Featured Case 11/20: LIP ENHANCEMENT

Patient:

“Sally” (name changed for privacy) is a 69-year-old female.

The problem:

“I lost my lips and would like to rejuvenate my smile.”

Patient History:

• Over time Sally noticed she lost the fullness of her lips and noted that it “aged” her smile.
• She wanted to rejuvenate her smile but did not want “duck lips”.

Pertinent Information:

• Sally had a relatively unremarkable health history.
• She noted that she was very active and spent a lot of time in the outdoors.
• Admittedly, she had tremendous sun exposure with little sunblock or “chapstick”.

Procedure

• Sally received injectable filler augmentation of her upper and lower lips under local anesthesia.
• A total of 1cc of Juvederm XC was distributed to both lips.
• She felt no pain at all as she received local anesthesia in a similar manner as one would have at a dental appointment.
• The results were instantaneous with some minor swelling.

Pertinent Info:

• Sun or ultraviolet (UV) exposure is well known to induce degenerative changes in the skin.
• Over time, the UV light damages the layers of the protective skin.
• The lips receive a tremendous amount of sun as it is very difficult to shield unless you are wearing a mask.
• This damage leads to thinning (atrophy) of the skin/loss of volume, loss of elasticity, and anatomical definition.
• The lower lip is also one of the most common areas for skin cancers.
• Another consideration is the “pursing” of the lips with chronic use of straws. This increases the vertical lines/wrinkles around the lip and mouth as we age.

Commentary:

• Lip augmentation is one of the most common rejuvenation procedures performed today. Augmentation should restore natural appearing volume, anatomical definition, texture, and tone.
• The most common technique is the use of injectable hyaluronic acid fillers. Hyaluronic acid is a major component of our natural tissues.
• These filler procedures are performed in a short 5-10 minute procedure as an outpatient with results lasting 6-12 months depending on the Hyaluronic acid product and location of injection.
• Some transient swelling is expected in the first 72 hours. This can be disconcerting to the uninformed patient thinking they were “overdone”.
• As the swelling resolves, some patients seek even more volume. It is always easier to add than to remove.
• However, this is one advantage of Hyaluronic acid fillers as it can be reversed by the enzyme Hyaluronidase.
• As an alternative, other filler materials are available. The inherent pros and cons may be entertained during a detailed consultation.
• We are big proponents of comfort and pain-free procedures.
• You may be surprised to hear that most of these procedures are performed around the world without local anesthesia, but we believe that there is no reason to subject oneself to such discomfort.
• As Oral and Maxillofacial Surgeons, we are experts in anatomy, surgery, and anesthesia of the face. All our patients receive topical and local anesthesia to ensure comfort.
• Procedures may address rejuvenation in the older patient or augmentation in the younger patient candidates who simply seek more natural volume.