Temporary Injectables For Lip Augmentation
Temporary products will require costly maintenance but are embraced by many because they are eventually resorbed and with that comes peace of mind.   With a temporary filler, you can attain the look you desire without the concerns of a permanent option.   You may wish to use temporary fillers to determine if you want to pursue more permanent options.  I prefer using temporary fillers which are proven as safe in the event of an adverse reaction of a more more permanent option which will be difficult to remove. 

Collagen

Bovine (cow)

Zyderm I, II, and Zyplast:  These were the original injectable fillers for wrinkles and acne scarring.  The FDA approved Zyderm in 1982.  These products are created by extracting the dermal collagen from the skin of cows which from a closed and isolated herd.  The collagen is then highly purified and processed into an injectable form which is suspended in a buffered saline carrier with lidocaine added as a pain reliever.  My first experience with lip augmentation in 1998 was with Zyderm. 
Manufactured by: Inamed Aesthetic, acquired by Allergan (Irvine, CA)
Made from: highly sterilized bovine collagen
Allergy Test:  Required.  A pre-test is needed which involves a small amount injected into your forearm.  You will have to wait at least 4 weeks to determine if you are likely to have an allergic reaction (affecting 3% of patients) before you can go back for a treatment.
Aesthetic Results: When the lip is manipulated and pinched, the product can be felt.  Blanching and lumpiness are possible with superficial injection.  The lips are less likely to hide the color of the product and lumpiness due to the nature of the lip skin.   Injection into the vermillion border also has been reported to result in blanching. I experienced both blanching and lumps several times, however, it was our only injectable option back then (other than silicone).  Do your research before deciding upon this injectable for lip augmentation.  This product is NOT recommended for under eye injections.  I would be hugely surprised if these products were used for lip augmentation anymore since the invention and approval of hyaluronic acid fillers.
How Long It Lasts: 3 to 4 Months
Cost: $250 to $350 per syringe
CE Marking: Yes
FDA Approved: Yes

Porcine (pig)

Evolence: This product is made from Type 1 collagen derived from the tendons of pigs which are kept in a closed and isolated herd.  The collagen is highly sterilized and crosslinked using their patented Glymatrix Technology which uses the natural sugar, D-Ribose and suspended in phosphate buffered saline.
Manufactured by: ColBar LifeScience Ltd, ultimately owned by Johnson & Johnson
Made from: porcine (pig) collagen
Allergy Test:  Not required
Aesthetic Results: Blanching and lumpiness are possible with superficial injection.  The lips are less likely to hide the color of the product and lumpiness due to the nature of the lip skin.  Injection into the vermillion border also has been reported to result in blanching.  Also, the massage required to keep this product from lumping can cause significant bruising.  This product is NOT recommended for under eye injections. 
How Long It Lasts: Up to 12 months
Cost: The cost of this product varies greatly with the region of the country you live.  The average costs runs anywhere from $400 to $700 per 1 ml (35 mg/ml of collagen) syringe
CE Marking: Yes
FDA Approved: Yes, however J&J discontinued marketing of this product and it was subsequently removed from the market.  The reports on the reason for removal was a combination of the recession and their financial spending on acquiring Mentor Corporation.  The product also did not fare well with the rivalry of hyaluronic acid fillers from competing companies.  However, there were many reports of lumpiness by patients and doctors. although this was not mentioned in their explanation of removal.

Human (cadaveric or autologous)

Cosmoderm I, II & Cosmoplast: These products are made from human fibroblasts created in a lab which his highly purified and suspended in buffered saline with 0.3% lidocaine for added pain relief.  Cosmoderm 2 contains almost twice the human fibroblast concentration as Cosmoderm 1.  Cosmoplast is crosslinked with glutaraldehyde for even longer augmentation results.  These products last about as long as bovine collagen but are considerably more expensive.
Manufactured by: Inamed Aesthetics, acquired by Allergan (Irvine, CA)
Made from: human collagen
Allergy Test: Not required
How Long It Lasts: 3 to 4 months
Cost: $300 to $600
CE Marking: Yes
FDA Approved: Yes

