CHAPTER 72 Lip augmentation
History
With the FDA approval of the first hyaluronic acid (HA) preparation for soft tissue augmentation in 2004, this opened the door to a new generation of injectable dermal fillers. The hyaluronic acid products have proved exciting materials which work superbly in soft tissue augmentation. HAs are a naturally occurring polysaccharide found in the dermis and through the cross-linking process, a greater tissue residence time has resulted. As injectors refine their techniques and as manufacturers work on better cross-linking materials and techniques, these agents have proved superior to bovine collagen and in the right hands with the best technique, we routinely obtain lasting results which approach and in some cases exceed one year.
Physical evaluation
• Evaluate general health and medical condition of your patient.
• Take photographs for before and after comparison.
• Assess whether or not your patient has undergone prior lip augmentation procedures and if so, which injectable fillers were used. This is critical to a good outcome.
• Discuss with your patient what she or he expects from the procedure. Many patients have unrealistic expectations of lip augmentation and as a result will not be entirely pleased with the result.
• Examine the degree of structural/bony loss the patient has experienced and the degree of volume lost in the lips. This will help determine how much filler you will need and how much you will need to rebuild the support in the lower third of the face.
• Explain to your patient what your plan is for their procedure, what you recommend and what they should expect. This is generally where we explain to some patients that contrary to what they may have been told or have seen, it is not appropriate to inject large amounts of filling material into the lips as this will not provide an aesthetically pleasing result. We explain that there is more to lip augmentation than just injecting volume into the lips; we must also rebuild structural support on which the lips sit.
• Pain is always a significant concern to our patients and lip augmentation can be a painful procedure if not done properly. Take the time to reassure the patient that you will take certain steps and explain what they are so they will not experience pain.
• Discuss with your patient postoperative expectations from ice application, use of pain relievers, the possibility of bruising, and temporary distortion due to swelling. Most patients expect that they will have the final result the minute the procedure is completed and many do, but educating the patient is critical.