Questions and Answers Regarding The Lips

Sunday, January 30th, 2005 5:01 PM Here are two questions received from email: First Question: "I want full lips but I am not sure. Thank you for all your information." Answer: There are better ways to make the lips what we want them to be than just by making them fuller.  Some lifting can be done. I would like to explain this to you. It can make lips more full or not. It is adjustable and reversible and the fullness can be added a little at a time as desired. The young lady in the following pictures had only the injection adatosil, because that was all that was needed for the look the she wanted to have. It is permanent and does not go away in a few months.         Before                After                     Before  Smile            After  with Little and  Big Smile     Fifteen minutes after permanent lip enlargement by injection of fda approved  adatosil                            L                                           L           Before                After                    Before                After                  Before             After                    L                                      L                                     L Fuller is easy. But making fuller without proper design and without lifting,  can sometimes result in a duck look or can cause the lips to obscure the teeth while smiling if there is no lift and shortening of the upper.        This blonde girl on the lip page has Gore-Tex implants with no lift. The teeth still show, and she has been happy for about 3 years. She is on the lips pages of our web site.                This young man has had a lip lift with no implant at all. All of this patient’s full size pictures are in the office, and you may click on the pictures to enlarge the images. You may also see him in the lips section of this website. This patient’s lip procedure is different from one that just makes the lips fuller; there is actually a lift involved. The upper lip was actually shortened and given more curve. All of this is a matter of choice and can be designed according to each person’s preference.  Optimally, when using fillers like silicone, lip fullness can be added a little at a time so as not to do too much and to make sure you can get it “just right”. With a combination of these techniques (lifting, shortening, curving, silicone or other filler injection, etc.), we should be able to create lips that you and everyone will like. As usual, you can feel free to design them yourself. Just draw the lips you want on your photos and send them to me and consider it done. Thank you for your question. William Morgan, M.D., F.A.C.S. Next Question: Hello, I'm very impressed by the before and after photos of lip lift surgery performed at your clinic. I'd like to have a consultation, however, as I'm in another state, I would appreciate it if you could please send me an estimated price of what the surgery usually costs. I'm interested in scheduling a consult and (hopefully) having the surgery, but I'd like to have some info. on the cost, so that I'll know if it's something that I can afford at this time. Thank you,   Here was the  reply:   Hi Lisa:   Thank you very much for appreciating our work. We can do different types of injections and surgery to lift and shape the lip without any scars The best implants in the lip are the patients own tissue and this is often used, The cost of injections can be as little as two hundred dollars  for temporary materials such as collagen or hyaluronic acid. To have the lips made permanently nice and beautiful can involve a small surgery with no scars, and could involve lifting and shaping and includes injecting or implanting permanent material such as adatosil or teflon cloth, can cost up to three thousand for more complicated cases, more or less, depending on how much work is involved.   There are many important considerations in making nice lips. The beauty is in the details. Some of these routine considerations that are routinely designed by drawing on the patient's pictures are shown as follows:   1.      Wrinkles should be minimized, and  lessened or eliminated 2.      Skin and pink area colors and color of the junction of skin and mucosa need  to be made symmetrical, regular and of a  beautiful, designed and chosen natural appearance 3.      Philtrum, size, shape depth, position (the curve or valley between two little vertical ridges in the upper lip, which give the upper lip shape instead of being flat.) 4.      Cupids bow ( the two little points and the curve between them at the line of the junction of the mucosa (pink area) and the skin 5.      Curve of the upper and lower lips on the profile view. This curve becomes straighter with each decade of aging.. 6.      Fullness or pink (mucosa or vermillion) showing. 7.      Length of especially the upper lip which becomes noticeably longer and less mobile as well as thinner with aging. 8.      Position of lip line to the teeth with smile and with the lips just parted and not smiling 9.      Position of lip lines with smiling, laughing  and with normal talking and animated speech 10.  Curve of margin of the junction of mucosa and skin especially on the side or quarter view appearance 11.  Curve of mucosal margin over mouth must be totally natural in shape and movement 12.  Stiffness, softness, and movement with speech and smiling. 13.  Must look good from side, front, and all views. 14.  There are more than a dozen fillers (Radiance, Artefill, Restylane, Perlane, Collagen, Adatosil, Silicone, Silikon, Gore-tex and other forms of threaded material are a few)   These are some of the variations that need to be considered to achieve the desired result. We hope to see you and get a chance to meet you someday.   If you would like, we could look at pictures of the lips with front and side views of  lips parted, smiling and non smiling and let you know what can be done and give you a better idea of what the procedure. permanence, recovery, resulting appearance and cost would be.    Thank you. Yours truly,   William Roy Morgan M.D., F.A.C.S. 1419 Superior Ave #2 Newport Beach CA 92663 ph 949 645 6665  fx 949 645 6784 web site wrmorganmd.com

How much improvement can one expect?

This is a crucially important question. The best answer is to see the improvement in advance.

Generally this can be seen in the pictures of the faces that are shown here on this web site and the many others that we can show in the office that are not on this web site. 

But in your specific face the best answer is to see the improvement in advance. Looking in the mirror with the doctor and holding the tissues of the forehead in more attractive positions is the standard traditional way of seeing how much improvement can be obtained in the face. This is simply done by holding the forehead tissues up and back or in whatever position looks best. 

We also answer this question for each person by using drawings. The drawings should be of good enough quality that the answer can be clearly seen. It is much like trying on clothes; you can see how they look on you. 

And with the drawings, the patient can take them home, and hang them up on he wall and look at them when in different moods. And her or she may get the opinion of others as to which looks best or how much improvement there is or can be. 