Cymetra: This product is made from micronized AlloDerm® Regenerative Tissue Matrix which is made from acellular cadaveric dermis.   The dermal tissue is heavily screened and free of DNA and disease.  The particulated dermis (330 mg dry) is rehydrated using lidocaine for added pain relief upon injection.
Manufactured by: LifeCell Corporation (Branchburg New Jersey)
Made from: acellular, micronized, cadaveric dermis
Allergy Test:  Not required, however patients with autoimmune disorders should not use this product.
Aesthetic Results: This product has been reported as producing lumpiness and blanching when injected into the lips.  Although some surgeons may use Cymetra for lip augmentation, others feel it may be better suited for dermal applications.
How Long It Lasts: 6 months
Cost: $600 - $900 per 1 ml
FDA Approved: Yes

Fascian: Fascian is made from irradiated human cadaveric fascia lata  This product was introduced in April of 1999.  Fascia is comprised of the lateral (outside) sheets of Fascia from cadaveric thighs.  Fascia is the fibrous wrapping that covers your muscles and some organs.  Its primary makeup is collagen protein and is very thick and dense.  Fascia is a firm, yet spongy, natural human tissue that can be used for soft tissue augmentation, acne scarring and other scars.  Some doctors have used it in the lips.
Manufactured by: Fascia Biosystems (Beverly Hills, CA)
Made from: particulated, irradiated cadaveric fascia lata (the thick covering of the human thigh)
Allergy Test: Not required
Aesthetic Results: This product has been reported as producing lumpiness when injected into the lips.  Although some surgeons may use Fascian for lip augmentation, others feel it may be better suited for dermal applications.
How Long It Lasts: 6 months
Cost: $300 o $500 per 1 ml
FDA Approved: Yes

Fibrel (sometimes incorrectly referred to as Fibril): This product is a three-stage concoction.  You must first have your blood drawn where it is then placed in a centrifuge.  The centrifuge spins your blood until the plasma rises to the top.  Your plasma (about .5cc)  is then mixed with a porcine-derived (pig) gelatin powder (similar to Gelfoam, although Gelfoam was removed from the market), e-aminocaproic acid, and sometimes saline and lidocaine.  The injected mixture causes an inflammatory response which triggers your own collagen to grow within about 3-6 months post-injection.  The swelling may be prolonged and the results are not completely predictable.  Also since the process is time-consuming and involves collecting your own blood, many doctors do not offer this product.  Over-correction is often recommended which can cause distortion until the swelling and inflammation subsides and some of the product is metabolized.
Manufactured by: Mentor Corp (Goleta, Georgia) - now owned by Johnson & Johnson
Made from: porcine (pig) collagen powder, e-aminocaproic acid, and your own plasma
Allergy Test: Not required, although some patients may be sensitive and have an allergic reaction to the e-aminocaproic acid.
Aesthetic Results: This product has been reported as painful and may not be the best option for lip augmentation. Although some surgeons may use Fibrel for lip augmentation, others may feel it is better suited for dermal applications.  Doctors will commonly use in their practice what they feel is best for their patients, however not all doctors will have the same opinion.
How Long It Lasts: 9 months
Cost: $400
FDA Approved: Yes

Isolagen: Isolagen is a product that is cultured from your own tissue.  A small, pencil eraser- sized (3mm) piece of tissue is removed from behind your ear using a skin-punch and it is sent to a lab where it is then cultured into more fibroblasts which takes about 8 weeks.  When injected, the fibroblasts encourages your own tissue growth which causes augmentation.  The Isolagen process is expensive and time-consuming, it must be carried out in 2 to 3 sets of injections 2 weeks apart.  Isolagen has no risk of rejection or allergy because it is your own tissue. 
Manufactured by: Isolagen, Inc.
Made from: your own tissue
Allergy Test: Not required
Aesthetic Results:  Unknown, although it reported to be like your own natural lip tissue.
How Long It Lasts: Unknown, although it is speculated to be years with dissipation only occurring with normal aging.
Cost: $1,500 for 1ml
FDA Approved: No, and it has been in review since application review acceptance by the FDA in May of 2009.  The review was supposed to be complete in January of 2010.   Their website is no longer valid, as well.  Isolagen has had a long history of attempting to raise capital for a private lab.

