Accentuating Expression With Fillers
The lips are an incredibly sensitive part of the human body, and an important characterizing feature that defines and accentuates a woman’s sexuality. Through the lips, love is expressed, communicated and experienced.
It’s no wonder women spend so much time trying to beautify them. Luckily, fillers provide excellent options for accentuating and providing supple and full lips in a natural way. Most physicians use two specific types of hyaluronic acid (HA) fillers, Restylane and Juvederm for lip enhancement.
It all started in early 1980s when Zyderm, a bovine-originated collagen product, was approved by FDA for use as a filler for cosmetic purposes. It was mostly used in the folds and wrinkles of the face but quickly gained notoriety for its predictable and reliable use in the lips.
For 20 years, collagen products grew in popularity and enjoyed a monopoly as the only fillers approved for cosmetic treatments. Downsides to collagen, however, included a 3 percent hypersensitivity reaction rate. Thus, patients had to get skin tests prior to treatment. Even so, upwards of 1 percent of people developed allergic reactions. And patients also had to return every three months for the same results-as the collagen only lasted 12 weeks.
The popularity of collagen injections grew steadily, peaking with more than a million annual injections until 2003. That’s when a new competitor came on the scene with the addition of HA and its FDA approval for the treatment of facial lines and folds.
Restylane, the first HA FDA approved for cosmetic use, was a significant improvement over collagen. HA, a complex carbohydrate and one of the building blocks found in the living layers of the skin, is the same in all people and species; therefore, allergic reactions to the HA are unlikely, negating the need for skin testing.
Additionally, HA is extremely hydrophilic and has a high affinity for water, resulting in a smooth, soft, natural result. The product also lasted significantly longer than collagen with most patients seeing correction of their lips lasting at least six to nine months after injection.
Moreover, HA gained additional popularity when we learned its effects could be immediately reversed if necessary. An enzyme agent, hyaluronidase, injected into the skin will digest the HA gel, reversing the effects of the product within 24 hours. Thus, if a patient was not happy, we could remove the HA the next day.
However, HA is thicker than collagen, causing more pain. And, at first, there was no numbing agent premixed within the gel. Therefore, we would need to numb the mouth with a few strategically placed injections of an anesthetic. Patients appreciated the painless injections of the HA, but many did not like the prolonged numbing sensation of their mouth for one to four hours following.
Today, some practices, including my own, pre-mix the product with lidocaine, creating a filler similar to collagen in that it has minimal pain on injection. Another caveat with the HA treatments: the injections require much more technical skill from the injector in order to get a reliable and attractive result.
In 2006, the second HA was approved for use in the United States, Juvederm, providing some competition to other products. Anecdotally, advocates report that Juvederm provides a smoother injection with more plumping. Juvederm seems to attract more water than Restylane. But for those not wanting as much augmentation, Restylane may be a better choice. Nevertheless, either product will result in a nice improvement when done by an experienced physician or provider.
In the near future, expect to see the emergence and request by patients for permanent filler products. Although controversial, many are used overseas with arguably respectable safety and efficacy reports. (See sidebar on smoker’s lines.)
After Care is important. Following treatment, the lips are numb and usually feel bigger than they actually are. To prevent drying out, patients can use topical ointment such as Vaseline or Aquaphor. Additionally, we may use an anti-bruising Vitamin K cream named Auriderm. This product has been shown to reduce bruising time and severity. Most people take home a tube of it and reapply two times a day for a week if needed. However, with our new methods of injecting a hyaluronic-lidocaine mixture, bruising is unlikely or very minimal.
We also provide an ice pack and recommend that patients apply it to their lips on and off for the next 12 hours. Most people go home that evening and comment that their lips are tender, but not significantly enough to interfere with their routine. Some enjoy the swollen look of their lips and do not use the ice pack at all. They will go out immediately that night with their enhanced lips enjoying their engorged appearance.
We allow lipstick to be placed six hours following the treatment. Most people return to their daily schedule the next morning. Some will comment that their lips feel a bit sore for up to a week. If a bruise occurs, which is more likely for those on blood thinners, cover-up makeup may be necessary. Patients can eat and drink whatever they would like, and they can start kissing within hours after being treated. Most people enjoy the benefits of their enhanced lips for six to nine months.
Occasionally, some people metabolize the product quickly, and it is gone in 12 weeks. Others hardly break it down at all, and it will persist up to three years. Everyone is different, but overall satisfaction from this procedure is high for just about everyone.
Thankfully, today we have relatively safe, effective and affordable options to meet one of the most basic human desires: voluptuous, attractive, fuller lips.
Source: June 24th, 2010 by Dr. Cappiello at http://myrinnova.com/blog/2010/06/accentuating-expression-with-fillers/
