Lip augmentation is a cosmetic procedure done to create fuller, plumper lips and reduce fine wrinkles around the mouth.  The procedure can be done by any of the following options

• Injections
• Implant surgery
• Grafting
• Laser
• Lip laceration/Scarification
• Lip lift
• Lip suspension
• Micropigmentation / Permanent Make-up
• Philtrum & White Roll Augmentation (Paris Lip)
• Lip enhancement in conjunction with P.Veneers

Lip augmentation is done when the following conditions are present

• Thin lips
• Loss in shape and fullness of lips due to ageing process

Lip lift for

• Long, sagging upper lip that covers most of the teeth and is thin
• Corners of the lip droop down
• A sad or depressed look, especially around the mouth
• Inadequate improvement of the lips even after enlargement
• Something still needs to look better about your smile or mouth even after a nice facelift
• Desire for a softened, delicate, happy mouth and lip appearance

Lip suspension for

• Vertical lengthening
• Thinning of the vermilion (pigmented edge of the upper lip)
• Loss of volume of the lips

• Temporary injectable fillers – autologen,collagen, restylane, perlane, hylaform, etc.
• Injectable microimplants - Artecoll, Silicone, Metacrill, Aquamid, Radiance, Amazingel, etc
• Injectable biocatalysts - Isolagen, NewFill, Reviderm Intra, DermaCellagen, Sculptra, etc

• Synthetic implants - Advanta , Gore-Tex , SoftForm, UltraSoft
• Cadaver derived bioimplants – derived from deceased donors eg. AlloDerm, Cymetra, Fascian, etc.

• Candidate without oral herpes, diabetes or lupus, any scarring or connective tissues disorders such as blood clotting problems.
• Candidates without any cardiac condition or serious incidence of hypertension
• Candidates not taking anticoagulants such as warfarin or heparin
• Candidates who wish to improve their external appearance
• Candidates who are physically healthy, psychologically healthy and have realistic expectations from the procedure
• Candidates who seek improvement rather than perfection
• Candidates who are not "overly" skinny, with a major metabolism and have a little extra fat somewhere on the body to spare for augmentation procedures using fat grafting

Candidates for Permanent make-up
Candidates, who are allergic to cosmetic products, wear prescription glasses, have unsteady hands, or simply people with busy lifestyles that like to look their best all times

• Injections
  Allergic reactions can range from prolonged redness, swelling or itching, to firmness at the injection site

• Grafts
  • Rejection, contour irregularities, absorption, additional site infection
  • Infection, haematoma and asymmetry
  • Permanent discoloration due to a ruptured superficial blood vessel at the treatment site during an injection.
  • Calcification
  • Fat embolism resulting in stroke, when a substance has been mistakenly injected into a blood vessel
  • Formation of a distorted look, fatty cysts and fat necrosis if extreme over correction is used
  • Intra- (during) and post-operative bleeding, blood clots at the treatment and removal sites 
  • Vulnerability of treatment sites to blood borne infections for up to three months
  • Formation of scar tissue
    
    
• Implants
  • Implants shift out of position requiring a second operation to correct the problem
  • Infection
  • Lip asymmetry
  • Bleeding
  • Numbness
  • Reaction to the anaesthesia
    
    
• Laser
  • Cold sore outbreak
  • Infection
  • Re-absorption of the implants
    
    
• Lip laceration/Scarification
  • Uneven scarring
  • Excessive upper lacerations can cause less frontal tooth show
    
    
• Lip lift
  • Poor scarring
  • Scar stretching and thinning
  • Infection
  • Haematoma
  • Allergic reaction to anaesthesia
  • Seroma
  • Permanent numbness
  • Asymmetry
    
    
• Lip suspension
  • Infection
  • Haematoma
  • Allergic reaction to anaesthesia
  • Seroma

• Permanent make-up
  • Infections
  • Adverse reactions to pigment
  • Temporary swelling or burning in the affected areas while undergoing magnetic resonance imaging (MRI)
  • Scars, skin peeling

