Semi-Permanent Injectables For Lip Augmentation
With the increase in the demand for longer lasting injectable fillers, medical science is working hard and thus advancing by the minute. The costs involved in maintenance when using temporary fillers which may only last 4 months in the average patient, semi-permanent fillers are a welcome addition to aesthetic medicine.  Semi-permanent products may last up to 2 years in most patients and provide the peace of mind of being eventually resorbable, without the concerns of being a permanent product.

BioInBlue™ Lips: BioInBlue Lips is made from 92% apyrogenic water and 8% PVA gel (polyvinyl alcohol).  PVA is used as a drug carrier, artificial tears and even as a human plasma-replacement and has been proven to be safe in these applications.  BioInBlue is crosslinked by using alternating cycles of freezing and thawing.  The product is eventually resorbed.
Manufactured by: Scientech Corp S.r.l. (Brindisi, Italy)
Made from: polyvinyl alcohol
Allergy Test: Not required
Aesthetic Results: Very natural when injected properly
How Long It Lasts: 12 to 18 months
Cost: Unknown
CE Marking: Yes
FDA Approved: No

DermaDeep (hyaluronic acid and hydrogel): DermaDeep is comprised of 40% hydroxyethylmethacrylate (HEMA), ethylmethacrylate (EMA) and is suspended in 60% hyaluronic acid.  hydroxyethylmethacrylate is hydrophilic in that it absorbs water (anywhere from 10% to 600% it's dry weight) and is used in contact lenses  Interestingly, ethylmethacrylate  is used in artificial nail enhancement and is reportedly safer than the use of MMA.  The EMA particles are 45 to 65µm (averaging 55µm) in diameter and reportedly is not absorbed by the body. This product is intended for use in the dermal  layer.  The product is not meant to be combined in one area with other products.  So if you have another product already in place, you must wait to inject DermaDeep, and vice versa.
Manufactured by: Dermatech
Made from: hydroxyethylmethacrylate (HEMA), ethylmethacrylate (EMA) susupended in hyaluronic acid
Allergy Test: Unknown, but reportedly not required
Aesthetic Results: Unknown
How Long It Lasts: Unknown, although reportedly several years.  The hyaluronic acid suspension is eventually metabolized by your body, leaving about 40% augmentation from the hydrogel.  Your collagen is strengthened and the dermis (or lips) augmented from the hydrogel and your own collagen.
Cost: $500- $1,000
CE Marking: Yes
FDA Approved: No.  Their website is no longer available.

DermaLive (hyaluronic acid and hydrogel): DermaLive is also comprised of 40% hydroxyethylmethacrylate (HEMA), ethylmethacrylate (EMA) and is suspended in 60% hyaluronic acid.  hydroxyethylmethacrylate is hydrophilic in that it absorbs water (anywhere from 10% to 600% it's dry weight) and is used in contact lenses  Interestingly, ethylmethacrylate  is used in artificial nail enhancement and is reportedly safer than the use of MMA.  The EMA particules are 45 to 65µm (averaging 55µm) in diameter and reportedly is not absorbed by the body. This product is intended for use in the dermal and sub-dermal layers.  The product is not meant to be combined in one area with other products.  So if you have another product already in place, you must wait to inject DermaLive, and vice versa.
Manufactured by: Dermatech
Made from: hydroxyethylmethacrylate (HEMA), ethylmethacrylate (EMA) susupended in hyaluronic acid
Allergy Test: Unknown, but reportedly not required
Aesthetic Results: Unknown
How Long It Lasts: Unknown, although reportedly several years.  The hyaluronic acid suspension is eventually metabolized by your body, leaving about 40% augmentation from the hydrogel.  Your collagen is strengthened and the dermis (or lips) augmented from the hydrogel and your own collagen.
Cost: $500- $1,000
CE Marking: Yes
FDA Approved: No.  Their website is no longer available.

Evolution: Evolution is comprised of positively charged polyvinyl microspheres suspended in hydrophilic polyacrylamide gel.  Polyvinyl is already used in suture material in the United States.  The company claims that the positively charged polyvinyl attracts the negatively-charged glucosaminoglycan (GAG) which is your own hyaluronic acid. Other GAG attracted is the fibroblasts to create your own collagen.   The other mode of augmentation is the addition of polyacrylamide which once hydrated can hold up to 300 to 400 times its dry weight.  The product is two-fold in that both of these products cause augmentation, the polyacrylamide by added volume and the polyvinyl which triggers a fibroblast response.  Polyacrylamide also causes a fibroblast response but not as heavily as polyvinyl.
Manufactured by:  ProCytech (France)
Made from: polyvinyl microspheres and polyacrylamide
Allergy Test: Reportedly not required
Aesthetic Results: Unknown
How Long It Lasts: Reportedly 2 to 3 years, however polyacrylamide is considered permanent.
Cost: £400 per syringe
CE Marking: Yes
FDA Approved: No

