Your lips have important functional and aesthetic roles in daily living and they are the focal point of your lower face. They are intricately controlled by a complex series of muscles and several key factors make any cosmetic changes regarding your lips especially challenging. That is why it is imperative when you consider any cosmetic procedure for your lips; you secure the services of a qualified and experienced physician. Dr. Brent Moelleken, M.D., F.A.C.S. is a Plastic and Reconstructive surgeon practicing in Beverly Hills and Santa Barbara, California. Double board certified, he received his training at Harvard University, Yale University, UCSF, and UCLA. Dr. Moelleken is one of three specialty-trained surgeons in the world to complete the yearlong Aesthetic Surgery Fellowship at UCLA and he maintains the prestigious FACS degree and is a member of the ASPS and ASAPS.
When Dr. Moelleken performs your lip augmentation, he is aware of functional considerations including oral continence, mobility that allows for sound formation and facial expression, adequate oral access, and of course sensation. Oral continence is critical in the ingestion of food and the confinement of salivary fluids within the oral cavity. The lips are also essential in forming many sounds and the preservation of sensation is preferred both socially and functionally. Aesthetic considerations include appropriate symmetry and normal anatomic proportions, presence of a philtrum, normal oral commissures, and establishment of a vermilion-cutaneous white border. The lack of any substantial fibrous framework increases the risk of anatomic distortion leading to poor functional and aesthetic outcomes.
When scientists list the top areas of the body in terms of sensitivity, the lips and fingertips are often ranked as the areas with the highest concentrations of receptor cells. More brain energy is spent interpreting sensations of touch from the lips and fingers than from any other areas that contain receptor cells. Human lips have the slimmest layer of skin on the human body yet they are among the most densely populated with sensory neurons. When you use your lips to kiss someone, the neurons, along with those in your tongue and mouth, send messages to your brain, setting off passionate sensations, intense emotions, and powerful physical reactions. Of the 13 cranial nerves that affect cerebral function, five send messages when you kiss transmitting messages from your lips, tongue, cheeks and nose to a brain that grasps information about the temperature, taste, smell, and movements involved.
Due to the high content of nerve endings, your lips are an erogenous zone and your brain responds to this by ordering your body to produce:
Some information enters the somatosensory cortex, a swath of tissue on the surface of your brain that represents tactile information in the map of your body. In that map, the lips appear large because the size of each represented body region is proportional to the density of its nerve endings. According to research, psychologists say that men find a woman with full lips to be more sexually attractive than those with thin lips. Full lips are a result of a woman’s estrogen and the higher your estrogen level is, the fuller your lips are. Plump lips serve as a biological in¬dicator of a woman’s fertility and this has made the demand for fuller lips a very popular procedure.
Your lips age faster than other areas of your skin because they are often the most neglected skin on your body. Lips have been compared to a sponge that when subjected to moisture absorbs water and plumps but when dehydrated, shrinks and dries out. Your lips are always exposed to he elements so they are extremely susceptible to dryness. When most of us think about our lips, we think about the skin we see inside the line that defines them. We forget that our lips are actually a large muscle and the skin is only the outer level with both factors contributing to how your lips look. Like many muscles, your lips have muscle memory and if you frequently use your lips to mimic certain positions and movements, this action will be reflected in the skin covering your lips.
One of the major culprits of premature aging around your mouth is due to smoking. Smokers are more likely to develop lines around the mouth because of the use of the perioral muscles to hold the cigarette. Smoking increases the hits of ageing free radicals by about a million per inhalation and generally; smokers age 10 years earlier than their non-smoking counterparts. In addition, smoking decreases the secretion of estrogen from ovaries and it also is thought to make the liver destroy estrogen supplies. Nicotine activates enzymes in your liver that metabolize sex hormones, speeding up the rate at which they are removed from your body causing the earlier onset of menopause. If you purse your lips frequently to smoke, the skin around your lips folds constantly pucker and over time you will see distinct lines forming around your lips.
