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Philadelphia - The state of the art in lip augmentation isn't about fillers or filling technique but a conceptual breakthrough, says Sydney R. Coleman, M.D., a plastic surgeon with a New York City practice.
"It used to be enough to make lips look like sausages, but people aren't accepting that any more," he says. "In the last few years, we've made a huge transition toward looking at the lip as an aging anatomical structure that requires 3-D sculpting."
Dr. Coleman formed his idea of comeliness by listening to patients and looking at the lips of people whom society considers "beautiful"; for example, film stars and models.
Obtaining this look requires an understanding of the underlying biophysical process that leads to aging, the stages lips go through as they age and meticulous planning. The ideal candidates for augmentation are people who had full lips in their youth. Patients born with thin upper lips are the most difficult to augment aesthetically.
Mistakes Dr. Coleman is the author of Structural Fat Grafting, released by Quality Medical Publishing in August. The book has a chapter on lip augmentation based on his experience with more than 2,000 patients dating back to 1987.
Dr. Coleman says he sees the same cosmetic mistakes over and over again. One mistake is to add fullness to the cutaneous part of the upper lip in an attempt to remove wrinkles. This strengthens the skin of the upper lip so that it inverts the vermilion; the lip looks puffy and smaller. Another error is to make the upper lip larger in volume than the lower.
Other errors can impact the patient's health. "If a physician inserts the tip of a needle into any artery and injects a filler, she or he can precipitate an embolus that can block the artery. In a certain percentage of patients, this will cause necrosis of the tissue supplied by the artery. I know of three cases alone with Restylane, which isn't approved for injection subcutaneously," Dr. Coleman says.
Even worse is what happens if a dermatologist threads filler into an artery, overcoming blood pressure. The material can exit anywhere, such as in an eye, the brain or face. Since 1963, there have been numerous reports of permanent blindness and strokes caused by injections of collagen and other fillers.
"I know of four cases of blindness from facial injections into the subcutaneous tissues with a needle in the last few years," Dr. Coleman notes. "It's rare, but in most cases, avoidable."
Favoring fat as filler Cosmetic practitioners have been spending a great deal of time debating the pros and cons of different fillers. This is an important process, Dr. Coleman says, because large medical companies are buying up fillers and pushing them in the marketplace. Physicians have to make sure they are using safe products.
He considers grafted autologous fat not only the safest but also the best overall filler in the long-lasting category. Lip augmentations he did 13 years ago, upon refining his technique, continue to hold up well.
The problem with fat, whether used to fill the lips or any other area, is its fragility. His book details handling and injection techniques that will optimize cosmetic results.
Dr. Coleman says, "People need a system of instruments. Sharp needles can traumatize fat. You want parcels of fat to move through the cannula without pressure. That takes a 17- to 18-gauge lumen."