Fat Grafting:  Although fat grafting should be under autologous implants, I consider it a chimera of an implant in the convenience of an injectable.  With the further convenience of it being your own tissue, thereby causing no rejection.  However, the longevity of the augmentation varies greatly--from absolutely zero to 90% or more.  There are certainly steps which can be taken by the surgeon to increase the chances of the viability of a fat graft, but your body must do the rest.  With fat grafting, your body's own fat cells are removed via liposuction or by a gentler method, BodyJet, which uses a stream of water to break up, but not burst, fat cells.  The fat cells are spun and any broken cells are removed.  The fat cells are often treated and also may be incorporated into a mixture of your own stem cells which are spun from your blood.  The technique will vary with the surgeon so please ask your surgeon how he or she ensures that the graft is viable.  Once the graft is available for re-implant it is injected into your treatment area.  Some doctors over correct, others feel that it will only compromise the viability of the fat cell and reduce blood vessel genesis, thereby killing the fat.  Again, please ask your surgeon about his or her protocol.  Obviously there will be a secondary scar(s) at the donor area associated with fat grafting.
Manufactured by: You!
Made from: your own harvested fat cells
Allergy Test: Not required as it is your own tissue, although an allergic reaction to the anesthetic is possible.
Aesthetic Results:  There is considerable swelling associated with fat grafting,  Fat cannot usually be injected into areas needing very fine correction. However, when placed deeply it causes full augmentation of the target area. once the area heals, and if there isn't over-filling, the result can be very natural.
How Long It Lasts: Longevity truly depends upon your body and the method used.  Some report as little as a few months, with only the collagen formation from scarring and the fat cell membrane (not no viable living fat cell) to many years depending upon the technique. I have had fat grafting twice to my cheeks and it did not seem to last longer than 6 months.
Cost: By comparison with most injectable fillers, fat grafting is expensive, anywhere from $1000 to $2,500 for the lips.
CE Marking: Not applicable
FDA Approved: Not applicable

Outline: The Outline products are comprised of positively charged polyacrylamide gel.  The company claims that the positively charged polyacrylamide gel attracts the negatively-charged glucosaminoglycan (GAG) which is your own hyaluronic acid. Other GAG attracted is the fibroblasts to create your own collagen.   Once hydrated, Polyacrylamide an hold up to 300 to 400 times its dry weight.  Polyacrylamide also causes a fibroblast response.
Manufactured by:  ProCytech (France)
Made from: positively charged polyacrylamide gel
Allergy Test: Reportedly not required
Aesthetic Results: Unknown
How Long It Lasts: Reportedly 2 to 3 years
Cost: £400 per syringe
CE Marking: Yes
FDA Approved: No

Radiesse® (formerly Radiance for tissue marking): Radiesse is comprised of synthetic calcium hydroxylapatite (CaHA)  (55.7%) microspheres 25 to 45 microns in size, suspended in a polysaccharide gel made from 1.3% sodium caboxymethylcellulose USP (United States Pharmacopeia), 6.4% glycerin USP and 36.6% water USP.   The gel gives you immediate augmentation which slowly dissipates over time.  During this time your body's fibroblasts integrate around the CaHA and give you augmentation. Blanching is visible if injected superficially and sometimes within the lips.  I had Radiesse in the lips and had surgical excision.  Please see the Radiesse / Radiance Removal Product Photos section for more information.  Some physicians feel that Radiesse is better suited within the dermis. 
Manufactured by: Bioform Medical, Inc. (manifactured in Franksville, WI) in partnership with Merz Pharmaceuticals (Frankfurt, Germany), now Merz Aesthetics
Made from:  calcium hydroxylapatite suspended in a polysacharide gel
Allergy Test: Not required
Aesthetic Results:  Although some surgeons recommend it for the lips, I have had Radiesse in this area and feel that the blanching (white product showing through the skin) and the firmness once the polysacharide has been metabolized is not aesthetically pleasing.  I have had 1.3mL total injected into the dermal areas (my cheeks) and feel that it is a wonderful, long-lasting product in this area.
How Long It Lasts: 2 years
Cost: $750 - $1,200 per 1.5 mL syringe
CE Marking: Yes
FDA Approved: Yes

Remake®: Remake is described as a tri-dimensional made from 96% apyrogenic water and 4% polyethylene glycol (PEG) di-acrylate which has many uses in medical science and household items including being used in precipitation for pathogenic virus recovery, as a laxative, to a dispersant used in toothpaste to keep the product uniformly gelled.  The di-acrylate is used to crosslink the product to slow the rate of resorption.
Manufactured by: Scientech Corp S.r.l. (Brindisi, Italy)
Made from:  polyethylene glycol di-acrylate
Allergy Test: Not required
Aesthetic Results: Unknown
How Long It Lasts: 18 months to 2 years
Cost: Unknown
CE Marking: Yes
FDA Approved: No

 Your Options In Permanent Injectables >