Question: What are the best and most common ways to achieve fuller, but still natural-looking, lips?

1. Injections of different injectable materials.
Collagen and Restylane ® are the most popular temporary solutions. These can be done in the office (outpatient) and take about 15-30 minutes with local numbing cream (topical) or injection (nerve block). Collagen usually lasts about 3-4 months, Restylane about 6-7 months.

2. Fat grafting to lips.
This procedures can be done under local anesthesia but is frequently done with other surgical procedures. Fat can be permanent but its lasting affect is unpredictable, especially when it comes to the lips as the frequent movement tends to allow more of the fat to reabsorb than fat grafting done in the cheek or under-eye area. Only about 10-20% may last long term. It may require repeat procedure 3 months later. This procedure needs to be done in the operating room.

3. Surgical enhancement.
The most permanent way to augment the lips involve more advanced surgical procedures done under general anesthesia such as V-Y lip advancement to increase fullness of lips. In some cases, an upper lip lift can be used to shorten the upper lip and improve upper incisor. These types of surgical procedures require the use of the operating room and anesthesia.

For more information on lip augmentation, please read Dr. Svehlak's article "The Perfect Lips: In Search of Size and Shape", from the Sept 2003 issue of Plastic Surgery Products Magazine.

Question: Do I need to lose weight before seeking liposuction, a tummy tuck or body lift surgery? Or, will those procedures help me lose the weight and motivate me?

Liposuction is a body sculpting tool, not a weight loss solution. Ideal candidates are typically within 10 or so pounds of their normal/ideal weight for their body type and frame. Liposuction targets areas of the body resistant to diet and exercise, for example, a woman whose thighs have always been out of proportion with the rest of her body. She could be in great shape, exercise, and follow a healthy diet, but due to hereditary factors, her thighs will always look out of proportion. Liposuction/liposcuplting can correct this.

Tummy tucks and body lifts include the removal of fat, but excess skin is also removed. During these procedures, liposuction is first used to remove excess fat, and then loose skin which has lost its elasticity is also removed to beautifully contour the body and tighen the skin.

The bottom line is this: Potential patients who are 15-20% overweight or more should focus on reducing their weight first, whether that means a weight-loss program or, in more extreme cases, being seen by a bariatric doctor first for gastric bypass or other types of obesity surgery.

If a patient has lost a lot of weight and has problems with hanging skin, or if they are slightly overweight, then we can do cosmetic surgery like liposuction, tummy tucks, or body lifts.

Question: OK, I've heard all kinds of conflicting information-- is fat grafting permanent or not?

In my experience 90% of people get a lasting result in the cheek and under-eye areas with fat grafting. It is expected that a portion of the fat that is injected will re-absorb in the months following surgery (typically 40-50%). The rest should remain permanent, and most people do get a lasting result. A few, I'd estimate maybe 10-20%, may need a little more fat injected 6-9 months later. This "touch up" of sorts does cost some if needed, but typically it's much less than the inital surgery and simply covers the overhead costs such as OR room and/or anesthesia.

I have found that people who smoke do not get a lasting result.