Hyaluronic Acid or Hyaluronic Acid Base

Belotero Balance™:  Belotero Balance is a hyaluronic acid based monophasic gel that utilizes a cohesive polydensified matrix.   If you are wondering why the American market needs another hyaluronic acid based filler, you may be happy to know that in European trials, patients who received Belotero Balance did not experience the bluish tinge (called the Tyndall Effect) when injected superficially.  I have experiences the Tyndall Effect under the eyes and in the lips as well, although the effect wasn't as noticeable in the lips. 
Manufactured by: Merz Pharmaceuticals, LLC
Made from: hyaluronic acid
Allergy Test: Not required
Aesthetic Results:  The result is similar to that of other hyaluronic acid fillers, with no bluish tint to the skin.
How Long It Lasts:  The company reports that the product may last up to 12 months
Cost: $400 to $500 for 1 ml
CE Marking: Yes
FDA Approved: No. The PMA was accepted into review by the FDA in September of 2009.  The PMA is for the study of Belotero Balance in the superficial wrinkles and mid to deep folds.

Elevess™:  Elevess is made from crosslinked hyaluronic acid with lidocaine for added pain relief.  Elevess was approved by the FDA approved in 2007, however, they never truly gained momentum like competing HA lidocaine products in the U.S. (Prevelle Silk, Juvederm XC).  This is unfortunate because it is a good product.
Manufactured by: Anika Therapeutics, Inc. (Bedford, MA)
Made from: crosslinked hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 6 to 12 months
Cost: $400 - to $700 a syringe
CE Marking: Yes
FDA Approved: Yes

Juvederm®: Juvederm is made from crosslinked non-animal hyaluronic acid gel and may last longer than non-crosslinked HA gels.  I have had Juvederm in my cheeks, nasolabials and once in my chin.  I found that it lasted about 6 months.  Juvederm XC also contains lidocaine.  I normally choose Juvederm for nasolabials, cheeks and the chin but have had it in the lips as well.  I have used Juvederm in the fleshy part of the lips and Restylane in the vermillion border and have been very pleased with the results. Juvederm Ultra Smile was recently introduced at the IMCAS and also has lidocaine added and is specifically formulated for the lips.
Manufactured by: Allergan (Irvine, CA)
Made from: crosslinked non-animal hyaluronic acid gel
Allergy Test: Not required
How Long It Lasts: 6 to 12 months, with natural tissue formation occurring from repeat injections. 
Cost: $400 to $700 per syringe
CE Marking: Yes
FDA Approved: Yes

Juvederm Ultra Smile®: Juvederm Ultra Smile was introduced on the market at the IMACS in 2010 and is made from crosslinked non-animal hyaluronic acid gel and contains lidocaine for added pain relief.  They report that the product is smoother than other monophasic HA gels and although it is visible when the product is compared side by side (not within tissue) to a product with 100,000 particles per ml (like Restylane) I don't know how aesthetically different it would appear once injected into the lips.   I do not see anything aesthetically displeasing with a product that has 100,000 particles per ml (Restylane).  However, I have noticed the difference between a product which has 10,000 particles per ml (Perlane) in areas requiring subtle augmentation.  In other words, I would use Restylane for the vermillion border and fleshy part of the lips, but Perlane only in the fleshy part of the lips.
Manufactured by: Allergan
Made from: crosslinked non-animal hyaluronic acid gel
Allergy Test: Not required
How Long It Lasts: 6 to 12 months, with natural tissue formation occurring from repeat injections. 
Cost: $400 to $700 per syringe
CE Marking: Yes
FDA Approved: Yes

Perlane®: Perlane is made from non-animal hyaluronic acid gel and has a larger participle size than Restylane. .  Perlane contains 20 mg/ml stabilized hyaluronic acid which contains approximately 10,000 gel particles per ml.  Perlane was the first hyaluronic acid product that I had injected.  I feel that there is more swelling associated with Perlane, but it gradually diminishes. Also feel that injection site lumping occurs more with Perlane than with Restylane.  However, this lumping diminishes within a few days. I personally feel that Perlane is better suited for deeper folds of the face or the fleshy part of the lips.
Manufactured by: Q-med (licensed by Medicis Pharmaceutical Corp in the US), which is possibly being acquired by Galderma (2011)
Made from: non-animal hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 3 to 9 months, with natural tissue formation occurring from repeat injections
Cost: $400 to $500 per syringe
FDA Approved: Yes

