1. How do I know if I need lip augmentation?  Am I a good candidate for lip augmentation?

If you are reading this page, I am going to assume that you want bigger lips, or are at least considering the possibility.  Only a qualified and experienced surgeon or injector can determine if you are a candidate for lip augmentation based upon the current size of your lips and your health.

You must be in good mental health to process the ups and downs of the recovery process, as well as have a good body image which will keep you from going overboard.  However, an experienced and respected injector would never give you abnormally sized lips no matter what you feel would look good on your face.  A respected injector would only give his or her patient the shape, size and appearance of a set of lips that would create harmony and balance.  There are, of course, exceptions to this rule when certain physicians provide their patients with more than normal augmentation to attain a particular look (as in cartoon character style, or for impersonators).  However, the augmentation will thus be apparent and you must be prepared to accept the comments of critics. 

You must be in good physical health to give your body the foundation for a good recovery.  This requires preparation such as determining if you have no conditions or disorders that would impede your body from healing.   If you have oral herpes (also known as herpes simplex virus 1, HSV-1, fever blisters, or cold sores), you should take a prophylactic antiviral medication such as Valacyclovir (Valtrex) tablets before having lip injections or surgery.  Talk to your doctor about this at your consultation as injections and surgery can trigger breakouts which may move to the surrounding areas such as the face, nose and inside of the mouth.  Patients may also wish to use Acyclovir (Zovirax) cream in the event of a breakout.

Preparations will also include no aspirin, ibuprofen, alcohol, or vitamin E consumption which would cause excess bleeding or bruising.

Back to Top

2. How will I know what size will look good on my face, and how do I know I will get what I want?

Due to the influx of enlarged lips in Hollywood (or in the runway fashion world). there are some misconceptions of what a pair of lips should look like.  Granted, there are all types and sizes of lips, but if you weren't born with it naturally, there are some general guidelines that a surgeon will adhere to when planning your outcome.

Although I hesitate to use the term ideal when describing what is thought to be most attractive, there are formulas or guidelines when determining what size and shape the lips should be in creating overall harmony with the rest of the face.  Let's use the term targeted proportions when attempting to create an attractive pair of lips for one's face.  The goal is to keep the lip size in the correct ratio relative to one another and with the remainder of the rest of the face.

• The top lip, although smaller vertically, normally protrudes a bit further than the bottom lip, but only very slightly.  This creates an attractive pout.  When too much protrusion is created it can give the appearance of an overbite, too little the appearance of an underbite

• The bottom lip should be roughly 75% larger than the top lip.

• The ideal lips should have defined borders (called the vermillion border)

• A defined philtrum adds the appearance of youth and attractiveness.  It can also cause a lifting effect to the top lip, further enhancing the top lip pout as well as affecting tooth show.  When the philtrum is undefined it can create a flat, elongated appearance of the skin between nose and the upper lip. This area normally flattens with age as well is present in those with alcohol fetal syndrome.  Defining this area can correct these negative features.

• Slight upper tooth show is desirable.

• The chin may also need to be enhanced to create an attractive relationship to the lips.  It is thought that a 4mm depression between the lower lip and chin is attractive.  Augmentation to the chin using Radiesse may be a suitable option, an implant if more chin augmentation is needed.

Back to Top

3. Does lip augmentation hurt?

Depending upon which product or method you use, you will possibly experience discomfort during the initial anesthetic injection, the injection of augmentation fillers, or during recovery from lip lift or lip implant surgeries.  The only exception would be the use of topical anesthetics to numb the area without the need for injections.  However, breakthrough pain may occur.  With lip augmentation fillers, the injections are usually over very quickly in the hands of a skilled injector.  However, I always prefer a topical anesthetic to get any facial injections (except for Botox).

Recovery from lip lifts or lip implants may be present for a few weeks to a month, gradually dissipating over time. The exception may be an incorrect size implant for your lips or complications of a lip lift incision line.  Also, even though you may feel that you are fully healed, it is common to feel discomfort when you yawn or stretch your mouth..  This will eventually subside.

Tylenol and ice is usually suggested for injections, whereas prescription pain medications should alleviate most discomfort associated with surgical methods.

Back to Top

4. It is my first lip augmentation procedure, should I choose a temporary injectable or a permanent solution?

I strongly recommend a temporary injectable filler as your first experience before choosing semi-permanent or permanent methods.  I consider this a try-on period where you can determine which size you feel will enhance your appearance.  The obvious plus of temporary fillers is that if you do not like the result, it will gradually fade. However, if you really do not like the look and it is apparent that the augmentation is more than just swelling you may request an injection of hyaluronidase to dissipate the product within a week (only for hyaluronic acid based products).  Removing a semi-permanent or permanent option requires more discomfort and cost.  Some products, such as silicone and Artefill, are almost impossible to remove completely. 

