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Plastic surgery has become a leading business in America and is venturing in to all parts of the body. First there was the liposuction of the thighs and butt then the face-lifts, the beast implants and now the injections of the lips. The volume of the lips can be thick and prominent, as in certain races, or else thin and retracted as in other races. A full, fresh prominent mouth, which invites a kiss, is the latest object of cosmetic surgery. There have been many types of materials that have been injected and several techniques that have been used. Materials such as collagen, silicone, Gore-Tex, fat or dermis has been used for the injections. The surgeon should choose his technique carefully and according to the patient’s wants.
The procedure is very simple. Lip procedures are usually carried out under local anesthesia with intravenous conscious sedation. The surgeon and patient decide which material to use for the injections. Some of the other materials that are used are Collagen: A molecule that makes up the body’s connective tissue; usually taken from cow skin. Three percent of patients have hypersensitivity problems, and some develop allergic reactions as long as three to four years later. Alloderm: A collagen created with tissue taken from human cadavers. The results last four to six months, then must be repeated. Can carry the risk of becoming infected and may feel slightly hard and unnatural. Gore-Tex: A hollow, tube-shaped implant made from synthetic material. Procedure requires a fine incision made along the edge of the lips; the tubing is inserted and the area stitched up. New tissue grows into and around the tube. Results are permanent, but may feel slightly less natural. Autologen: Skin taken from a patient is sent to a lab that makes collagen from it, so the chances of allergic reaction are eliminated. Results are permanent. The marking of the lips is done intraorally creating a set of W’s on the interior of the lips. The incision is made along the marking and extends deep to the submucosa and dissection is carried above the muscle to the vermilion (Samiian162). A suture stitch is transfixed to the center of the lip; pressing over rubber patches until the tissue at the center are slightly pinched. Some cases a catheter is used and a needle threaded with a steel wire is passed through the center of the lip and then perforated by the catheter. After there is sufficient tension so that a soft undulations is produced at each side, then the material is injected.
The dressing is removed after five to seven days. The sutures are usually absorbable and have absorbed by this time but if this is not the case then the sutures should be removed at this time. Initial swelling, stiffness, and numbness of the lips are significant during the first week and this is makes most patients uncomfortable. They are unable to talk properly or hold fluid inside their lips easily. The initial result with the swelling and stiffness of the lip may not be pleasant and will take at least a month before the patient starts to feel comfortable. After four to six weeks, the patient is encouraged to massage the lips in order to soften up the firm places. Initial swelling may make the lips appear to be fuller than what was wanted but the lips will settle down over three to six months. The lip sensation returns to normal over six to nine months. After the swelling ceases and the lips are full, voluptuous and sensuous.
The lip procedures were performed on a number of women and the follow up period ranged from four months to three years. Majority of the people had about two years of follow up. The scar heals well in most cases and is only as big as the scar of a brow lift. Some times the patient experiences a tightness of the lips. This gradually subsides within two to four months. Numbness is temporary and self-resolving. There have been cases where inflammatory papules and milia along the incision has occurred. There is sometimes an unusual feeling while smiling but this feeling will go away after a while. The process and scar maturation seems to occur more slowly in younger patients. There are a few complications that have been found by a surgeon. Asymmetry was noticed in two cases, undercorrection of the upper lip and hypertropic scar also occurred in one patient. All of these things were corrected without much hassle or pain for the patient (Fanous 1983).
Sensation and motion of the lips has been further evaluated. Two point discrimination was slightly decreased, but not significantly so. All the patients have experienced normal protective sensation against hot, cold and sharp. Fine sensation as far as touch has been completely normal in fifty percent of the patients. The other fifty- percent of the patients had a funny feeling and slight tingling but it did not interfere with their pleasures of touch. This is expected to improve over time. One of the patients did receive paresthesia on one side of the upper lip but only persisted for about a year (Samiian, 1991). These are things that are pretty important to the lips. Point discrimination is some thing that is very important to the lips, but for a short period of time the patients of this surgery do not have this discrimination.
For the lip augmentation to be such a simple procedure it takes a long time for the lips to be fully healed. Up to three years is a long time for follow- ups for such a simple surgery. There is such swelling of the lips that it will be a while before the lips are at their actual size. One’s life is interrupted that for about the first year it is hard to enjoy your new full lips. The time is a big issue with this surgery. Although the surgery itself only takes about twenty minutes the actual healing varies from person to person. Healing times does not matter according to what injectable is used but according to the patient. Not all patients experience the same side effects and for the same amount of time.
The injections are not guaranteed to be the correct amount once the swelling has gone down. Sometimes the surgeon does not inject enough material into the lips for the desired size. If this is the case, the patient has to go back through the surgery to get the desired size achieved. The injection material has been found to remain in place and does not disintegrate. The materials are usually not such that will cause allergic reactions within the body. Things that are compatible with the system are best used as the injection material.
Through all cultures and across races of man, certain features in females are found to be more attractive. These are large upper faces, a small lower face, with large eyes, small nose, and last but certainly not least full sensuous lips. For many years’ models and actresses have tried many different make up tricks to achieve this fullness of the lips. In the 80’s the ability to create the desired enhanced lips by a surgeon with injectable collagen became reality. After a while many more agents were introduces as injectable to use in the procedure.
Whether they are the result of aging or just not full enough, thin lips are just not as attractive as full lips. The thin lip correction is a short procedure and it has minimum morbidity and few complications. The scar is usually pretty well hidden on the border of the lips. Drawbacks to this operation are the long swelling and the stiffness of the lips. The swelling is usually for such a long duration of time that it seems as if the patient will never get to enjoy the new lips. If the lips are not the desired fullness then the surgeon can go back and increase the lips with another simple surgery. The healing time for the procedure varies from patient to patient and can have follow-ups for as long as three years.
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Lips.Plastic and Reconstructive Surgery.1993;91:162-166.
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