Ans.: Seriously, a lot. Such options are...

Lip implants:

• Advanta
• AlloDerm
• Dermis grafts
• Fascia Grafts
• Gore-Tex
• SoftForm
• Tendon Grafts
• UltraSoft
• Plus a few more

Ans.: The benefit of an injectable is the volume it can give the lips. The poutiness it can give is significant compared to the implants which gives a more subtle, defined lip. The downfall is, you really need an experienced injector. This is imperative, especially with the permanent products!

Most available injectables are temporary. Collagen, which has been the industry leader for a very long time, usually lasts only 3 to 4 months and requires a skin/allergy test. Fascian lasts a little longer although not by much. It is made up of fascia lata, strips of the tough covering that surrounds the outer thigh muscle. It is harvested from cadavers. It reportedly lasts longer than collagen.

Cymetra is a particulated, Injectable version of AlloDerm. LifeCell's product, AlloDerm (cadaveric dermis graft) seems to last a lot longer itself, but the injectable is somewhat "broken down" already. There are a few injectable products which are permanent, such as Artecoll, Aquamid, Metacrill, Silicone oil (Silikon 1000, Adatosil 5000 which are used off-label), etc. Artecoll is made from PMMA (polymethylmethacrylate) beads suspended in bovine (cow) collagen. The polymethylmethacrylate is formulated into microspheres (extremely small round balls) and suspended in a mixture of with 0.3% lidocaine for comfort and bovine collagen (3.5%) as well. The method of operation is that the PMMA is delivered into the dermis by the collagen vector, the collagen is then broken down by the body over time, yet the PMMA microspheres are left behind to be encapsulated by the body's own collagen. These microspheres are "networked" together by your body's collagen structure, therefore creating augmentation. Aquamid, Bio-Alcamid, Argiform, and other polyacrylamide implants are made from a polymer that holds moisture.

Ans.: There are permanent and reversible options like Gore-Tex , SoftForm, UltraSoft and Advanta soft tissue augmentation implants made from expanded polytetrafluoroethylene (ePTFE). These implants are made from a white material which could be described best as a foam-rubber type of material. ePTFE has been used for decades in the body for all sorts of applications. These are the most popular and the only FDA approved, synthetic implants which are considered permanent, yet they possess the benefit of being removed in the event of a problem.

There are permanent injectable permanent options which include, Artecoll, Metacrill, Aquamid, Silicone oil (off-label use), etc.

The downfall with these implants are their permanent nature.

Ans.: The surgery is not at all complex nor does it take a substantial amount of time to perform. You're injected with local shots of Lidocaine for pain relief and epinephrine, a vasoconstrictor, to restrict the amount of bleeding and bruising. After making the necessary 4 incisions at each corner of the mouth, the surgeon inserts the implant using either an implant pre-threaded on trocar or using a pair of alligator forceps. After insertion, the surgeon cuts the implant to the size best for the patient's individual lip and trims the ends of the implant if necessary. The incision areas are then sutured with a thin, either dissolving or non-dissolving suture material.

Ans.: You should expect to be swollen, tender and very full-lipped post-operatively. You may also difficulty drinking or eating without spilling as well. There will be pain, especially to pressure. You may feel numb in the lips for several days from the swelling putting pressure on the nerves in your lips. Your pain relievers prescribed by your doctor should alleviate any discomfort.

You will have your sutures removed in about 5 - 7days. You will be accustomed to the extreme swelling and once this swelling subsides you may wish for a little more fullness -- this is normal. For a reality check, compare your befores with an updated after before passing judgment.

Ans.: It takes about a week for most of the swelling to subside, although it will be sensitive to light to medium pressure for about 3 weeks. There is really not too much bruising with average cases, although it should be looked upon as individual. Some patients are prone to bruising more than others.

Ans.: The results are usually immediate. For implants, fat grafting and most injectables, your lips will be quite large and swollen and you will see a difference in the swelling as it subsides in the first week post-operatively (or post-injection). You should take photos before and after to compare and look back on your old lip's size. After viewing the before and after photos you should be able to appreciate a change in the lip volume.

Ans.: There are not too many risks associated with lip augmentation in comparison to other elective procedures, but there are enough to pay attention and have concern. It typically depends on the chosen implant or filler.... Let's start with Gore-Tex, SoftForm, UltraSoft and Advanta: There can be infection and irritation if the ends of the implant are too long for the cavity or not rounded, if needed. The good thing is that it is reversible and can be readily removed. UltraSoft is hollow, allowing your own tissues to grow into the implant. When tissue ingrowth occurs, infection and rejection are less likely. Extrusion from the body attempting to reject the foreign material, palpability and lessened mobility of the treatment areas are possible. Migration can be an issue as well, although tissue ingrowth can decrease this risk significantly. There may be permanent discolorations from the bruising. Possible hematomas resulting in additional surgeries and excessive scarring from delayed healing or trauma. Deformity from excess scar tissue arising from an infection or the hands of an unskilled doctor is also a possibility.

