plastic surgeon Dr. James Marsh, who handles at least two cases a day.

All the body's tissues thin with age, says Bauman's doctor, John Fezza. Because of their constant movement, lips tend to wear more quickly than other parts of the face. Smoking, kissing, even sucking through a straw can cause fine lines along the outer edges. When you add volume, he explains, "You do stretch out some of the lines caused from smoking and age."

And age is no barrier. Fezza's youngest patient is in her late 20s, but he's placed implants in a patient in her early 80s. If you're looking for ways to plump up your kisser, here are some of the most popular options.


Nationwide, just 23,000 patients chose some type of surgical lip enhancement in 2003. "In this town, most people won't go for surgery on the lips," says Fezza. "They want something temporary and injectable."

"The most reliable and safest is Restylane," says Sarasota plastic surgeon Dr. James Schmidt. Since its approval by the FDA about nine months ago, it has become all the rage with women seeking immediate gratification with little pain and no down time.

Before Restylane, lip fillers were made primarily of collagen, first bovine, and then human. "The problem with [bovine] collagen is that it requires testing for allergies," says dermatologist Dr. David Sax. At least two to six percent of patients cannot tolerate it.

Made of a clear, jelly-like substance, Restylane is derived from a sugar molecule found naturally in the skin, so allergy testing is unnecessary. After a numbing shot of Novocaine, doctors inject the Restylane and 10 minutes later, patients stroll out the door. Restylane costs around $500 (bovine collagen is $350 and human collagen costs about $450).

"It's quick, easy, and if there's a problem, it's not permanent," says Marsh, who estimates that 80 percent of his lip augmentation patients receive Restylane.

Down time is limited to the procedure itself, and side effects are limited to minor bruising, swelling and bumpiness that dissipates within a few days. To prevent bruising, patients should stop aspirin or Vitamin C a few days before the procedure. Patients can expect results to last anywhere from six to nine months.

Sarasota dermatologist Dr. Brad Abrams combines Restylane in the body of the lip for fullness and a human collagen filler called Cosmoplast along the vermilion (outside) border to give structure. "Older women can lose the border between the lips and skin. Cosmoplast will give back the sharp border," he says.

The best part about Restylane and collagen is that "it's biodegradable. It goes away," says Abrams. Since it's created from human molecules, it is absorbed back into the body and eventually secreted.

Silicone is another matter. Although it's approved by the FDA for treating retinal detachment, some doctors are also injecting it into lips. "I won't do it because it's off-label use," says Fezza. Plus, unlike other injectable fillers that leave the body, silicone remains there permanently. "A permanent result is not always a good result," he cautions.

"I've got people who had silicone injected from 30 years ago who are still coming to me with problems," says Marsh. Schmidt claims the silicone droplets can create granulomas around the lips that must be removed. He does not recommend injecting silicone into any part of the body.

Besides silicone, the least favored injectable material is human fat, taken by syringe from another part of the body, mostly the hips and thighs, and then re-injected into the lips.

"It doesn't give long-lasting and predictable results," says Fezza. "The lips are very mobile, and fat doesn't take well to areas of high mobility."

Marsh goes further: "I can't tell the difference between a before and after picture," of a patient who's had a fat injection. Of all the injectable fillers, fat is the least permanent, so for the potential bruising and infection risks, he sees little worth in them. "You look awful for three weeks, you look bad for three months, you look good for three weeks, then it's gone."


A more permanent solution is an implant, and several are on the market. Some sound downright creepy, like AlloDerm, which is made from sheets of donated human cadaver skin. (Fezza uses it in facial reconstruction but not for the lips.)

More common are synthetic implants like Advanta, a soft, tube-shaped material that can be cut to individual size, and Goretex, which comes in strands. Both are porous and allow the body's tissue to incorporate into them. Fezza uses both, but usually in conjunction with injectable fillers. "A permanent implant like Advanta will puff the lip out, but it's not particularly good for shaping," says Fezza, so he often layers it with collagen to define the fine, cupid's bow on the upper lip.

The 10-minute procedure involves inserting the implant through a small incision in each corner of the lip and sometimes one more at the center of the upper lip. Single stitches mark the incisions, then are removed after about five days (although Fezza uses stitches that dissolve).

Advanta and Goretex are implanted under local anesthesia and cost around $1,800. Patients can return to work or their normal daily activities the next day. And although they are designed to be long-term, both Advanta and Goretex can be removed.

It was the perfect solution for Sarasota bank teller Becky Pollock, who received her Advanta implants in June. "I can't see doing collagen," she says. "My lips are fuller, and with one down time, it's done." Her only reservation is that she wished she'd discussed in advance of her procedure how full her lips would become. After the initial swelling subsided, she realized, "I might have gone a little bigger."

Not all doctors are enamored of implants. Marsh discontinued them three years ago after some of the 250 implants that he'd inserted began to extrude and become asymmetrical. "The patient dissatisfaction rate was only about 10 percent, but that was too much for me," says Marsh.

Fezza acknowledges that migrations of the implant away from the lip do occur, but in less than one percent of patients overall. And infections are most often seen in smokers, "because the habit creates an unhealthy environment for healing."


