Sexy Fuller Lips

By Dr. Paul S. Howard

There exists an extraordinary amount of misinformation regarding lip augmentation.  There are reputable Boarded Plastic Surgeons who honestly believe harvested and re-injected autologous fat does not “take” when placed in the lips.  Over the last 10 years, several Plastic Surgeons have proven fat is permanent when placed in the lips as long as it is processed appropriately when harvesting the fat for re-injection.  None of this would matter if we had an off-the-shelf filler or implant that provides a soft, natural, and long-lasting enhancement.  Clearly none of the hyaluronic acid based products, such as Restylane® and Juvaderm ®, come even close to providing a permanent enhancement.  There are dozens of other products that claim to be longer lasting, but fall woefully short of permanent or even soft and natural.  When compared to all of the products currently available, autologous fat may be the “perfect filler” for lip enhancement.  There will always be a subset of patients that may require a surgical procedure to improve lip shape especially if the upper lip has lost elasticity to the point of lengthening the lip.  There are also procedures available to reposition the corners of the mouth (commissure). 

The pathology of the aging lip includes a loss of soft tissue and muscle volume causing the lips to look deflated and wrinkled.  The skin quality is poor including the vermillion, or red portion of the lip.  The philtral columns flatten causing the lips to lose their dimensional shape.  The white roll and the undulation of the upper lip are lost contributing to the flat, veil-like appearance of the lip.  The treatment of the aging or even congenitally thin lips begins with fat grafting to replace the missing volume.  Judicious fat grafting may also be used on surgically reconstructed lips such as from trauma or cleft lip repair.

To think that fat is indiscriminately injected under the vermillion only to achieve more vermillion show is not correct.  Different amounts of fat are injected deeply in the muscle as well as in the body of the entire lip and some beneath the vermillion to increase the lip “pout.”  To elegantly contour the lip, fat is placed beneath the white roll for accent and in the upper lip to re-create the philtral columns.  A moderate amount of fat is injected in the corner of the mouth and the “marionette lines” to help elevate the commissure.  In our experience with the new fat grafting techniques and fat harvesting procedures, the graft “take” is consistently 80-90% even though the lips are a mobile area of the face.

The processing of fat or adipose tissue has led to some remarkable discoveries regarding the biological activity of the fat cell.  Stem cells and tissue growth factors may replace lost cells that have either died or become inactive due to the aging process.  Rejuvenation of the skin appears to be one of the unexpected benefits of fat grafting.