Before	After

Classic beauty has traditionally included full-bodied lips. This has been the case throughout the ages and in all cultures. Artistic images depicted in history and works of arts by “Masters” have typically shown the beauty of full-bodied lips. It is a desired physical trait that is not always found.

Many women have often found themselves in the unenviable position of applying lip-liner to enhance their existing small lips. Acquiring this look often becomes a task rather than an enjoyment. The application of lip-liner is often limited because the lip starts to look distorted extending outside of the natural soft curves.

Today many women, and to a lesser extent men, are seeking to enhance or augment their lips through different means. Presently, patients have the option of using a variety of different fillers. They can choose collagen injections (bovine or human), fat injections, implantation of the patient’s own fascia, implantation of SoftForm® (a gortex material), or implantation of Alloderm® (human connective tissue). The patient’s individual needs are scrutinized and a recommendation made to best suit the patients desire, anatomy and lifestyle.

There are some other products pending FDA approval such as Restylane® (Hyaluronic Acid). Many more are being introduced every year. We will do our best to bring you the latest advances in this field. Patient safety comes first however, and until the product has been proven, we will not offer it to our patients. Always ask.

PROCEDURE
If your lip enhancement requires an injectable product, it will done so at the office. In most cases, local anesthesia is not used because it distorts the normal anatomical landmarks, therefore making it very difficult to shape the lips. Sometimes a topical anesthetic cream can be applied but it is frequently not necessary. Dr. Perez-Gurri will introduce the filler material through a small injection and distribute the material as to enhance your particular needs. If Collagen® (Bovine) is used, a skin test needs to be performed thirty days before the actual treatment. This is a must so that we minimize the patient’s chances of an allergic reaction.

Lip enhancement through the use of Alloderm® is a small surgical procedure performed in the office under local anesthesia. Although none of the above-described methods is permanent, the use of Alloderm® offers a longer lasting effect than the others. Lip enhancement or augmentation with the use of Alloderm® is, at the present, our preferred method. Alloderm® is an allograft, this means that the tissue obtained comes from a human donor (cadaver). Like kidneys, hearts and corneas, individuals or their families frequently donate the skin. The FDA has set up strict guidelines for processing to minimize the transmission of disease. First, the epidermis (or outer layer) is removed, along with all of the cells in the dermis. What remains is a collagen matrix that provides the strength to the skin. There are no components left to cause rejection or inflammation that can result with unprocessed tissue transplants. The material is processed in such a way that pathological agents such as HIV, Hepatitis and others are screened against in the donation phase. The tissue is freeze-dried for transport and once it is opened for the procedure, it is reconstituted (or rehydrated) in saline. The alloderm piece can now be rolled and shaped to accommodate the area of enhancement.

A local anesthetic will be administered via injection into the nerves that give sensation to your lips. After allowing sufficient time for the anesthesia to take effect, Dr. Perez-Gurri will make two small incisions on the inside of the lower and upper lip. The incisions are connected by creating a small tunnel between them and the Alloderm® is then introduced into this space. The incisions are closed and your lips are done.

POST-OP RECOVERY
The Alloderm® gradually becomes part of your own tissues, and feels like your own tissue. This process takes a while with complete incorporation into your tissues between 2-3 months. Initially the lips will feel firm and will be quite swollen. The lips will also be numb for an extended period of time that varies with each patient. Most patients require 5-7 days before returning to work.

You will experience a feeling of tightness and discomfort in the first 24-48 hours. Bruising and swelling is sure to follow reaching its peak at 48-72 hours postoperatively. This is normal. We urge you to apply ice compresses to help reduce the amount of swelling and bruising. We will need to see you within the week to remove sutures. Every patient is unique and will recuperate differently. If you feel great, don't over do it.

COMPLICATIONS OF LIP ENHANCEMENT
Although complications are not frequent and percentages will vary, you need to be aware that the following complications may occur:

KELOID OR HYPERTROPHIC SCARS, SENSORY NERVE DYSFUNCTION
HEMATOMA, CONTOUR IRREGULARITIES, HYPO OR HYPERPIGMENTED SCARS, DISTORTION, INFECTION, LOSS OF TISSUE, RESORPTION OF THE GRAFT w/LOSS OF VOLUME

Some of these complications if severe enough, may delay recovery time, require further surgery for correction at additional costs and may involve other specialists within the medical field. Please be aware that smokers, diabetics and overweight individuals have a higher incidence of complications when compared to those who don’t smoke, have diabetes and/or are overweight. You should also note that patients undergoing combined procedures also have a higher complication rate than those undergoing a single procedure.

WHAT & WHAT NOT TO EXPECT
These procedures are considered enhancing in nature. They are not meant to totally change someone's looks. We have found that one of the key factors in achieving patient satisfaction is patient expectation. No guarantee implied or in writing is given regarding how you will look postoperatively. All attempts will be made by Dr. Perez-Gurri to satisfy your requests, within reason. The end point of this surgical procedure is to make your lips look better and enhanced. Please note that all individuals are unique and will require a different surgical approach. A suggestion is made by Dr. Perez-Gurri based on his professional experience as to the procedure(s) best suited to achieve your aesthetic goals. Remember that many things are taken into consideration but the one limiting factor is the skin elasticity and availability of good tissue.

There seems to be an inverse relationship with expectation and satisfaction. That is, the higher the expectation, the lower the satisfaction. Body image is unique and what the patient frequently sees may not be what is seen by the surgeon. Therefore, it is important that you become keenly aware of your expectations for the procedure, know its limitations and fully discuss any concerns that you may have regarding the procedure with Dr. Perez-Gurri. We encourage questions and have allowed ample time to answer them personally or with our literature and videotapes. Please realize that the results obtained through lip enhancement are not permanent. All materials used are eventually absorbed by the body. We have found that Alloderm® is the substance with the longest duration when compared to currently available products.

OTHER QUESTIONS
How long does the procedure take to perform?
It will vary from 15-20 minutes for Collagen® (and other similar products) to 1 hour for Alloderm®.

Are my results permanent?
No. At the present time there are no filler products approved for use by the FDA that have any degree of permanency. Collagen® may last 4-6 months whereas Alloderm® may last about 1-2 years. After 1 year many patients will find that there is some residual.

Can I re-do my Alloderm® at a later date?
Absolutely.

The above information has been compiled as a benefit to you. We hope that this document has served to better inform you on the proposed procedure. We encourage dialogue. Dr. Perez-Gurri and his staff at Imagos Institute of Plastic Surgery, Inc welcome your questions.

It is our sincerest wish that your surgical experience at IMAGOS INSTITUTE OF PLASTIC SURGERY, INC. be a pleasant and informative one. We recognize that all patients will experience pre-operative anxiety and fear of elective surgical procedures is normal. Our trained professional staff and doctors are here to serve your needs and answer your questions.