Then there is the question of how close the post-surgical appearance is to the drawings. You can see that for yourself by looking at any of the thousands of photographs of befores and afters and comparing them to the chosen drawings. 

We also have the opinions of hundreds of our patients who have had work done. A majority say that the results equal or exceed the drawings. You may see hundreds of these Results Questionnaires and the summaries of the answers to these questions. 

Anything that can be done with the fingers on the face such as lifting up and back or lifting eyebrows or the corners of the eyes up and back can be done with surgery. In effect, this is a preview. And even without drawings, most doctors look in the mirror with the person and discuss the possible changes and improvements in the mirror. Often, it is good to see that you and the doctor agree more or less on what is possible and most advantageous. 

The drawings have an advantage over looking in the mirror in that they can take more details into consideration, they can show more at one time, and they are more objective in that they can be studied and critiqued by anyone, anytime, and anywhere even without the subject being there. And they are much more permanent. In king Tut's tomb, the drawings would have lasted thousands of years if the tomb remained undisturbed. 

There is permanent improvement and temporary improvement. It is a good thing to emphasize and plan for the permanent changes of shape and form over the temporary. The face-lift is mostly temporary compared to the many changes that can be made and chosen in drawings that are permanent. We can make many persons appear permanently younger and more attractive without a face-lift. And those things can be explained to each person and shown to them in drawings. 

The amount of improvement is quite different for each person. The best estimate is with drawings. Looking at a lot of the results of surgeon's works in before and after photographs is a very good way of getting a general idea of what can be done. Beware of retouching of photos, especially those that are digital. Seeing actual film prints, slides and negatives in a doctor’s office is more of a sure thing. 

How long will the improvement last?

Those aspects of the face that are changed in shape such as the nose, cheeks, chin and even the eyelids and removal of bags around the eyes are very long lasting or even permanent. 

Those things that are accomplished by tightening and repositioning the skin are much more temporary. And so, tightening the skin of the face with a standard face-lift by itself may take 5 to 20 years off the person’s appearance in age. One way to express how long improvements will last is to say that if it takes 10 years off one’s appearance, the person will always look 10 years younger than if they had not had it done. And so it will take 10 years for their appearance to catch up to what it was in the beginning before anything was done. 

Thus, by that formula, however much younger a person looks in years is how long it will last. But on the other hand, even the tightening up or face lift is permanent in the sense that the person who looks 5 or 10 years younger will always look that much younger, no matter how many years go by. 

No operation can permanently prevent aging, but the individual never appears as old as s/he might have if the operation had not been done. The exact duration of improvement can be most accurately predicted with drawings that show the expected result. 

In Summary: The improvement is permanent in terms of the change in shape and structure, such as of the chin, under chin, nose, etc. Some looseness of the skin always returns. If a person is made to appear five or ten years younger, they should always appear that much younger than if they had not had the surgery. This effect is cumulative, in that if a person has two or three procedures, each causing them to look five years younger over a period of time, they may look a total of fifteen years younger as a result.

How is the surgery done?

The surgery is performed with the patient in a twilight sleep. The patient is given sedatives, tranquilizers and medicines to prevent any feeling of discomfort. Our anesthesia questionnaire shows that more than 94% say they had a pleasant experience.

With the person comfortable and mostly sleeping soundly, the work is done as planned with small sterile instruments made for this purpose. All of the instruments and equipment used are sterilized. 

While surgery is in progress the person is connected to a pulse oximeter, automatic vital signs monitor, and electrocardiograph. But most important of all, the person is always under direct observation of the surgeon and his nurses and assistants. 

Where is the operation performed?

It may be done in the federally approved, Medicare certified, outpatient surgery center of our office, or in the hospital. Most persons choose the office because it is more convenient and it offers greater privacy and safety with less chance of infection, and patients can avoid the added cost of a hospital bill.

We have had an occasional patient have consultation and laboratory work at the hospital both before or sometimes after a surgical procedure. 

But from the surgeries performed in our outpatient surgery center over the course of thirty-plus years, we have had a perfect safety record and there have been no emergencies.

Is there much swelling or bruising?

There is some bruised appearance in nearly every case. Usually this can be hidden by make-up within a few days or in one or two weeks. It is mostly gone in three weeks. Many procedures can be done without bruising.

Is there much pain?

No pain should be felt during surgery. After surgery there is a feeling of tightness and tenderness of the area for a few days. Our anesthesia questionnaire that has been filled out by every patient after surgery over the course of many years is available for your information. It shows that well over 90% are pleased with the experience. 

Will insurance pay for this kind of surgery?

Strictly cosmetic surgery is rarely covered by insurance.

How long does the operation take?

Careful surgery may require one to several hours.

Are bandages worn on the face?

In most cases no bandages are needed. If they are used, they will be removed the second day following surgery. We find that little plastic drains that cannot be felt by the person are much more comfortable than bandages when needed. 

When are the sutures removed, and is this painful?

There are no scars and no external or visible incisions. If there are hidden sutures, some sutures may removed within the first week. Some sutures are removed each time you are seen over a period of one to several weeks. There is no real pain with suture removal. Each suture removed may feel like one hair being plucked from the head and should not even feel that much. Usually there is no sensation or just a tickle with suture removal. 

Are there any scars?

Cosmetic surgery should produce no scars and no signs that it was ever done.  The location of the incisions can be drawn on the patient to show where they will be. Most patients heal well and do not have any visible scars.

How long is the recovery period?

A day or a week or so depending on what is done. You will be given the specific information that applies when you are seen.

How long before I will be presentable in appearance after a lip-lift?

Most patients heal well and do not have any visible effects except for the enlargement of the lips. Occasionally there is a bruise, but it can most often be covered with makeup the same or the next day.