Fascian, AlloDerm, CosmoDerm, CosmoPlast and other forms of cadaveric grafts or tissue derivatives supposedly are absorbed within your body with no after-effects. Newer injectable fillers like Restylane, Perlane and Hylaform supposedly have no side effects. However, some patients have reported prolonged swelling and inflammation, and nodules at the injection sites with Perlane.

With Artecoll, Metacrill, Silicone and other permanent injectables; not only do the risks include infection, necrosis, granuloma formation, nidus, severe inflammation, palpability, and extrusion; but they are not easily removed. In the event of a problem, Injections of Kenalog, a corticosteroid, can help alleviate inflammation and reduce fibrous tissue. If the need for repeat injections persists, excision is usually the only option to lessen the amount of product in the tissue which is triggering an inflammatory response.

Injectable products made from hydrophilic polyacrylamide gel do have some questionable issues, one such being residual unpolymerized acrylamide. Acrylamide is a known carcinogen, mutagen, neurotoxin and also a reproductive toxin. However, the manufacturers do report that the levels are extremely small, less than what you would receive on a daily basis in drinking water and foods. The other issue is the ability to sustain bacteria. Bacteria can and does thrive within polyacrylamide implants. Aspiration, and or excision, may be necessary in some cases.

Ans.: The reason the risk of infection is high is the incision site and location of the procedure - as well as it is a synthetic material.

Although many implants are made of a well-tolerated material such as expanded polytetrafluoroethylene, infections can and do happen to the best of us. The mouth is a very dirty place on the body and is a prime habitat for bacterial growth . Plus, your mobile tissues take longer to heal than those of which are not very mobile. If you try and keep your mouth clean, rising regularly with Listerine and not "pick" at the incision sites, your wounds will have less of a chance of becoming infected. Good oral hygiene is imperative and any cavities and other dental work should be tended to well before any lip augmentation procedures.

Ans.: Many injectables wear off but give wonderful, voluptuous and immediate results. Many injectables are cheaper, but more expensive in the long run. Implants and permanent injectables (injectable micro implants), such as silicone, Artecoll, and Aquamid give results which are long lasting yet are more invasive than a regular injection of say, Perlane or collagen. It's really your call. If you would like permanent, yet reversible results, get the regular non-injectable synthetic implants. Such as Gore-Tex, UltraSoft or the Advanta Facial Implant. However, a very full and bumpy lip may not be possible with these implants. They create more of a smooth, full Julia Roberts type lip. If it is a very full, pouty mouth that you desire and don't want anything permanent, get the temporary injectables, but be prepared to spend a lot of money on touch ups and maintenance. It's really your call and your body. Choose your products wisely.

Ans.: Lip augmentation with most injectables is temporary so, yes, figuratively, it is reversible. Lip augmentation with an ePTFE implant is reversible. Permanent injectables are more difficult to remove, so consider this when you make your choice.

Ans.: It really depends on whether or not you had very thin lips beforehand. If you had very thin lips and had a large implant or or a lot of a firmer injectable into a tight space it is quite possible for he or she to be able to feel the change. But! the good thing is, you get used to it very quickly. You will usually grow very accustomed to it and no longer feel as though it is foreign.

Ans.: It is quite possible that you will notice a difference in your smile, how you speak and sensation after a lip enhancement procedure. Especially during the healing stage. Lip implants can feel very stiff and immobile; it takes some getting used to. NO WONDER this surgery is delicate and causes discomfort even when you try not to move. The muscles of the lips move involuntary as well, any change to this area be it surgical or injectable is bound to change or affect its movements either slightly or hinder them severely.

Ans.: This is a choice only you can make as many factors are involved.

• Remember to think ahead, and go for what is safe and proven - not some whim. The choice is yours and you must make it.
• Price may be an issue for you. But remember, doctors offer deals to those patients they are practicing on with a newer product. Be careful about this.
• The material or product that you may want may not be available. New and improved products are developed all the time, it is only a matter of waiting for that material. What look do you want? More define a total lip change? Less nose to lip ratio? Angelina Jolie? Take this into account before you make a choice.
• Risks. What are you willing to chance? Do you want something reversible?