LAM FACIAL PLASTICS

Dr. Lam-

What is the best filler to use to increase lip volume? I want something that looks natural and permanent? Do you offer this service?

Thank you!

Absolutely! Let's first identify three different "permanent" options for lip enhancement: 1. injectable lip fillers like silicone and artefill, 2. implantable surgically inserted solid implants like verafil, gore-tex/softform, 3. lip advancement procedures.

First , let me explain why I don't prefer solid implants of any kind. Solid implants that are based on gore-tex invariably shrink over time and become hard. I have seen that happen with any brand you would like to mention, including softform, ultrasoft form, and Atrium's Advanta brands. Also, solid implants have a high likelihood over time of becoming displaced or infected, both of which I have seen. They simply feel unnatural if you are touching them, licking your own lips, or kissing someone. Finally, they don't permit very much sculpting of a lip to make it look natural (more of that comment to come). With the new verafil or silicone lip implants with gore-tex that are inflatable, I have the same potential problems. I have also felt these lips and they are NOT soft. Personally and professionally, I would stay away from solid implants in the lips.

Second, as far as lip advancement procedures are considered, I do perform them in rare circumstances. I do not prefer the direct lip advancement in general, i.e., cutting the lip ad the red and white border to advance or move up the red portion of the lip. I have found that this procedure has three inherent problems. First, it causes an unacceptable scar in almost all patients. Second, the lip advanced does not look natural. Three, it is not balanced with the lower lip. As far as a subnasal lip lift (i.e., an incision immediately below the nose to lift the lip up), I can see validity in this procedure in rare cases in which too much white lip is present but I would be very cautious as there is still a very real risk of a visible scar with or without makeup. Also, this procedure can look unnatural if over done and also not good if the upper lip becomes too large vis-a-vis the lower lip (more of this comment to come). The corner of the lip lift is a helpful procedure to turn up the corners of the mouth but only if done conservatively. There is a risk of turning the lip too far upward and creating a joker look which is unnatural looking. In summary, I am not a big fan of lip advancement surgeries except in the much older patient willing to accept potential scarring who still may require injectable fillers to create balance. Further, makeup would almost always be necesary to cover scarring so this option is a not available for men, at least in my opinion.

Finally, permanent injectable fillers is what I prefer. I do not use Artefill and have no plans in incorporating this new treatment into my practice for two reasons. First, there have been numerous reported problems with its kissing cousin Artecoll in Europe and Canada where the products were approved in a slightly different molecular formulation. I am not convinced that changing the particle size of the plastic beads is sufficient for long-term safety. The jury is still out and I would like to wait before implementing something permanent and irreversible like Artefill.

That leaves us with liquid silicone treatments. I personally prefer this option as the number one way for me to enhance the lips. If done well with microdroplet treatments over a period of several months (minimum time one month between sessions), the lips can look stunningly natural and remain very soft (but can become firmer if you simply have no lip and I perform multiple injections like 5 or more, which is rarely necessary.) I find liquid silicone treatments to be the most natural in appearance compared even with Juvederm and Restylane treatments. Remember that liquid silicone can also be done very badly in inexperienced hands. I have personally had to correct numerous silicone lip jobs from across the United States and other countries. Most oftentimes the problem is not using medical-grade silicone (I use Silikon 1000 from Alcon Labs) or very poor technique (large amounts deposited in non microdroplet technique). Silicone has been around as a cosmetic treatment option since the 1960s so I believe the track record is there for safety. I have worked with physicians who have used the product safely for over 40 years. Just a word of caution: silicone treatments are considered "off-label" meaning they are approved for use in the human body for retinal detachments, i.e., for use in the human eyeball, but use elsewhere in the human body, for example for cosmetic purposes, is perfectly legal if the physician informs and consents the patient regarding the nature, purpose, risks, benefits, limitations, and off-label status of this treatment.

I personally perform liquid silicone treatments almost every day and have done so for years without clumping or migration of the product due to the very conservative safety profile that I use every time. There is also no pain with my technique. Using restylane and juvederm is fine but the problem with these treatments is three fold. Injection burn out is common. Most people do not want to keep coming back to get filled all the time, especially if the treatment is painful (which it is not with me). Second, it oftentimes does not last a very longtime, making it also a cost burden besides being a hassle. Third, the product can still feel relatively hard.

For silicone treatments, typically 2 to 3 treatments spaced a month apart will suffice in most cases. The cost that I charge is $700 per treatment. The other point that I mentioned which is so important is understanding the beauty and shape of a lip. If you look at my lip designs, the bottom lip is almost always bigger because that is the way that nature has it in most cases. (Most women come in wanting only the upper lip done. Big Mistake!) Also, I design a lip that has proper shape. Bottom line, you must have a good aesthetic sense when designing a lip. I hope you like my lip examples. Like any artwork, please make sure you like the artist's work. check out my before and afters for both my primary lips and lip correction work. To review my philosophy in video format, either watch the video when I was on Good Morning Texas or my lip enhancement virtual consultation. Also, visit the many video testimonials I have on lip enhancement and lip correction.

One more thing: I am more conservative when it comes to the size of permanent lips since they are permanent and tastes and styles change. I typically recommend a more conservative shape that can be augmented with a temporary filler if you want to go bigger until you are convinced that is the size you want. Also, you must trust my eye in terms of when to say no. I have a lot of women who come to me and say that they want very subtle lips only because they are used to seeing these horrendous duck lips walking around town and then when they see how beautiful the lips I created for them is then want more and more. I WILL cut you off if I think your lips will look unnatural. Remember beautiful lips should be absolutely undetectable. Mine are.

Hope this answer helps you.
best,
SML.

Dr. Lam, although I just saw you last week, the girls wanted me to come back for you to look at my lip to see if I need more Silicone. I would love a little more in the bottom and possibly the top? I am there tomorrow at 4:30. Is it something that can be done in the office quickly? How swollen are you afterwards? You did an excellent job of making it look very natural!

After experiencing how you do your injections, I would only allow you to do any injections on me from this point forward. THANKS!!

hi tammy,
very easy to do in a few minutes with NO PAIN, as you know. i would be happy to do it for you tomorrow. usually, a little swelling for less than a day. however, if you bruise it can last 1 to 2 weeks. (hopefully not.)
best,
sml