Posted on September 5th, 2010
Posted by Julene
Okay…I’ve about had it…I am getting really, really tired of seeing really awful lip augmentations. It’s no wonder that, as I embark on a series of lip augmentation treatments for a new patient, that I need to park it on my stool and have an honest discussion of the goals of the procedure. In fact, I often spend a good bit of time at the beginning of many new patient consultations calming valid patient fears. I believe many of the fears that a new patient shares with me are founded on the fact that the bad results are out there…everywhere!
As I tell my patients, especially those who do not know me well yet, plastic surgery is very simple…if you have a plan, a good aesthetic sense, and a good understanding of what the patient wants. Of course, we always have to plan for the unexpected, but in reality, the unexpected is a rare event.
As far as lips are concerned, there is a natural, very beautiful shape to the upper and the lower lips. Rarely, should we ever augment the upper lip exactly as we do the lower lip, or with the very same amount of injectable product. The aesthetic goals may be to ease lip lines, shape the lips, or to make them fuller. As a surgeon, I don’t have to always have the goal of making the lips fuller, and this is perhaps what amazes and scares patients the most…that their lips will be HUGE after the procedure. I think that fear stems from the fact that some lip injection results out there look, simply put, like “sausages up and sausages down”! The poorly done lips have lost all sense of natural beauty and proportion in the attempt to create fullness. Sometimes they look very irregular and lumpy.
The upper lip should maintain a Cupid’s bow shape, have natural eversion (or pout) at the border of pink lip vermillion and white skin, and have a central fullness that tapers down gracefully to the outer corners. The lower lip should have a natural pout as well, and central fullness, and the lips should maintain a proportion of fullness; that is, the lower lip should be 1/3 fuller than the upper lip (ie, the upper and lower lips have a fullness ratio of 1/3 in the upper to 2/3 in the lower). Too often, as injectors create fullness, they will continue to inject only the upper lip, and this eventually causes an imbalance in the upper and lower lip proportionality, with the upper lip overbalancing the lower lip.
I love to inject lips, and I will tell patients these things, so they better understand my recommendations, and also so that together, we can maximize benefit and reduce overall cost of the injectable materials as we maintain youthful lip contours.
What are my favorite lip injection materials? I love the hyaluronic acid products, such as Restylane and Juvederm, because they are so malleable and longlasting. I dislike the permanent products, because they are too artificial looking, too stiff, poorly animate, or because they are…too permanent. They are less flexible as the patient ages, and cause more problems than they fix in my opinion. They do not replace “like with like”, because what we lack often in hypoplastic lips is collagen that provides fullness, or fat…not Goretex or mineralized bone pieces. I like fat injections also, if the patient has fat which can be harvested, although the cost is a bit higher than the shelf products, due to the harvesting step required for fat transplantation and the preparation process necessary to ensure good fat healing and retention.
Lip augmentation by injection of Restylane or Juvederm is an office procedure in my hands, under just a numbing cream and ice, although we also provide lip blocks as well upon request. My office employs 2 nurse injectors, in addition to myself, and we use injectables that last 9 to 12 months or more. The cost depends on how many syringes are needed. I will often treat lip lines by just injecting along the lip edges, and this has the added benefit of shaping the lips better and creating a bit of lip eversion which is very pretty. Injecting the lip edge stretches the lines smooth, and prevents the need to inject each of the vertical lines, which is more painful and can cause ridges where the wrinkles used to be. Injecting just the lines themselves also too often distorts the lips. After the lines are corrected, more product can be injected if desired to create as much fullness as the patient needs. Swelling is temporary, bruising is rare, and both usually dissipate within 24 hours.
Beware…a great lip augmentation can be very addictive!!!
So go ahead…pucker up!!!
Posted on August 30th, 2010
Posted by Julene
Unfortunately, there was some negative publicity last week in our plastic surgery community. This led me to some introspection regarding my chosen profession (cosmetic plastic surgery), and I wish to share a bit about some personal thoughts on the matter…thoughts I seem to have quite frequently.
I have often considered myself very blessed to have discovered a profession which allows me to inject a lot of myself in the care of my patients, very many of whom are female, and I love what I do. After many years of rigorous college academic preparation, medical school, two surgical residencies, and years of clinical practice, I feel I have earned the true honor of getting to know and care for my female patients. I respect them, I value their intellect and understanding of the cosmetic plastic surgical process and experience, and I really value the relationships I have built with my patients over the years. It never ceases to awe and amaze me regarding the amount of trust that is required of any surgical patient when they elect to undergo a surgical (or even non-surgical) treatment by a surgeon.
These patients may know us well already at the time of their treatments, or they may have just come to us upon the recommendation of a friend, family member, health care or other professional, but at some point, they make the decision to allow me to operate on them, or to treat them in some way. I (personally) do intensely feel a weight of responsibility to provide the best treatment experience available to these patients, and do truly feel honored to have been chosen by them. I think that if all physicians felt this degree of intimacy and privilege with their patients, that we would never read or hear of some of the negativity that sometimes surrounds this profession…lawsuits, sexual misconduct, poor outcomes from poorly selected procedures, or procedures performed on poorly selected patients, lack of attention to safety measures, lack of sound surgical judgement in selection of procedures or their combinations in properly accredited facilities, and on and on…
I am very proud of the road taken which has led me to the place where I believe my patients have selected a plastic surgeon who truly cares about them, involves them in sound surgical decision-making prior to embarking upon a plastic surgical plan, and a surgeon who has strived to maintain the highest standard in achievement of excellent surgical results.
My advice to prospective patients has always been to do your homework, insist upon open and honest communication, ask questions, seek referral opinions of other patients and professionals, pay attention to board certification and membership in aesthetic and professional societies, look for involvement in new research and technology, and maybe above all, look for a great feeling of rapport and even friendship with the surgeon you choose. If it doesn’t feel “right”, it probably isn’t, and don’t just look for the cheapest price in making your final decision. You deserve a surgeon and staff with whom you can foresee a long and enduring relationship. My staff and I believe that anyone can be fooled once, but it is the returning patient we feel who most honors us in our endeavors to be the best small practice around.
Posted on August 11th, 2010
Posted by Julene
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