Lip enhancement (enlargement, augmentation) deserves mention separately from other forms of facial contouring for two reasons. First, not all materials used for facial contouring are suitable for use in the lips. Second, lip enhancement is one of the most commonly overdone cosmetic procedures and has produced some serious complications as well as some results prime for parody (look for Goldie Hawn doing a halibut imitation, or for an alternative piscan analogy, the “trout pout,” in the movie The First Wives Club).
Lip enhancement is performed to reduce wrinkles, to change contours, or both. Over the years injections and implants have been used in lips. Implants have included autografts (fat, tendon, dermis), biological materials (collagen), and synthetic materials such as ePTFE.
Lip augmentation is an office procedure performed with local anesthesia with or without sedation. Depending on the material used, the procedure may take the form of an injection or a surgery performed through incisions made inside the mouth. The most recent trend has been away from permanent fillers to temporary or semipermanent materials. The current fad for “bee-stung” lips so far shows no sign of waning and nonmedical products, such as lipsticks containing topical irritants and other “plumping” substances, fl ood the market.
The bottom line: Lip enhancement can dramatically alter a person’s appearance. The options for lip enhancement are more limited than are those for other areas of the face. Complications can be difficult to manage. A shifting filler or an improperly performed procedure that results in an undesirable mouth contour will be extremely disturbing to the patient.
The Latin word for chin is “mentum,” and an operation that enhances or reduces the chin is called a mentoplasty. Chin enlargement can be accomplished either by inserting an artificial implant or by cutting and advancing the lower jaw.
If the jaw surgery includes the teeth, the procedure is considered orthognathic surgery, which is major surgery performed on one or both jaws to improve tooth alignment, correct facial deformities, or simply alter one’s appearance. Orthognathic procedures are considerably more extensive than chin surgery alone and have the potential for more serious complications. Some plastic surgeons perform orthognathic surgery, but in most communities these procedures are performed by oral surgeons.
A much less complicated procedure to enhance the chin entails cutting only the lower edge of the jaw and moving it forward. The bone is wired or plated to hold it in its new position. Jaw or chin recession/ reduction is also possible either through an orthognathic operation or by a more limited procedure that removes the bony prominence of the chin.
Chin surgery can be performed alone, but surgeons also suggest this option to some patients seeking rhinoplasty in order to balance the facial profile. In this situation, computer imaging can be useful. General anesthesia is recommended for patients contemplating all but the simplest procedures. After surgery the patient can expect swelling and bruising for several weeks. Procedures on bone usually will cause more swelling than will the insertion of an implant. The final effect on the patient’s profile may not be evident for months. Risks include damage to the nerves along the edge of the jaw, which can cause permanent lip and chin numbness; infection; and deformity related to poor positioning.
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