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Your Lip Augmentation: Fat Transfer or Fillers?

Blog post - before after photos fat transfer lips cheek facelift neck

Before and after photograph of lip enhancement with fat transfer. Fat was placed in the upper lip, lower lip, cheeks, and under eye areas to augment volume and increase definition. Patient also had revision facelift and neck lift by Dr. Chaboki to improve the jawline and neck.

Lips with volume, definition, and smooth skin are common requests among lip augmentation patients in Washington, DC. Lips thin gradually with time, but can also be thin from a young age too. In addition, wrinkles develop around the lips and smile lines from volume loss and sun damage.

Cosmetic enhancement of the lips and area around the mouth (smile lines) can be achieved with a variety of treatments. Facial fillers made with hyaluronic acid gels to plump the lips are available in every plastic surgeon’s office, which include JUVÉDERM®, Restylane®, and BELOTERO®. Gradually dissolving over time, these fillers offer results that last several months. Some people, however, are looking for more permanent lip augmentation and consider fat transfer over filler.

Fat Transfer to Lips

We’ve previously reviewed facial fat injection, also known as fat transfer. During this procedure, your own fat is obtained via gentle liposuction of the abdomen or thighs and immediately reinjected into desired facial areas, such as the lips, cheeks, etc. The entire fat transfer procedure itself usually takes less than hour. Fat transfer procedures fall under the general term of liquid facelift and considered part of the spectrum of regenerative medicine.

Regenerative medicine broadly involves three areas: stem cells, growth factors, and platelet rich plasma (PRP) or platelet rich fibrin matrix (PRFM). Stem cells are cells that may exert a regenerative effect on surrounding tissue and are naturally present in fat transfer procedures. For example, skin may appear smoother with fewer wrinkles beyond the volume augmentation itself after fat injection. The mechanism of this possible “stem cell facelift” effect remains poorly understood.

How much fat is injected into the lips?

The total volume of fat for the face, including the cheeks and lips, may be similar to volumes when using fillers. However, fat transfer is one treatment, while facial filler injections may be gradual over time. In addition, plastic surgeons usually don’t want to “over inject” the face or lips with fat. Typical facial fat transfer volumes for the lips and smile lines may range from approximately 2cc to 10cc, but each patient and surgeon will determine together the volume and areas of injected fat.

Recovery after fat transfer to lips

Downtime and recovery after fat transfer is usually worse, as compared to lip injections with fillers. Think a recuperative period of weeks instead of hours or days. Patients should anticipate much more swelling, bruising, stiffness, and chapped lips initially. The lips will also appear overdone at first with fat transfer due to swelling and bruising before shrinking back down.

Lip volume

Both fillers and fat add volume to the lip. The amount of volume added is largely dependent on the volume of fillers or fat injected. Being living tissue, fat may have more unpredictability with volume as a portion of the fat may dissolve or be absorbed. In addition, fat may fluctuate in size before settling down.

Lip shape

Plastic surgeons customize lip injections with facial fillers to enhance and restore a desired shape. Fillers can be injected in the white or red part of the lips, lip line, sides, center, etc. Fillers can be used somewhat similarly to a lip liner to add definition. Fat transfer, however, might not modify the shape of the lips as much as compared to fillers. Fine tuning of the lips is better with fillers.

Fine wrinkles of the lip

Fat transfer does not really treat fine wrinkles of the lips and perioral area. Facial fillers are a better option than a fat to address these wrinkles. These fine skin wrinkles can also be treated by other nonsurgical treatments, such as BOTOX® or Dysport® injections or skin resurfacing with a chemical peel or laser.

Lip feel and sensation

Feel and sensation are very personal, so it’s difficult to compare. Neither may have an advantage with regard to the way the lip feels and sensation. Both may have irregularities, bumps, and nodules. Being gels, facial fillers might be considered softer than fat.

Lip movement

Facial fillers and fat transfer are also considered similar in regards to lip movement, such as smiling and kissing. Gels and fat conform to the lips during movement.

What if you don’t like it?

Advantage here is for fillers. Being temporary, results will gradually go away with time. Hyaluronidase may be injected to dissolve facial fillers faster if desired. Removing fat after fat transfer is generally considered very difficult and not recommended. Another surgery is required to remove a fat and may cause undesired results.

Blog post - before after lip enhancment facial filler injection

Before and after photograph of lip enhancement with facial filler injection. JUVÉDERM was placed in the lip line and main portion of the red lip to augment volume and increase definition.

Permanent lip enhancement

Fat transfer procedures are considered “permanent.” However, some patients may need or want additional volume enhancement with another fat transfer. Many plastic surgeons will wait at least 1 year before proceeding with another fat transfer procedure.

Facial fillers are not permanent. Permanent materials, such as silicone, should never be injected. Solid implants should be the only permanent material considered for cosmetic enhancement, such as cheek and chin implants. Other than fat transfer to the lips, other “permanent” lip enhancement procedures include lip lift surgery.

An upper lip lift is the only method to reduce the excess skin that develops with age. Not only does the lip become thinner with time, but the upper lip also becomes longer and flatter with age. An upper lip lift is a minor cosmetic procedure to reduce this excess skin and create fuller lips. This cosmetic lip surgery can be performed on its own or combined with a facelift, eyelid surgery, or other cosmetic procedures.

What is best for the lips?

As with any cosmetic procedure, there isn’t a “best” option for the lips. For most patients, facial fillers will be the top choice, especially for those who wwant naturallooking and feeling lips with minimal downtime. We’ve previously reviewed facial fillers as “lipstick in a syringe.” Have an event in a few days you want to look your best for? Then a facial filler injection may be the best option.

For those patients who plan a facelift or eyelid surgery and seeking a more “permanent” solution for thin lips, fat transfer is an option to consider to add volume. One potential benefit of fat transfer is that it can be very long-lasting and considered “permanent.” Keep in mind, however, that the face continues to change and age with time, so even plastic surgery with fat transfer may not “permanent” per se. Another possible benefit is the potential regenerative effect of using living fat as part of a stem cell facelift.

Have your considered lip augmentation? Speak with a trusted surgeon who specializes in facial aesthetic procedures. Give my office a call at (202) 800-2025 today to schedule your first visit.

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    Houtan Chaboki, M.D.