Question :

Dear Cosmetic Courses,

I did the basic course with you a while ago and wondered if you can give me some advice please.

I saw a patient recently who received Evolance in her lips a year ago from another clinic. She now has hard lumps in her lips (collagen I presume).

She asked me to add volume to her lips again and I’m not sure whether it is a good idea!

From my understanding, Juvederm will not cause further lumps, but I would appreciate your opinion.

Answer :

Thanks for your email.

Unfortunately Evolance, unlike Haluronic acid fillers, cannot not be dissolved and will absorb over time.

Overall we would advise the patient to let the Evolance absorb before injecting Juvederm.

It would be possible to inject into the areas without the lumps to improve the appearance but this would not be guaranteed to improve it and could make the situation worse.

Overall we would leave her alone if possible.

Good luck!

When you set up your own Medical Aesthetics practise, you will quickly find a Ghost that haunts you. You will particularly experience her looming shadow if you decide to offer Lip Filler treatments. But we can pretty much guarantee that her name will crop up over and over regardless. “I don’t want to end up looking like Leslie Ash!”: it is a plea from your clients that will become all-too familiar.

The Leslie Ash “Look” is certainly not high on most people’s aesthetic wish-list. You have most probably seen the recurrent pictures in the media of her now infamous “trout pout”. The unfortunate woman has been hauled over the coals as an example of Cosmetic Surgery Gone Wrong in every woman’s mag. article of that theme ever since her Lip Body treatment in 2002.

Ash originally claimed she had collagen Lip Implants to correct her disappearing top lip (an unfortunate but common side-effect of ageing) and maintain her image in the public eye. Ironically, the treatment had the opposite effect, bringing her notoriety for all the wrong reasons. Back in 2003, the actress typically told the Press that her permanently swollen, upwards-curled top lip was a terrible accident and the result of a reaction to the collagen in the implant. By 2010 she had conceded that it was not an implant at all, but an injection of liquid silicone (the same lethal cocktail responsible for the recent death of Claudia Aderotimi) which had caused the ridiculous effect.

“The Curse of Leslie Ash” is therefore that hundreds of women who would otherwise have considered lip-enhancing treatment have now been put off completely. And of those that do approach you for procedures, a large number will need reassurance that they will not leave your Clinic looking similarly over-the-top or caricatured.

In his talks to delegates attending Medical Aesthetic courses at the Cosmetic Courses National Training Centre, Mr Adrian Richards (Consultant Plastic Surgeon) is always keen to set the facts straight. For starters, there should be broader awareness of precisely which treatment Leslie Ash underwent: it seems very wrong that by initially shielding the truth, she has created mistrust and fear of both Lip Fillers and Lip Implants. Prospective clients do not realise that Dermal Fillers are not the same as the injections which she had, and can give lovely subtle enhancement to both the lip body and border (in the hands of a qualified, trained medical professional). Nor do they always understand that she did not have a Lip Implant at all and that it is therefore well worth investigating the potential of Permalip implants. In fact, Mr Richards highly recommends the Permalip implant as a method of augmenting the lip body: these implants come in a huge variety of sizes and shapes, are sculptable, safe and above all can be removed if necessary.

In contrast, Liquid Silicone injections, like Ash had injected into her lips by a plastic surgeon whilst at a friend’s house, is permanent. And as Mr Richards warns all his trainee Aesthetic Practitioners, ‘Permanent fillers cause Permanent problems’. In Leslie Ash’s case, the silicone set around the muscles in her lips and it is now impossible for surgeons to remove it.

So there you have it: of course, however silly the actress may have been, she is also incredibly unfortunate. She is certainly not alone, but possibly receives more publicity about the matter than most and will almost certainly be one of the names you come to regard as a bug-bear. Instead of getting irritated by this, however, try to see your role as educating your clients, so that others do not make the mistakes of Ash and others. With this knowledge, you can ensure that you offer only the best and most suitable treatments and therefore provide genuine reassurance that your clients will not walk out of your Treatment Room and straight into the Gossip Columns!