• During the initial consultation, a thorough discussion on the expectations of the patient is done
• Photographs are taken for further comparison after procedure.
• The doctor discusses and advises on options of anaesthesia, surgery options, incisions (if any), type of facilities and cost with the patient.
• The doctor provides guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications
• The patient must arrange for transportation and assistance to leave for home after the surgery

Implant surgery and grafting procedures

• The patient may seek a copy of the manufacturer’s brochure for the implant
• The doctor will perform a physical examination to evaluate the general health, skin and facial structure
• Patients should stop smoking and discontinue all medications containing aspirin or NSAIDs for two weeks prior to surgery
• The patient should not eat or drink anything for eight hours prior to the procedure.
• Patients scheduled for an intraoral approach should rinse the mouth with mouthwash three times a day for two days before surgery.

Injections

• The doctor will inject a small amount of fillers prone to cause reactions, usually into the forearm just below the skin's surface, to determine if the patient is eligible for the injection or not.  The injection site should be watched closely for at least 4 weeks for signs of inflammation

Laser

• The doctor will inject a small amount of collagen, usually into the forearm just below the skin's surface, to determine if the patient is eligible for the injection or not.  The injection site should be watched closely for at least 4 weeks for signs of inflammation

• Injections
• Local anaesthesia may be administered.
• The filler is injected using a fine needle inserted at several points along the edge of the treatment site.
• The doctor/nurse  massages the area to evenly distribute the filler
• The area may be slightly overfilled in case of collagen and similar materials, to account for the partial absorption of the substance within a few days.

• Implant surgery

1. Bioimplants
   • Local anaesthesia is administered
   • Tiny incisions made in the inside corners of the mouth through which the implant is inserted.
   • Incisions are finally sutured
     
     
2. Synthetic implant
   • Local anaesthesia is administered
   • A small incision is made in the inside of the lip.
   • The implant material is then made into the shape of a small tube and inserted with a small needle.
   • The incision is finally closed
     
     
3. Grafting
   • The patient is administered local anaesthesia on the
     • donor areas, the areas from where the fat is to be taken and
     • the treatment area

• The lip is then augmented either by fat transfer or other grafting procedures

1. Fat transfer or fat grafting or fat injections
   • Fat is removed from the donor site, usually the buttocks, abdomen etc, with a small hypodermic needle
   • The fat is spun in a centrifuge to remove excess fluids and the damaged fat cells are picked out
   • The undamaged fat cells are then
     • injected with the use of a separate smaller hypodermic either just under the lip or deep within the muscle or
     • Implanted, taking individual strands of fat cells one by one through minute incisions on the lip. The incisions are then closed

The procedure is completed in 1-2 hours.

2. Other grafting procedures

• Incisions are made on the lip through which grafts obtained by any of the following methods are inserted after which the incisions are sutured.
• Dermis Grafts – Tissue is excised, deepithelialized by removing the epidermis, cleaned, then rolled up and inserted
• Dermis Fat Grafts - Tissue is excised, deepithelialized by removing the epidermis but leaving the fatty layer, cleaned, then rolled up and inserted
• Fascia Grafts – The fascia, which is the thick white covering over muscles and some organs, is removed most often from the temporalis muscle and inserted.
• Scar Tissue Grafting - This requires the presence of a large scar that needs to be removed. The scar is removed, cleansed, and re-implanted in the lips. 
• Tendon Grafting – The palmaris longis tendon is removed, located on the inside of the lower forearm, near the wrist. Is removed. A tunnel is created within the lip and the tendon is then inserted and positioned
• Local flap grafts (V-Y enhancement)– incision may be made
• inside the mouth to push the tissue inside the mouth upward, and outward, into the lip, or
• along the upper lip line, where the skin above the lip is removed, and the lip is then stitched along the line of the incision

• Laser lip augmentation
• Local anaesthesia may be administered.
• Plumping-The doctor will inject a thick human-based collagen (Fascia) or fat into the lips to enhance the lips.
• Refining - The plumping process is repeated two to three more times, at one-month intervals which causes the lips to make new collagen.
• Laser treatment- Finally, the lips are resurfaced using a laser, which removes the fine lines leaving the texture of the lips smooth, soft and supple.