Puragen™, Puragen Plus™, Prevelle Silk™: Puragen and Puragen Plus are double crosslinked, non-animal hyaluronic acid gel products with Puragen Plus having 0.3% lidocaine for added pain relief.  Prevelle Silk has 5.5 mg non-animal hyaluronic acid per with 0.3% lidocaine added.
Manufactured by: Mentor Corp, ultimately owned by Johnson & Johnson
Made from: crosslinked non-animal hyaluronic acid gel
Allergy Test: Not required
How Long It Lasts: 3 to 9  months
Cost: $300 to $500 per syringe
CE Marking: All have CE Marking.
FDA Approved: Prevelle Silk is FDA approved, Puragen and Puragen Plus are pending FDA approval. 

Restylane®: Restylane is made from non-animal hyaluronic acid gel and is my product of choice for the lips and under eye hollows.   Restylane contains 20 mg/ml stabilized hyaluronic acid which contains approximately 100,000 gel particles per ml.  When I first started getting Restylane, it only lasted about 3 to 4 months, but with repeat injections I have found that I only need it once a year.  Although I do notice that the augmentation diminishes gradually over about 9 months, the dissipation is far less pronounced than before.  Ideally I would get injections twice a year to maintain a constant level of augmentation, obviously requiring less on this schedule than if I were to wait the full year.  Also, I only needed one injection in the upper eyelid and that was a few years ago.  Injection site lumping has been reported to occur in the lips (which I have experienced) but diminishes within a few days.
Manufactured by: Q-med (licensed by Medicis Pharmaceutical Corp in the US), which is possibly being acquired by Galderma (2011)
Made from: non-animal hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 3 to 9 months, with natural tissue formation occurring from repeat injections
Cost: $300 o $450 per syringe
FDA Approved: Yes

Stylage Special Lips®: Stylage is made from crosslinked hyaluronic acid and is designed specifically for deeper folds and lip augmentation (18.5mg/g 0.8ml).  However, Vivacy advises that this product has an added antioxidant property and is "IPN-like" (Interpenetrating Network-like).  Stylage Special Lips' contains lidocaine for comfort.  I must say thatI don't respect the fact that it can be bought at any online discount pharmacy.  Medical devices should be controlled and the lack of control by the company, or distributor, which supplies these products for online sales alarms me.
Manufactured by:  Laboratories Vivacy (La Revorre, France)
Made from: reticulated hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 6 to 9 months
Cost: $150 a syringe cost, cost to the patient unknown
CE Marking: Yes
FDA Approved: No

Succeev Three®: Succeev Three is made from hyaluronic acid of non-animal origin and is designed specifically for deeper folds and lip augmentation.  The product is very similar to what we have in the states.
Manufactured by: Sanofi-Aventis Medical Aesthetics (the same manufacturers of Sculptra®)
Made from: monophasic, non-animal Hyaluronic Acid
Allergy Test: Not required
How Long It Lasts: 3 to 4 months
Cost: $300 to $400 per 0.8ml
CE Marking: Yes
FDA Approved: No

Teosyal® Kiss and Teosyal® Deep Lines:  Teosyal is a hyaluronic acid filler made by bacterial fermentation from streptococci bacteria.  Teosyal Kiss is made specifically for lip augmentation (25mg per ml), whereas Teosyal Deep Lines (25mg per ml) is also suitable for lip augmentation.  There are several Teosyal products such as Teosyal Ultimate (22mg per ml) which is for deeper injections, the cheeks and chin mainly, and costs £600 per 3ml.
Manufactured by:  Laboratoires TEOXANE Geneva (Geneva, Switzerland)
Made from: non-animal hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 3 to 9 months
Cost: £200 to £400
CE Marking: Yes
FDA Approved: No

Varioderm® Lips & Medium:  Verioderm Lips contains 12mg crosslinked (with BDDE, butanediol diglycidyl ether) hyaluronic acid per ml which is their special formulation for lips.
Manufactured by:  Adoderm GmbH, U.S. distributor is in Napa CA
Made from: non-animal, highly crosslinked hyaluronic acid
Allergy Test: Not required
How Long It Lasts: 6 to 16 months
Cost: £200 to £400
CE Marking: Yes
FDA Approved: No

 

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