Lip augmentation treatment is a cosmetic procedure that is popular today among the routine cosmetic options that help women look younger. It increases the size of the lips. TheLip Augmentation upper and lower lip may be treated at the same time or one may be treated alone. On the majority of sites where patients can discuss their cosmetic procedures only 50% of the women who have had lip augmentation were happy with the results. It is a simple procedure that can have great benefits, so why do so many people regret having it?

Many plastic surgeons believe that the main cause of bad lip augmentation treatment is because the injector is inexperienced. Without thorough knowledge of the subject they tend to inject too much filler. Since it is easier to add more filler later than it is to remove excess, it is best to start with small amounts of filler and see the results.

There are different types of filler from fat to hyaluronic acid-base material such as Restylane and Juvederm. These are clear gel that is similar to what is found in the body. Fat is also a good filler because it is a permanent solution for most people. First, it needs to be harvested then injected into the lips. 30% to 50% of it grafts to the new location so it usually needs to be done twice to get the best results. Implants are permanent but sometimes are not put in the right place and end up looking lopsided. Any permanent cosmetic procedure needs to look right the first time. Otherwise, it is better to use the fillers that wear off in three to six months.

Recovery time varies. Injections take 1 to 2 recovery days but bruising and swelling may last a week. Implants and grafts take 1 to 2 recovery weeks and may be stiff for 2 to 3 months. Synthetic implants are good because they form scar tissue, so they stay in place and are never absorbed by the body, but there is the possibility of infection and rejection by the body. Fillers made from collagen taken from cadavers or cow skin can cause an allergic reaction even though the collagen is purified.

It is advisable to seriously consider whether or not lip augmentation treatment is a good idea. Even though significant complications are rare, there are risks depending on the chosen filler as well as the possibility of allergic reactions and scarring.

Full, curvaceous lips instantly light up one’s smile, making it so much more alluring and charming. Most certainly, a provocative pout exudes an air of confidence and sex appeal, making it the object of envy and desire.

Today, lip enhancement surgery is probably one of the most popular procedures in the field of aesthetic plastic surgery.

Despite the recent rise in demand for it, lip enhancement surgery is not a new invention. It has dated back to ancient times, when women have used plant dyes and coloured clays to enhance the appearance of their lips. In the 1980s, collagen injection was introduced, which soon became popular and widely adopted by practising surgeons all over the world.

Now a new graft technique in lip surgery has been recently discovered that can certainly bring a smile to those who seek a simple and safe procedure that can produce a more prolonged result and look.

A team of plastic surgeons from the Aesthetic Surgery Centre in Naples, Florida recently discovered the new breakthrough that involves the use of muscle tissues along the patient’s neck. To date, the team has successfully carried out the surgery on 25 patients.

According to findings which were published in the Archives of Facial Plastic Surgery, the lip graft can be carried out simultaneously with a facelift surgery. This new technique adds fullness and shape to the appearance of one’s lips and reduces any signs of aging around the area of one’s mouth.

Renowned cosmetic surgeon, Dr Anurag Agarwal and his colleagues have employed this latest technique on many of their patients by using segments of the sternocleidomastoid muscles along the sides of the neck as well as their connective tissues to add fullness to their patients’ lips.

Dr Anurag and team are confident that this new surgical advancement produces a more prolonged result, which can last for at least two years. The procedure is also straightforward with quick uncomplicated recovery. As soon as the swelling subsides in a few weeks, the patient gains the luscious full lips she desires.

The new technique has fared well with all its patients who think that it produces a more natural feel than using artificial filler or implant. Even though they are optimistic about its results, they also acknowledge that the technique is not perfect and cannot altogether eliminate the signs of aging.

According to cosmetic surgeon and past president of the British Association of Aesthetic Plastic Surgeons, Mr Douglas McGeorge, this new technique produces a far more permanent result.

He said that this technique certainly pose the same risks as in all surgery procedures however slight the risk may be. He also warned that if a patient has not performed facelift simultaneous to the lip enhancement, the removal of the neck muscle tissue may leave a minor scar along the hairline.

