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Avoiding 'Trout Pout': 4 Options for Lip Enhancements

We've come a long way from liquid silicone, which was used in the 1960s, and today there are several safe surgical and non-surgical ways to achieve fuller and more youthful lips.
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Lips thin with age. People increase the size and fullness of their lips for a more youthful appearance. Like a good facelift, an expert lip procedure will enhance and rejuvenate facial contours. A recent American Society of Plastic Surgeons study showed that lip augmentation rose by 49 percent in 2011, with over 25,000 procedures performed in the U.S. alone.

While lip augmentation is growing in popularity and is wildly successful, poorly-done enhancements have earned the procedure the infamous name "trout pout." Trout pout results from too much injection and a disproportionate size (typically the upper lip, which is naturally smaller than the lower lip, becomes bigger than the lower lip).


An example of trout pout

There are several different options for enhancing the lips. We've come a long way from liquid silicone, which was used in the 1960s, and today there are several safe surgical and non-surgical ways to achieve fuller and more youthful lips.

1. Fat grafting

This is achieved by transferring fat from one part of your body (such as hips or abdomen) to your lips. This can be done as an isolated procedure or in conjunction with another aesthetic facial procedure such as a facelift. The theoretic advantage of fat injections is that it is the patient's own tissue and there is no risk of a late infection or extrusion which might occur with an implant, for example. The major disadvantage of fat grafting is the unpredictability of the final result. What you get at two years might be very different from what you see at two months. Too often some of the fat survives and remains in one area, but does not survive and therefore disappears in another. The result is an uneven, lumpy result which can only be treated sometimes, with difficulty, through surgery.

Another problem with this approach is an ever-growing lip if the patient gains weight. In response to caloric excess, the transplanted fat will behave in the same way as the area from which it was harvested behaves. An inch or two in the waistline will result in a commensurate amount in the lips (see example above). Uneven take of the graft and later weight gain can be even more unsightly, with exaggerated lumps and bumps.

2. Injectable lip "fillers"

Hyaluronic acid is my personal preference for lip augmentation. This filler (under brand names Restylane and Juvederm) gives the plastic surgeon greater control, results in extremely little downtime for the patient, and has the potential for reversibility. Since there is no variability in the "take" of hyaluronic acid fillers, they provide greater predictability in the result (unlike fat). Hyaluronic acid fillers are also reversible. If the patient doesn't like the early result, the plastic surgeon can dissolve the hyaluronic acid with an injection of hyaluronidase. And, if the patient should get tired of the new look, they can be assured that this filler (and the "look") will gradually disappear in time.

Calcium hydroxyapatite fillers, another type of injectible filler, can be permanent and very difficult to remove. While results may last for years, rather than months, the procedure is not recommended for those unsure of the look they want. Imperfections in their injection can be difficult, if not impossible, to correct.

3. Implants

Strands of biocompatible materials (e.g. Gore-Tex) can be threaded into the lips to increase their volume. Results can be dramatic but, too often, problematic. These large foreign bodies have a significant incidence of infection and extrusion (eruption/migration from its normal position) which often results in scarring and distortion. They can sometimes be visible and palpable.

4. Lip lifts

As lips thin with age they also tend to sag. This results in less upper tooth showing, both at rest and with smile. Lip lift procedures involve removing a small strip of skin and tissue directly under the nose, elevating the lip and exposing more of the upper teeth. The lip vermilion (red lip) is turned outward with a lip lift, making it appear fuller. The main disadvantage with this procedure is the resultant scar (usually inconspicuous) at the base of the nose. See example in the photos below.