With lip implants, you will not get the vermillion border enhancement, nor philtrum definition, that you may desire.  Only augmentation using fillers or even threads, will give this result.  Lip implants and lip lifts may turn the mucosa out, giving you more tooth show and the appearance of larger lips, but will not define the vermillion borders specifically.  Not only have I had experience with having injectable fillers placed over an implant, I have spoken to many patients who have also chosen the injectable filler route even after implant placement.

Back to Top

5. What type of anesthesia is available for lip implant or lip lift surgery?  Will I be awake?

Common types of anesthesia used for lip implants and lip lips can be an in-office regional block, or local anesthesia.  IV Sedation is also very common.  Depending upon the surgeon, you may be awake or sedated.  For surgeries over an hour, sedation is often used. This is also called Light Sleep and is not as deep as General Anesthesia.

Please see our Anesthesia Information Section for more if you have not read this section already.  If you choose to visit this section now, this page will launch a new window so that you do not lose your place in the Lip Augmentation Tutorial.

Back to Top

6. How do I know I am going to the best doctor for my needs?

Research. Research. Research.  I cannot stress this enough.  You can check your surgeon's medical license or disciplinary history online, and you can also ask around the medical community for referrals.  Although temporary injectable fillers have far less repercussions when performed by an inexperienced injector, a skilled injector knows the anatomy of the lips and what looks better in the end than someone who has only been injecting for a month.  Skill takes time and is earned.  Not to mention everyone is trying to cash in on the cosmetic enhancement industry, meaning your dentist or your nail lady is not the best person to give you an injection no matter how much of a discount they offer.  Stick with those who do this for a living, not those who use it as a cash cow on the side.

The best place to get names is on the Surgeon Locator Section and on our Lip Augmentation Discussion Forum.  We only list the very best surgeons and injectors, as well as the word-of-mouth referrals on our forum can guide you through other patients' experiences.  If you choose to visit these sections now, their pages will launch a new window so that you do not lose your place in the Lip Augmentation Tutorial.  We will visit these sections very soon.

Back to Top

7. What if my injector is not a surgeon, but rather a physician's assistant or nurse?

I have had injections by R.N.s and Physician's Assistants (P.A.) and they have turned out very well.  Usually an R.N. or P.A. is trained by the surgeon who is the medical director for that practice.  If you choose to have your injections by the surgeon, it may be more expensive, but this is completely up to you.  I have done both under the same practice roof. 

The choice is up to you whether you wish to have the surgeon or the staff perform your injections.  However, please ascertain that no matter who injects you, this person is skilled and has happy patients.  You don't want to be the first or even the tenth real person treated by the injector.  Again, experience is earned.   Injectors don't become great overnight.

I do not recommend going to a medical spa which utilizes injectors who received a one day class on a manikin head and the medical director is only there via a certificate on the wall, or the occasional visit for legal purposes. 

Back to Top

8. What is the average amount of product that is needed to augment the lips in the average patient?

The amount of product needed depends upon your own lips.  For a first time patient,1 to 1 1/2 syringes is common.  However you may only need 1/2 a syringe.  The unused product can be labeled with your name, placed in the refrigerator and be used for touch-ups in a few weeks or months.  Or you can choose to have other areas injected (your nasolabials, the cheeks, or chin).

Back to Top

9. What are the risks of lip augmentation?

Risks for lip augmentation include:

• Seroma

• Hematoma

• Infection

• Necrosis

• Nerve damage

• Hyperpigmentation from bruises

• Herpes simplex virus 1 (HSV-1) breakouts in those who have the virus

• Allergic reactions to the anesthetics

• Over injection resulting in disappointment or distortion

• Prolonged swelling

• Sensitivity to the product

• Rejection

Back to Top

10. How long do the bruises last?

The length your bruises (if you get any at all), will depend upon your own body's ability to heal and the preparation before your procedure.  Abstaining from alcohol, aspirin-containing products, Ibuprofen, vitamin E and other medications or supplements will help decrease your chances of excessive bleeding during the procedure. 

Proper icing before and after can help alleviate the possibility of bruising.  After the first 48 hours, some surgeons advise that you may alternate between warm compresses and cold compresses to encourage good blood flow, thereby speeding up the healing process. Other surgeons may suggest the use of Arnica montana and Bromelain to prepare the body for healing and speed up the process.  Always discuss with your surgeon before incorporating any recovery tip that he or she did not specifically advise you to do.