There are all sorts of theories on why women desire fuller lips, ranging from having the sex appeal of movie actresses to simply looking more desirable. Lip augmentation providing a go to procedure in order to produce the desired look. 

While thin lips betray age, full lips cover it up. Since lip augmentation, creates smooth, full lips and reduces the fine lines around the entire mouth, this type of procedure enhances beauty and appears to reverse aging.

In fact, the irresistible appeal of beauty and anti-aging has created all sorts of solutions, including the following:

*Injections of collagen, primarily collagen derived from cows, bovine collagen. The effects last for up to 4 months before requiring repeated treatment.

*Injections of Hylaform and Restylane, derived from hyaluronic acid that is similar to that naturally found in humans. The effects of Hylaform last for up to four months and the effects of Restylane last for about six months before requiring repeated treatment.

*Injections of Radiance, microscopic spheres of calcium in a water-based gel that stimulates collagen production and regenerates tissue. The effects last for about one or two years.

*Injections of autologous fat, derived from the patient’s own body. However, the fat is reabsorbed, although results last longer than collagen.  While this may seem like an ideal solution, there are side effects: lumps and scars form and different areas of the body have to be harvested with each treatment.

* Other injected substances include alloderm, derived from cadaver tissue, autologen, derived from the patient’s skin, fascia, derived from donated white connective tissue, gore-tex, derived from a synthetic material, and verafil, derived from saline implants.

Besides injections of various materials that the body does not reject, but which require repeated treatments, there are also surgical procedures like the V-Y lip-plasty, where internal incisions are made then sewn back to roll the lips outward to appear fuller. In addition, there is laser lip rejuvenation, where the lips are lifted and smoothed, thus tightening them because of the underlying support from elastin and collagen

However, there is now a new procedure that has been reported in Archives of Facial Plastic Surgery (AFPS), a medical journal. It uses the sternocleidomastoid muscles, the neck muscles, for grafts. These muscles, also known as SCM, turn the head and pull it to the chest. The AFPS study reported that after an average of two years, head movement remained unaffected. The new procedure appears to provide positive long-term results.

Much of the focus in plastic surgery lately has been moving north…to the lips! A simple lip augmentation can give you a dramatic and sensuous look with the fullness of celebrities like Angelina Jolie. This procedure can give you more self-confidence and balance your appearance. Since aging can cause you to lose collagen and volume in your lips, lip augmentation can even make you look younger!

But with something as noticeable as your lips, you should take care to make sure the procedure is done right. It is difficult to cover up a mistake right on the front of your face! If you are considering a lip augmentation procedure, take the time to research the best products on the market.

Restylane is one of the more common products on the lip augmentation market, and its results are quite promising. Unlike other injectable fillers like fat and collagen, this substance is a biodegradable gel that contains no animal products. It is based on hyaluronic acid, a substance found naturally in the body with the purpose of providing fullness and elasticity.

Lip injections with Restylane are fast, easy, and relatively pain-free. You do not even need a skin test, since the product is not animal-based and the risk of an allergic reaction is low. Because Restylane does not contain lidocaine like collagen, you may experience pain upon injection. Using a small needle, the gel is placed in the inside of the lips in little amounts. The volume it adds, though, is impressive. The entire procedure can take from just a few minutes up to half an hour, and you can go home shortly thereafter. The full recovery time is only about two to three days, and there are relatively few side effects besides some tenderness and swelling at the site of the injection.

Since Restylane is one of the latest developments in lip augmentation procedures, costs will vary by physician and location. But Restylane is sure to be a great value for your money, since it can stay effective for six months (much longer than other treatments). Using Restylane can enhance and regenerate your lips to add volume and shape. The product has also been approved by the FDA for the improvement of facial wrinkles, aging lines, and crow’s feet.

Lip augmentation can be risky. If done correctly, treatment therapies that give you firmer, fuller lips can make you look dramatic and stunning. But after seeing pictures of so many cases gone wrong, resulting in taut and comically large lips, you may be nervous to give it a try. If you’re looking for a natural and safe alternative way to increase your lip size, don’t turn to injections – give implants a try!