Taking proper care of your lips can delay the signs of aging but once deep lines are present, there is little that can be done without professional intervention. Your lips need more moisture and conditioning as you age and the cumulative damage to your lips resulting from years of overexposure to the sun, cold air, and dry weather will eventually take its toll. Using a lip care product with a sunscreen (SPF 30+) is vital since your lips have little melanin and no protection from the damaging effects of the suns UV rays which can cause skin cancer. Besides environmental factors, gravity, smiling, chewing, frowning, and squinting are other conditions that influence your lips. Although many cultures may view lines and wrinkles as a sign of wisdom, we recognize the right to grow old gracefully by looking the best we can at every age.
Some people are satisfied with the look of their lips while others want to change them. One of the most noticeable signs of aging is the lines and wrinkles around your lips but the cure is quite simple: a cosmetic procedure known as lip augmentation. As you get older, you will lose volume in your lips making them look worn out and a lip augmentation will restore a fuller shape to your mouth, giving you more youthful lips.
Some of the reasons to undergo lip enhancement include:
Lip enhancement or augmentation is very important for enhancing your facial appearance. Dr. Moelleken wants his patients who are considering lip augmentation to know they have several options available to choose from today. He prides himself on being a skilled and artistic surgeon who has many tools to offer patients desiring the rejuvenation of their lips. The two types of lip augmenting agents include permanent and impermanent enhancing agents. These range from simple lip augmentation with hyaluronic acid fillers to LiveFill® grafts, lip lifts, corner lip lifts, DAO (depressor anguli oris) releases to reduce frowning, and augmentation of adjacent areas such as the marionette complex, etc. The results provide positive results and Dr. Moelleken understands that patients today want to achieve more fullness and poutiness, while at the same time appearing natural. This approach is a much more delicate issue than just pumping filler into your lips but he says it is best to try temporary fillers before getting anything permanent done. Doing this can help you decide what you specifically want and it is of course best to have Dr. Moelleken perform all the work, including the temporary fillers. This way, you can communicate which look is best for you as even a small difference in technique may result in a permanent change in your appearance that is not acceptable.
Lip injections are becoming increasingly common, since they are relatively inexpensive and have minimal recovery time. Dr. Moelleken believes that there has been a long-standing need for filler materials in the field of cosmetic surgery because these filler materials are used to fill-in spaces in your lips, smile lines, and the areas below your eyes. For temporary injections, Juvederm and Restylane are good hyaluronic acid fillers associated with very low complication rates. Swelling can be a problem post injection, so patients who are not familiar with their body’s reaction to the injections should allow at least two days of down time. When in doubt, it is wise to start with a filler such as Prevelle, which has a much lower incidence of swelling but does not last as long. Patients are usually happy with their results immediately after injection, but the benefits fade over time as the fillers dissolve. Lip injections are not for life and most last approximately six months before your body naturally absorbs the injection material.
Dr. Moelleken cautions strongly against the use of silicone or any semi-permanent filler in any form for your lips. Semi permanent injectable fillers such as silicone, Radiesse, Radiance, Artecoll, and Artefill are associated with numerous problems and he does not offer them at Neo Surgery Center. He avoids semi-permanent fillers for the lips due to chronic granuloma (lump) formation. They can also cause a chronic swelling reaction for years that becomes disfiguring and often uncorrectable. Even patients injected with micro droplets of silicone can develop a blunting of the vermillion border and white roll of the lip that looks as though swollen lips were sanded down. Silicone can run downhill and cause very characteristic “trout lip” deformities over the years and several celebrities who have experienced this have gone public about their unsatisfied use of silicone. While these problems are usually correctable (except for Alloderm where the scarring is severe and widespread), semi-permanent fillers such as Artecoll, Artefill, and Radiesse, or silicone injections are not always reversible. These techniques have a high complication rate due to granuloma formation and chronic swelling that distorts the tissues, often to monstrous proportions, and none of them is FDA approved for placement in the lips.