Less common are lip lift surgeries, which are usually reserved for older patients. Doctors make an incision to the inside or outside of the lip to draw the lip outward and reduce the downturned appearance of lips that naturally lengthen with age.

The procedure, which lasts about 20 minutes, causes more discomfort than injectables. In fact, says Fezza, "My patients always describe a lot of pain," most likely due to the incisions required inside the mouth.

Occasionally, lips can be raised by making a small incision just below the nose, but as Marsh notes, "You have to have the right shape nose to hide the scar."

Regardless of which technique doctors use, most agree that less is more, especially when it comes to something as potentially voluptuous as the female lip. "I don't like to get those fat Angelina Jolie lips," says Sarasota dermatologist Dr. David Sax. "I just don't think it looks very natural." Vainca Bauman started out slowly, receiving additional Restylane injections at two, two-week intervals to achieve the fullness she desired.

And be aware that if you have scarring from a previous injury or surgery, your tissues may not be malleable enough for any type of lip augmentation. If they are, go for a normal appearance. Notes Schmidt, "Most of our people in Sarasota just want to have the best version of themselves possible."


Can a new European treatment reduce fat?

Nearly 90 percent of women over the age of 20 have some degree of cellulite, and most of them spend a lot of time and money trying to get rid of it. Now, direct from Europe, comes a new, non-surgically invasive technique called mesotherapy that promises to remove fat and cellulite by injecting a medley of medications, vitamins and nutrients into fatty areas of the body.

Its proponents claim it can melt away fat and smooth the dimples of cellulite from the waist, hips and thighs, arms and even the neck, but, "In my mind, the verdict's still out," says Dr. Lori Abrams, a Sarasota gynecologist who performs tumescent liposuction. "Everybody has their own little cocktails" that may include blood pressure and asthma medications. She's concerned about the long-term effects those medications may have on people who are neither hypertensive nor asthmatic.

"There's just not much in the way of good treatments for cellulite," according to dermatologist Dr. David Sax. Both he and Sarasota plastic surgeon Dr. James Schmidt caution that even liposuction is really not a treatment for cellulite. In fact, warns Schmidt, "If it's done incorrectly, it can make it look worse." He maintains that the results of any treatment for cellulite depend on the quality of the skin. Rough skin with poor elasticity will not rebound sufficiently to hide the dimpled appearance associated with cellulite.

"I still think that conventional diet and exercise are the way to go," says Abrams, but if you are considering mesotherapy, she advises you ask whoever is administering the injections exactly what is in them, any possible side effects of each ingredient, any long-term effects, and how long they've been practicing the method. "If they've been doing this six months, they're not going to have 20 years of data," to refer to.



If over-the-counter antiperspirants aren't leaving you as fresh as springtime, try Botox. A study involving 600 adults found that 91 percent of those who received Botox injections under their arms experienced a 50 percent reduction in sweating. The effect lasted about four weeks.

This summer, the U.S. Food and Drug Administration approved the toxin that causes botulism as an alternative treatment for excessive underarm perspiration, but there's a catch-common side effects include sweating in other parts of the body, flu-like symptoms, fever, itching and anxiety. (As if soaking your dress shirts wasn't bad enough already.)


New Jersey residents considering cosmetic surgery have more to worry about than down time and some bruising. In June, Gov. James McGreevey signed into law a six percent tax on elective cosmetic procedures. At the same time, he added a new 3.5 percent tax on the gross receipts of physician-owned surgical centers that perform those procedures. The legislation makes New Jersey the first state to tax cosmetic surgery.

The six percent tax covers cosmetic surgery, hair transplants, cosmetic injections (like Restylane and collagen), soft tissue fillers, dermabrasion and chemical peel, laser hair removal and cosmetic dentistry.


A study coordinated by the American Society of Plastic Surgeons has found that patients who took a special mixture of bromelain, vitamin C, rutin and grape seed extract healed 17 percent faster after cosmetic surgery than those who did not.

Facelifts, which generally require recovery times of up to 18 days, healed fully within 15. Wounds were less inflamed. The doctors who authored the study believe the changes may be due to antioxidants contained in the herbs that enhance cellular stability and decrease swelling.

But they caution that they do not know which of the four ingredients is the active agent or whether they must be used in conjunction with each other to achieve the desired effect. Plus, supplements are not regulated by the FDA, and there are differences between brands.

Patients should also never take supplements without consulting their doctors, since some commonly used vitamins and herbs can cause excessive bleeding and slow down recovery time.


More than 220,000 cosmetic procedures were performed on patients 18 and under last year, giving teenagers almost 3 percent of the total cosmetic surgery market. The most common procedures were rhinoplasty (nose reshaping), breast reduction, correction of breast asymmetry, treatment of gynecomastia (excessive breast enlargement in boys), chin augmentation and liposuction.

Still, a 2004 study commissioned by the American Society for Aesthetic Plastic Surgery found that 18-24 year-olds are still the least likely group to consider plastic surgery. According to the ASAPS, only 7 percent said they would consider it, compared to 31 percent of people aged 45-54.

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