Life implants are a new trend in plastic surgery showing promising results. SurgiSil ™, a Texas medical device manufacturing company, recently introduced the Perma Facial Implant™. The product’s innovation is causing quite a buzz.

The Perma Facial Implant is a silicone implant designed for the lips, but with the capability for implantation into the cheeks, nose, and chin. It was approved by the FDA in 2007, and there are over 100 surgeons in the United States offering Perma Facial Implants. Unlike silicone injections, Perma Facial Implants consist of two solid elastomer pieces inserted into the lips. They come in different sizes, and can be easily removed if there are problems or you are unsatisfied. They look and feel smooth and natural. Because they are solid, they will not break or leak, nor will they develop scar tissue around the implant sight.

Although the cost of Perma Facial Implants is higher than injectable fillers, the procedure only has to be performed once or permanent results (unlike injections, which may be needed every few months). Following the surgery, you may experience side effects including swelling, bruising, and pain. You may be prescribed medication to help with these issues.

Although Perma implants are known to be safe an effective, there are other synthetic implants avialble. These include products like AlloDerm®, which is derived from human cadaver tissue. Although this product feels natural, it only lasts between six and 12 months. SoftForm, GORE-TEX® and Ultrasoft are other brands that rely on expanded polytetrafluoroethylene, a non-biodegradable synthetic polymer.

Meeting with a board-certified plastic surgeon is the most important step in determining which procedure is the best fit for you. Any procedure of this sort should be conducted by a trained specialist. No matter what, the doctor can make a huge difference between making your lips look full and just awkwardly swollen.

Full lips are unquestionably considered to be attractive and youthful, and one of the leading symbols of sensuality today. Since so many of the world’s top movie stars and models have the full-lipped look more people are starting to seek out ways to get the same plumped up lips. Today there are several different options for cosmetic lip enhancement, both temporary and permanent.

Injectable Fillers For Lip Enhancement

Injectable fillers are the most common method of lip enhancement today. These fillers are made of either bovine collagen or hyaluronic acid. Bovine collagen fillers such as Zyderm and Cosmoderm are injected via a very thin gauge needle into the borders of the lips or the body of the lips. Bovine collagen fillers are capable of filling out the lips immediately and of adding volume to any area of the lips. Bovine collagen fillers generally last for between three and six months. While bovine collagen fillers are extremely effective at adding volume and creating any change in the lips desired, they do have one potential drawback. Patients who have an allergy or sensitivity to bovine collagen cannot use this particular type of injectable filler. Most physicians require that lip enhancement patients undergo a pre-treatment bovine collagen allergy test to make certain that there will not be any problems with the treatment. In cases where the patient demonstrates an allergy to bovine collagen hyaluronic acid fillers are the preferred option.

Hyaluronic acid injectable fillers are used in a very similar way to bovine collagen fillers as they are injected through a long thin needle into any area of the lip that needs added volume or enhancement. Hyaluronic acid fillers such as Juvederm and Restylane are derived from non-animal sources and very closely mimic the hyaluronic acid that is found naturally in the human body. Fillers that are composed of hyaluronic acid do not require any pre-treatment allergy testing since the product is virtually identical to the collagen builders already in the body. One of the advantages of hyaluronic acid fillers is that they have more longevity than their collagen counterparts: Most hyaluronic acid fillers last from six to twelve months.

Permanent Lip Enhancement Methods

Some patients who are seeking a permanent lip enhancement may choose to use implantable synthetic materials such as Gore-Tex and SoftForm. These materials are soft, pliable, and can be surgically inserted into the lips to provide a permanent increase in volume. These options are more expensive than the injectable fillers but their permanent nature makes them a better long term value for some patients. Some patients may experience side effects from lip implants such as allergic reactions to the implanted material. In some cases migration may occur, meaning the implants will travel outside the area where they were inserted. In such cases surgical removal and repositioning is required.

A beautiful smile makes an indelible impression in the social world. Women of all eras have sought to acquire the full-lipped pout of actresses and models. Because of this, modern cosmetic surgeons never lack for business. Lip augmentation gives women the full lips they desire and it boosts their confidence in ways never thought possible. The technical aspects of lip augmentation are left to scientists and cosmetic surgeons, but they are fascinating even to the untrained population.