Bruising may last anywhere up to 2 weeks in severe cases, but most bruising dissipates in 4-7 days.  Some procedures or products may cause more bruising than others, such as with Fibrel injections.

Back to Top

11. How long does it take for the swelling to subside after a lip augmentation procedure?

The swelling usually subsides within a few days for lip injections.  Some products, such as Perlane, may cause more swelling as well as you may feel lumpiness at the injection sites at first with some products.  This is common and should subside in a week.  Proper icing techniques afterwards can help the swelling stay minimal.  Sleeping elevated can also help with swelling.

The swelling associated with Lip Lifts and Lip Implants (surgical methods) will take longer, usually up to 1 month to 1 1/2 months.  However, the initial swelling usually subsides within 10 to 15 days.   Residual swelling will gradually subside and will not really be noticeable.  Swelling is usually most apparent on day three and in the mornings during your recovery period if you are not properly elevated. 

Eating salty or spicy foods or exercise may also temporarily increase the appearance of swelling.

Back to Top

12. Will anyone be able to tell I have had lip augmentation?

If you have significantly thin lips pre-procedure, people will of course notice significant augmentation more.  If you return to work or are in the public eye while there is swelling present, or if you are bruised, people may suspect that you have had lip augmentation.  If you have your procedure and choose not see anyone other than those who know until your swelling subsides, people will be less likely to notice. 

Back to Top

13. What is the average cost of lip augmentation?

The average cost of lip augmentation depends upon the product(s) you use, how much product you will need, the region of the country and the doctor who you choose to perform your procedure.  Costs vary with all of the above factors, however a typical injection may cost approximately $400 to $600, and a surgery up to $4000.  You must also factor in medications, time taken off of work to heal (if surgery), touch-ups, the need for revisions on the event of a complication and upkeep.

Back to Top

14. Is it possible to finance my lip implant or lip lift procedure?

The initial cost of Lip Implant and Lip Lift procedures are significantly more than with injections   Patient financing is available in most plastic surgery offices.  Even if your surgeon does not offer patient financing, you may qualify for a personal loan.  However, I personally feel that you should be in a financial position to cover complications in the event that they arise.  The cost of cosmetic surgery is often higher than expected due to medications, recovery items, time needed off of work, etc.

Back to Top

15. What if I need a revision or touch-ups?

Determine what your surgeon's revision prices are ahead of time.  Touch-ups usually require additional costs, unless you did not use all of your syringe the first time around.  Obviously, periodic injections to sustain your level of augmentation should you choose temporary or semi-permanent options can be quite costly over time.

Back to Top

16. What if I need another procedure to balance my face, such as a chin implant or rhinoplasty?

Larger lips often make a large nose look smaller, but may cause a receding chin to look even smaller. Your surgeon should be able to offer his insight on what procedures you may need to complement your new lips.  Discuss this at your consultation.  Most procedures can be performed in the same surgery, but will obviously add costs.  Having separate surgeries will be more expensive in the long run.

Back to Top

17.  What about Do-It-Yourself injections?  I have heard about others ordering the product online and injecting it themselves.  How safe is this?

I absolutely do NOT recommend ordering a product off of the Internet (either from a reputable or unknown source) and choosing to perform the injections yourself.  Doctors go through rigorous training on not only knowing WHERE to inject, but also in knowing WHERE NOT TO inject.  The risk of injecting a product into a blood vessel, thereby blocking oxygen delivery and causing necrosis is higher in those who are not properly trained.  I have spoken to several patients who decided to self-inject and the majority of them injected far too much, or misplaced their injections and had to seek revision procedures

While the draw of saving money may trigger you into thinking about it, the ramifications of a failed attempt are severe and can cause tissue death or worse.

Back to Top

18.  If I have lip implants or a lip lift, how long will I have to wait to get the sutures removed?

Suture removal may be anywhere from 5 to 7 days. 

Back to Top

19.  Does suture removal hurt?

Suture removal can be unpleasant however it is over generally quickly. 

Back to Top

20.  What if I want a product that is not available in the United States, should I travel?

Although patients do travel to obtain access to products they normally would not have in the United States, please do extensive research before committing.  The Internet provides a plethora of information to any person who chooses to take advantage of it.  I suggest you take full advantage.  I have spoken to patients who chose to go to Mexico to have products injected and found out that they were injected with an unknown substance--not what they went there for!  Obviously, this doesn't happen all of the time, but if it specifically doesn't say the product's name on both the box and syringe, it probably isn't what you think it is.  Also, if the product doesn't have CE Marking, that's another factor to consider.