• Lip laceration/Scarification
  Small incisions are made inside of the lip and mouth and left without suturing.  This helps to release the skin of the lip so that it is not so tight and also causes the patient’s own scar tissue to form around the healing incisions and plump the lip out. 

• Lip lift
  • Local or general anaesthesia may be administered.
  • A lip lift shortens the distance between the bottom of the nose and the top of the red part of the upper lip to give the appearance of greater lip fullness
  • Incision to remove a thin strip of skin is made at the base of the nose or along the border of the lip and sutured back to the now higher skin
  The surgery takes 30 minutes

• Lip suspension
• Local or general anaesthesia may be administered.
• The incision will be made on the inside of the nose.
• The lip will be lifted by passing a suture through the inside of the nose to the inside of the upper lip.
• The lip height and outward roll desired is achieved by varying the suture tension when tying.
•  This procedure will be repeated on the opposite side of the lip to achieve the desired elevation and symmetry and the incisions in the nose will be sutured. 
  The surgery takes 30 minutes

• Micropigmentation or Permanent Makeup
  Enhances lips by darkening the lip colour, covering scars, extending the vermilion or colour correction to give the illusion of larger and fuller lips

• The lip area is either swabbed with alcohol or sprayed with an antiseptic solution to prepare the area for permanent makeup procedure.
• A thin layer of topical anaesthetic is spread over the area to numb the skin
• A tattoo is applied using either a small electric device or a hand tool which holds multiple needles to implant coloured pigments.
• The needle assembly rapidly moves up and down, pushing the needles into the lip, border

• Immediately following lip augmentation, the lips may swell and hurt. Oral pain medications may be prescribed to control the discomfort.
• Swelling and bruising may disappear in 3 days-1 week’s time
• Antibiotics may be given to reduce the possibility of infection.
• Patient may notice peeling of the lips.
• Following graft surgery the patient may experience some drooling
• Following graft surgery the lips may feel unnaturally stiff for 2-3 months.
• V-Y lip advancement procedures result in more swelling, which takes about four weeks to resolve

Stitches

• In case of lip implants, stitches are removed in 7 to 10 days
• In case of lip lift, stitches are removed in 3-4 days.

Permanent lip liner

• All tattoos may initially appear brighter or darker than desired, but will fade to the desired colour over several days.
• Some tattoos also appear crusty for a few days.
• The lips will be swollen for 2-5 days
• Minor bruising may also occur which may be concealed with makeup
• Additional touch-up procedures may be required to balance, supplement, darken, lighten, move, change or alter the make up in any way necessary.

• For injections, the recovery can take just a couple days.
• For surgical implants or grafts, the recovery can take up to two weeks after the surgery.
• Recovery takes about 1-2 weeks after grafts and flaps
• The patient will need at least three days off from work, at minimum.
• The patient must keep ice packs applied to the lips for the first 48 hours
• The patient must limit talking and chewing during the first 48 hours
• The patient must limit smiling and laughing for the first week
• The patient must sleep in a semi-upright position for the first week or so and must not sleep on his/her stomach
• The patient must not bend over, strain, exercise or do any other activities that could increase pressure to the lips that can lead to unnecessary swelling or bleeding
• The patient must avoid strenuous activities for 1-3 days in case of injections and for a few weeks in case of surgical implants.
• The patient must keep the lips clean to avoid infection
• The patient must touch the lips using a clean, cotton swab every time.

Permanent make up

• The recovery after permanent makeup is no more than few hours.
• Cool compress may be used on the area for 15 to 30 minutes to reduce swelling and help the healing.
• The treated area should not be exposed to sun, salt water, and swimming pool water for two weeks.
• Soaking treated area in a bath, swimming pool, hot tub, fresh water or salt water should also be avoided for at least two weeks.

Cadaver bioimplants
Grafts taken from dead donors

Vermilion
Pigmented edge of the upper lip