Three types of lip enhancing procedures are the most popular choices of dentists. Injectable fillers produce a temporary effect that lasts 6 weeks to 18 months, depending on the person who receives the treatment and the variety of product injected. Collagen, hylaform, perlane, and rofilan are typical products of lip augmentation with variable durations of effectiveness.

A more permanent solution is accomplished with fillers such as dermalive, alloderm, soft form, and aquamide. Depending on the area that needs to be injected, the treatment can last longer than its typical 3 to 10 minute duration. After the injections, a patient can expect swelling and, in some cases, discoloration. The discoloration goes away after a few days and the permanent effect of the fillers sets in, giving the patient beautiful, sensuous lips that will be with her always. A normal routine is resumed shortly after this procedure, leaving patients free to return to work or household duties.

In the majority of cases, Bio Alcamide is the choice of filler for this type of procedure. Its strengths are that allergic reactions are almost non-existent in its history. Discomfort is minimal. It consists of hydrogel. Its usefulness extends beyond lip augmentation and has been used to fill scars, wrinkles, and cavities in the skin.

A third procedure is conducted through plastic surgery. This, too, is a permanent procedure. There is no possible way to reverse it, so serious consideration should be given before undergoing this procedure. Gum lift and lip enhancement techniques are described in-depth on several sites, and it is wise to research the topics before scheduling a consultation. It is the most complex of the three procedures.

A cosmetic surgeon can examine your lips and discuss your medical history to determine what procedure and filler will work best for you. If you are suffering from low self-esteem due to small lips and desire the full, beautiful lips of actresses and models, it’s as easy as scheduling an appointment with a cosmetic surgeon or aesthetic dentist. Within weeks you can have your desires fulfilled and be happier and more fulfilled.

The possibilities with Aesthetic Dentistry are endless. See Laser whitening London for more ideas about dentists in the medical aesthetics industry.

Professional beauty experts contend that the key to a youthful appearance is the lips. If your lips are full and young-looking, other age-related flaws such as crows’ feet and frown lines become less noticeable in your overall appearance.

While such environmental factors as sun exposure adversely affect your facial features, the aging and thinning of your lips as you advance in years depends largely on your genes. You can prevent looking older than you feel by being proactive and correcting the demise of the thickness and plumpness of your lips. Additionally, if you are young but want more volume to achieve that ideal look of “kissability,” there are both temporary and permanent cosmetic fixes to give you the lips you desire.

Temporary Cosmetic Enhancement

Temporary treatments to replace the youthful lip fullness that time begins to take away include such injection programmes as Botox and collagen. While Botox works beneath the skin to immobilize the muscles that govern your facial expressions, thus smoothing those wrinkles that become apparent when you frown or smile, collagen injections actually plump up your lips, filling in the lines just beneath your skin surface. The downside of injection treatments is that their positive effects last only 3-9 months, and then the treatments must be repeated.

A Permanent Solution

Permalip® is a new advance in the field of cosmetic surgery that offers a permanent solution to the problem of aging lips. The ground-breaking procedure utilizes a unique silicone implant to fill and plump your lips for a lifelong, beautiful smile.

The Permalip® implant, developed by U.S. cosmetic surgeons, is composed of a soft, pliable silicone solid. A proven procedure that developers have extensively tested, Permalip® has attained CE Marked approval for use in Europe. This permanent lip enhancement that will keep your appearance youthful without repeated treatments.

Unlike older implant treatments, the Permalip® implant is rupture-proof, will not bond with surrounding tissue, and will not harden or deteriorate throughout years of use.

The Procedure

It takes less than one hour under local anesthetic for your cosmetic surgeon to place your implant. You will retain no visible scarring, and you can feel confident knowing that the procedure is fully reversible and can be adjusted for size upon your request.

You will enjoy full recovery from the procedure within two weeks, and the beautiful results will keep you looking as young as you feel. Permalip® is truly revolutionary.