Permanent Injectable Products For Lip Augmentation
Permanent injectables may be tempting to both first time patients (especially men) and those who have been getting temporary injectables for many years.  The thought of never having to spend another dime to have your lips plumped is indeed a convincing plus.  Although permanent injectable fillers can be removed to a degree, you should consider the possibility of an adverse reaction before committing.  I have spoken to patients who have had removal of these products, however the process was not an easy one.  Polyacrylamide products can be aspirated or cut out surgically in the event of a problem but not all of the product will be removed.  Polacylamide products also have been associated with delayed onset bacterial infections requiring extensive treatment.  Liquid silicone can be excised (cut out) due to the fact that it is normally encapsulated by your body's collagen  However, any product which has migrated may travel outside the lip which would require a more difficult removal process.  Polymethylmethacrylate can only be cut out since your body's collagen encapsulated the product, which is a solid.  Please consider the possibilities before committing to a permanent option.  If after you weigh the risk versus reward and feel that permanent lip augmentation may be for you, then and only then should you seek to pursue it.

Aquamid™: Aquamid is made from 97.5% apyrogenic water and 2.5% hydrophilic polyacrylamide hydrogel which can hold 300 to 400 times its dry weight once hydrated.  The product can be injected with regional anesthetic and takes about 20 minutes. The augmentation is immediate and reported as permanent.  Possible side effects may include secondary bacterial infections and abscesses showing up in the treatment area even years after implant.  Percentage of adverse effects is unknown, however removal can be very difficult.  One study* suggested that 55 out of 40,000 patients injected between 2011 and 2003 had adverse effects.  It was unknown why some patients had problems and others did not.  Patients were treated with broad spectrum antibiotics.  It was found that steroids and non-steroidal anti-inflammatory drugs (NSAIDs) actually caused more problems and were not recommended for those with polyacrylamide adverse reactions.  I have spoken with several patients who had problems months to years after their injections that had to undergo extensive treatment to get the bacterial infections under control and the product removed.  Some patients are able to be treated with aspiration of the product using a needle.
Manufactured by: Contura
Made from: Polyacrylamide Hydrogel
Allergy Test: Not required
Aesthetic Results: Natural looking when injected properly
How Long It Lasts: Reportedly permanent
Cost: $700 to $1,500
CE Marking: Yes
FDA Approved: No

Artefill™ / Artecoll™ Artecoll is made from a mixture of polymethylmethacrylate (PMMA, what Plexi-glas® is made from) microspheres suspended in bovine collagen and lidocaine. Artefill was once called Arteplast and is marketed as Artecoll in Europe and Canada, and as Artefill in the United States.  The product has gone through several changes since it first came out almost a decade ago.  At first, the microspheres were various sizes, whereas now attempts are made at completely homogenizing the size to lessen large granuloma formation and less of the "bad" inflammation.  Artecoll was suspended m bovine collagen, and nwo Art Artefill relies on a certain amount of inflammation to trigger your body to produce its own collage for augmentation.  The collagen is the suspension which allows injection to take place, as well as this gives immediate augmentation.  As the bovine collagen resorbs, and the microspheres become more exposed, your tissue generates collagen to encapsulate the microspheres. Patients are usually required to have 2 or 3 more injections to receive compete augmentation.  You may of heard of the product "rubberizing' in the lips.  The product does not change composition but rather what is being described is when the collagen fibers become too tightly woven and the tissue becomes firm.  Some doctors advise their patients to massage for a few months to lessen this effect, however some believe this only causes more inflammation.
Manufactured by: Artes Medical
Made from: Polymethylmethacrylate suspended in collagen
Allergy Test: Patient must have bovine collagen allergies.  Usually a pre-test of collagen only is given at 4 weeks before treatment.
Aesthetic Results:  Blanching from the bovine collagen can occur in the lips.  This product is not recommended for under the eyes.
How Long It Lasts: The PMMA is permanent, the collagen suspension is temporary and your own collagen grows around it is subject to normal tissue degradation from aging.
Cost: $1,000 to $1,500 per 1 ml
CE Marking: Yes
FDA Approved: Artefill is FDA approved

Bio-Alcamid™ Lips:  Bio-Alcamid Lips is made from 96% apyrogenic water and 4% polyalkylimide.  There are other formulations for the face and body.  Years ago, the term was typed on their website (when it was Progen) in some areas as polyacrylamide, and on other sections as polyalkylamide.  For argument's sake I will use the term as they advertise. Polyalkylamide can hold 300 to 400 times its dry weight once hydrated.   As with Aquamid, there are reports of problems occurring months to even years post-injection.  Inflammation, severe swelling, bacterial infections associated with injections of Bio-Alcamid** that necessitate treatment with broad spectrum antibiotics, and surgical removal have been reported.  Some patients are able to be treated with aspiration of the product using a needle.
Manufactured by: Research S.r.l. (Brindisi, Italy)
Made from: polyalkylimide hydrogel
Allergy Test: Not required
Aesthetic Results: Natural looking when injected properly
How Long It Lasts: Reportedly permanent
Cost: $700 to $1,500 per syringe
CE Marking: Yes
FDA Approved: No

Silicone (liquid, Adatosil™ Silikon 1000™)  AdatoSil 5000 is a liquid silicone oil that has a viscosity of 5000 (minimum) to 5400 centistokes at 25°C.  Silikon 1000 is another silicone oil which has a viscosity of 1000 (minimum) centistokes at 25°C.  There has been great controversy surrounding the use of liquid silicone in soft tissue augmentation applications.  This has largely been due to physicians (and non-physicians) injecting large amounts of product in one sitting.  The product itself is not what gives you the augmentation but rather how your body reacts to it.  The silicone triggers an inflammatory reaction which causes your body to encapsulate eth product.  The collagen which forms in this process is what gives your lips natural looking augmentation.  Migration of lower molecular silicone has been reported and I urge caution when choosing this option.  I personally believe that this method delivers the most aesthetically pleasing result (when done so conservatively) however, for me, I feel the risks are too great.  PLEASE do not ever get this product outside of a medical office (and I don't mean a Spa) and ascertain that you know which product you are getting injected into your tissue.  Eventual migration is possible into the surrounding areas.
Manufactured by: Bausch & Lomb, Alcon Laboratories, Inc. respectively
Made from: medical grade polydimethylsiloxane oil
Allergy Test: Not required
Aesthetic Results: Very natural looking, barring overcorrection or adverse reactions
How Long It Lasts: Permanent
Cost: $700 to $1,000 per treatment, liquid silicone should be injected using a gradual microdroplet technique and will require several treatments spaced approximately 6 weeks apart.  Overcorrecting is not recommended.
FDA Approved: Yes, for retinal detachments

Source:

*Adverse reactions following injection with a permanent facial filler polyacrylamide hydrogel (Aquamid): causes and treatment - [European Journal of Plastic Surgery Volume 28, Number 7, 464-471, DOI: 10.1007/s00238-005-0005-2] Lise Christensen, Vibeke Breiting, Jens Vuust and Estrid Hogdall

**Delayed Immune-Mediated Adverse Effects of Polyalkylimide Dermal Fillers; Clinical Findings and Long-term Follow-up [ARCH DERMATOL/VOL 144 (NO. 8), AUG 2008] Jaume Alijotas-Reig, MD, PhD; Victor Garcia-Gimenez, MD; Francesc Miro´-Mur, PhD; Miquel Vilardell-Tarre´s, MD, PhD
PDF: http://archderm.ama-assn.org/cgi/reprint/144/5/637.pdf

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