Lip augmentation may be performed to augment one’s natural lip proportions or to restore volume loss which occurs over time. Newer hyaluronic acid injectable fillers provide a non-surgical technique for lip augmentation. Results may last up to 12 months. Filler injection is performed as an office-based minor procedure with little downtime. Fat injection is another option for lip augmentation, which may lead to more longstanding results. Fat is harvested from the patient’s own body stores, prepared, and injected within the lips. Fat injection for lip augmentation is performed in the operating room, commonly under conscious sedation, and may be combined with other operative procedures.

In addition to augmenting the vermilion (red lip), hyaluronic acid fillers may also be injected to correct wrinkles which develop around the mouth region. These so-called “smokers’ lines” are vertical wrinkles around the lips, which often become prominent over time. Several factors relate to the development of these lines, including facial aging resulting in decreased skin elasticity, smoking, sun exposure, and genetics. Hyaluronic acid fillers with low viscosity (for example, Juvederm Volbella) may be injected superficially to plump up and soften these lines. Correction may last up to one year. Filler injection of perioral rhytids may be performed alone or in combination with lip augmentation or other plastic surgery procedures. It is common for the vermilion (red lip) to lose volume during the aging process as well.

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What are complications of lip augmentation using hyaluronic acid filler?

Local complications may occur following lip augmentation. Most are temporary and may occur shortly after injection, including bleeding, swelling, pain on injection, and infection. Following injection, it is recommended to apply cold compresses intermittently for the first 24 hours to reduce the risk of bruising, swelling, and bleeding. A hematoma, although uncommon, may occur following lip augmentation. This refers to a localized collection of blood or ongoing bleeding within the lip tissues, which may result following injury to blood vessels. If localized swelling and severe bruising develop following lip augmentation, please apply firm pressure, continue to perform cold compresses, and contact your plastic surgeon urgently. Aesthetic risks may include over-correction, under-correction, nodularity, and dissatisfaction with aesthetic outcome. Patients return for follow up 1-2 weeks post-injection to assess results once swelling has resolved to determine if further augmentation is desired. Other complications may relate to reaction to the filler itself (called a granuloma), which may require injection with a reversing agent (hyaluronidase).  If there is personal history of cold sores on the lips, a prescription for antiviral therapy will be given prior to injection to take two days pre- and 5 days post-injection to reduce the risk of a cold sore outbreak.

What are other complications of lip augmentation specific to fat injection?

Since lip augmentation using fat requires a new blood supply to be established, resorption (or incomplete fat graft take) is another risk to consider. Slight overcorrection is generally performed at time of fat injection to allow for partial resorption over time. Areas of fat necrosis may occur where the fat does not achieve an adequate blood supply, which may result in regions of nodularity. These may improve following massage and scar maturation, however minor surgical revision may be required if concerns persist.

When may I return to work and exercise following lip augmentation?

Patients are generally able to return to work the day following lip augmentation. I recommend for patients to refrain from exercise for approximately one week following hyaluronic acid filler injections and 3-4 weeks following fat injections. These precautions may lower the risk of bleeding and further swelling.

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