Back to Top

21.  My doctor has a product that is not FDA approved, is it safe to use?

Some products are investigational overall, some products are approved but its use in the lips is considered investigational.  Still other products are not even remotely in clinical trials in the United States.  You must perform your own research when determining if you are willing to have a product injected or implanted which is not readily available.  However, not all products will gain approval, and still others in the past have been pulled from the market.  Risk versus reward.

I have had a few products (Perlane, Restylane and Juvederm) injected before they were ever FDA-approved and most worked out.  But I chose products that were proven to be effective and safe in the EU and had the properties which were not known to cause adverse reactions.  I did, however, once choose a product for lip augmentation (Radiesse, but at the time it was Radiance) which was later not recommended for lips.  I found out the hard way and had to have some of the product removed via surgery.  I was lucky that it was able to be removed, and the rest eventually dissipated.  Some options, such as silicone, methylmethacrylate or polyacrylamide are difficult to remove.

Back to Top

22.  I am using  a product that is not FDA approved, my doctor is making me sign an informed consent form in order to get this injectable.  Am I setting myself up for future problems in signing this paper in the event I have an adverse reaction?

Your doctor will have you sign a consent form if the product has not yet been approved and is in clinical trials, or if the product is being used off-label (such as if the product is approved for another application but he is using it for your lips).  For instance, Botox® was once approved only for strabismus and then later, the glabella.  However, it was used "off-label" for other wrinkles of the face such as the forehead for crow's feet.

When a product is used off-label, it is allowed and accepted becausee of the 1997 amendment to the Federal Food, Drug and Cosmetic Act 6 which states: "Nothing in (FD&C Act) shall be construed to limit or interfere with the authority of a healthcare practitioner to prescribe or administer any legally marketed device to a patient for any condition or disease within a legitimate health care practitioner-patient relationship."  

I have had to sign informed consent forms on many occasions. but you must make this choice on your own.  The form is to have documentation that you know of the risks, the fact that it is not FDA-approved, or is being used off-label.  It does not mean that negligence will be excused, it just means that you know specifically what is outlined in the document and no more.  Read before you sign to determine what it is you are consenting to.  Don't ever feel forced to undergo a procedure you are not comfortable with.

Back to Top

23.  What is Lip Greed?

Ahhh Lip Greed.  I have had it several times and it is common.  Lip Greed can either be triggered by two factors.  Swelling, and a general More Is Better outlook. 

Let's begin with swelling.  When your lips swell from the procedure, your mind becomes accustomed to the size and begins to accept your new look.  Although they are, in actuality, out of balance with your face, but you become accustomed to the size.  When your swelling subsides like all swelling will, your mind is now thinking that you have no results at all and need MORE! 

The More Is Better outlook can become unhealthy so it is imperative that you listen to a few people who are outside of the equation.  Granted, not all people will have similar feelings about what is attractive but you can usually trust your surgeon.

How to keep Lip Greed in check?  Compare your before and after photos.  It is the best way to realize that you did, in fact, have results and that your lips are not the same size as they once were.  If you still want more, a slow and easy approach is a good idea.  There is nothing wrong with being conservative.  It is far easier to work up to a good result than it is to have a bad one corrected.

Back to Top

24.  How do I avoid Trout Pout or Fish Lips? 

Same as above, go slow, be conservative, listen to others and compare your photos.  Once you go overboard it is difficult to correct (unless it is temporary).  You don't want to be labeled as having trout pout or be the talk of the water cooler at your place of employment.

Back to Top

25.  What if my lips are too big?  Can I have some product removed?

If all the above fails and you went overboard.  A. Your surgeon should have known better.  B. You were very convincing and are now experiencing regret.  C. You chose a product that stimulates your own collagen and you are having an overgrowth of volume.

Most permanent products can be cut out, which is essentially like a lip reduction.  Although your tissue will be cut out with it which may cause depressions which in turn may cause you to need a slight augmentation procedure again to address asymmetry.    Products that require surgical removal are silicone, polymethylmethacrylate, Radiesse, and most polyacrylamide products.  Lip implants can simply be removed.

When you have too much hyaluronic acid injected, you can seek treatment with hyaluronidase.  It takes about 1 week to see approximately 80% dissipation and another week to see a100% reduction in detectable traces.  Or you can just wait for it to naturally dissipate, which may take several months.

Back to Top