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Surgical and Non-Surgical Options for Lip Augmentation

Having full, plump lips is often considered a sign of good health, beauty and youth. Whether you were born with thin lips or your lips are thinning due to the natural aging process, there are many ways to enhance them or restore soft tissue loss. Lip augmentation is a cosmetic procedure that can give you fuller, plumper lips. Nowadays, lip injections using natural or synthetic fillers to keep your lips plump for months at a time are the most commonly used method of lip augmentation. Lip implants and other surgical procedures (such as lip lifts, vermillion advancement and permanent make up) can also be performed for a more permanent solution. Every year, thousands of people undergo successful lip enhancement and are pleased with the results. In 2018, over 30,000 lip augmentation procedures (other than injectable materials) were performed in the United States, according to the American Society of Plastic Surgeons (1).

Lip augmentation with Permalip implant performed by Dr. De La Cruz.

There are many dermal fillers that can be injected in your lips and around your mouth to enhance them and provide aesthetically pleasing results. However, the most common fillers nowadays are products such as Restylane®, Juvederm® and Belotero® which contain hyaluronic acid. Hyaluronic acid is a natural substance found in your body. Hyaluronic acid fillers can improve the appearance of your lips by adding shape, structure and/or volume. One treatment is usually sufficient to produce the desired result. Nonetheless, the results are temporary (the effects typically last around six months) and require repeat injections (2). One of the benefits of non-surgical lip augmentation is that if patients are not satisfied with the outcome, it can be reversed by an injection of an enzyme which can dissolve hyaluronic acid fillers. This enzyme used to dissolve hyaluronic acid fillers is called “hyaluronidase”. It’s worth mentioning that if the fillers used were not hyaluronic acid-based, this enzyme will not break them down.

Injectable lip augmentation can be performed in a 30-45 minutes visit to your plastic surgeon’s office, with little to no downtime and minimal preparation. Before the injections, a topical or local numbing cream may be applied to ease discomfort. Sometimes, nerve block injections can be given before the treatment to completely numb the lips. After carefully marking the areas to be injected, very fine needles are used to inject the substance into your lips. Following injection, ice may be given to ease discomfort and control swelling, but no firm pressure should be put on the treatment area (3). Lipstick or other lip products are best avoided immediately after the procedure. You should be able to notice a difference immediately. After you have healed, your lips should feel natural. Because hyaluronic acid fillers are made from substances similar to those found in the body, they are unlikely to cause an allergic reaction. Fortunately, significant complications from lip enhancement are infrequent. Side effects of hyaluronic acid fillers are temporary and should only last a few days. They may include bleeding from the injection sites, swelling and bruising, and redness and tenderness at the site of the injection.

A longer lasting option for lip enhancement is fat grafting to the lips. Autologous fat (fat from your own body) may be injected safely into your lips to add volume. By obtaining autologous fat through liposuction, filtering and processing the fat, then carefully placing the fat into your lips, your lips can be shaped (4). Injections may need to be repeated until you get the desired results. Fat grafting typically lasts for years, making this the most durable option for lip enhancement. On the other hand, silicone injections are an unsafe and unacceptable option to use as a filler. These injections are not approved by the FDA and often offered by unlicensed individuals and should be avoided. These injections are dangerous mainly for three reasons: First, they can trigger an excessive inflammatory reaction in the body because the body identifies the biopolymer as a foreign object and triggers a defensive reaction. Next, the biopolymers may migrate from the original site where they were injected causing reactions elsewhere in the body. Lastly, most often they have no proper sanitary control which increases the risk of complications and side effects of infection. The physical complications occurring from these injections include granulomas, lumps, bumps, itching, burning, skin discoloration, and nerve damage. Patients who have had biopolymers injected (even without any manifestation of adverse effects) should consult with an experienced, board-certified plastic surgeon to be evaluated and discuss their particular condition and potential risks for complications. The plastic surgeons may suggest consultation with other specialties (immunologist, dermatologist, infectious disease specialist, internists, psychologists, etc.), according to the particular situation of each patient.

One alternative to temporary dermal filler injections and fat grafting for lip augmentation is to use lip implants, which is a more permanent option. Lip implants can physically change the plumpness and volume of the lips. There are many natural or synthetic implant options available. During your lip consultation, your plastic surgeon will determine what size lip implant would be best for you. The Permalip implant insertion may be performed in a hospital, free standing ambulatory facility or office-based surgical suite. First, the skin is sterilized around the surgical area. Next, the lips are anesthetized. Once the lips are numb, an incision is made in each corner of the mouth. A tunnel in the lip is created using a tool called a “curved alligator clamp” (5). The lip tunnel carefully follows the shape of the lip. Once the curved alligator clamp has reached the end of the tunnel, the clamp opens. The implant is grasped and dragged into the lip tunnel. The implant is positioned underneath the lip fat and above the lip muscles. Once the implants are in place, the incisions are closed with one or two absorbable sutures. Most lip implants procedures take 1 to 2 hours to complete. Patients will experience post-operative bruising and swelling, with mild to moderate discomfort for 24-48 hours. A cold compress can be applied to the operative site to reduce swelling, bruising and pain. Moreover, patients may be restricted to a liquid-only diet for one or two days. For safety, as well as the most beautiful and healthy outcome, it’s vital to follow your plastic surgeon’s post-operative instructions closely and return to his/her office for follow-up evaluations and whenever you notice any changes in your lip implants.


(1) “2018 National Plastic Surgery Statistics”. American Society of Plastic Surgeons.

(2) “Lip Enhancement Surgery: Lip Injections and Augmentation”. American Society for Aesthetic Plastic Surgery.

(3) “Lip Augmentation: Types, Side Effects, Risks”. WebMD.

(4) Roy, Kim. “The Best Lip Enhancement Treatment for You”. American Society of Plastic Surgeons.

(5) Katzen, Timothy. “Surgical and Non-surgical Options to Plum Up your Lips”. American Society of Plastic Surgeons.

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