Dr. Moelleken does not care for lip implants that are actually implanted because he believes you can feel the synthetic implant in your lip, making the composition strange. Permanent fillers such as Gortex, SAM, or lip implants are unnatural and patients treated with them are often disappointed by the long period of swelling followed by a re-absorption (loss) of the graft over time. He warns that there are a lot of things that can go wrong with lip injections, temporary or permanent. This usually happens when someone wants too much volume in their lips. The skin and mucosa in your lips is very delicate and built for a certain amount of volume. You can enhance that volume but you cannot exceed the volume because the result is that the beautiful white line on the top of your lip and the vermillion border starts to appear blunted. This results in a “stuffed sausage” look so Dr. Moelleken will not exceed the natural volume that your lip is capable of supporting.
For permanent lip augmentation, Dr. Moelleken prefers the LiveFill® technique, a non-traumatized fat-fascial graft procedure. These grafts are the patient’s own tissues placed directly into the lip to augment volume. LiveFill® grafts also do not distort the vermillion border long-term and most importantly, a LiveFill® procedure passes the “kiss test.” Since there are many parts to the lip that can potentially be augmented, Dr. Moelleken customizes each lip augmentation to meet the individual needs of his patient.
Cosmetic surgery has come a long way since the days of collagen and although there are still countless ways to augment your lips, Dr. Moelleken has innovated a technique he is proud to offer known as LiveFill®. Dr. Moelleken has presented LiveFill® at ASPS and ASAPS meetings, among many other national and international academic formats. Details of this procedure are in the Journal of Plastic and Reconstructive Surgery and in Dr. Moelleken’s chapter on cosmetic rejuvenation of the midface and upper face in the 8-volume textbook Plastic Surgery (ed Mathes, Saunders, 2006). He has performed and presented the scientific trials on LiveFill® and has shown it to be vastly superior to fat injection in terms of viability, long-term survival, and appearance on histology.
LiveFill is a new method of augmenting wrinkled or “deflated” areas in your face and a technique that expands on decades of research in the Plastic Surgery field. It involves grafts from your own tissues that are fully alive and the material is obtained as a customized fine graft with blood vessels in it. This differs fundamentally from fat injection, which incorporates sucking (aspirating) fat into a syringe, purifying it usually by centrifugation, and then injecting it through a needle. It is not surprising that this process is highly damaging to a living network of cells. With LiveFill®, Dr. Moelleken fashions completely untraumatized tissue into small, delicate grafts resembling strings of pearls allowing them to maintain their structural integrity. These grafts are different from any rendition of grafted material developed thus far and LiveFill® is usually taken from an incision in your lower abdomen.
Your face does not age in lines; it ages in areas. For this reason, it is better to fill in complete areas rather than placing something beneath a single line and LiveFill® is placed underneath the areas that need filling. During a LiveFill® procedure, Dr. Moelleken is taking cell grafts, which are small strips of your own, living tissue. Through tiny incisions inside your mouth as well as little nicks inside the corners of your mouth, he inserts the tissue into your lips calling it the LaLa Lip Graft. Because the tissue is taken from you, no artificial material, plastic, or temporary substance is involved so the healing process starts immediately because you will develop your own blood supply into the grafts. The LaLa Lip Graft looks natural as Dr. Moelleken enhances the volume in your upper lip accompanied by a nice graft on your lower lip.
Patients who have had previous fillers are still candidates for a LaLa Lip Graft however Dr. Moelleken allows time for the temporary fillers to go away. This will give him a good idea of how your lips will eventually look with the fillers gone. The swelling from the LaLa Lip Graft is much less than you get from fat injections because the amount put in is not exaggerated. During a fat injection procedure, the doctor has to anticipate how many cells will not survive so he has to overcompensate. This is why when all the initial swelling subsides; there is still a large amount of swelling in place. Sections of lumpiness can also be seen where areas of fat have survived unevenly. Dr. Moelleken feels the LaLa Lip Graft is much more reliable because when most of the fat you are injecting is dead, your body’s immune system will not accept it. Your white blood cells will focus on your lips and work on the dead cells, eventually destroying the fat injection. With the LaLa Lip Graft, research indicates that the cell material used is approximately 88 percent alive and studies show it will last forever. Smoking can kill the graft however and patients must take good care of themselves to ensure permanent survival.