March 22, 2022
Kiss and Tell: Revealing All The Ways Plastic Surgeons Can Beautify Your Lips
Revealing All The Ways Plastic Surgeons Can Beautify Your Lips
Lips are a central beauty feature on the face. Young or older, male or female, beautiful lips increase your appeal. Plastic surgeons have many surgical and non-surgical approaches to making changes in the appearance of the lips and restoring a youthful appearance as they age. Dr. Bass reviews the natural shape of upper and lower lips, injectable filler for lip augmentation and shaping, as well as Botox and other neuromodulators for wrinkle treatment and lip flip. Surgical treatments such as lip reduction and lip lift for the aging lip is also discussed. Find out about typical pitfalls and unnatural tell-tales in lip treatments today. Dr. Bass takes you through what you need to know to get and keep beautiful lips.
Links
- Read more about Botox
- Read more about injectable fillers
- Read more about the subject of beautiful lips in Dr. Bass’s blog
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to another episode of
Park Avenue Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. This is your cohost Doreen Wu.
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I'm joined by Dr. Lawrence Bass Park
Avenue plastic surgeon, educator,
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and technology innovator.
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This episode title is kiss and
tell revealing all the ways plastic
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surgeons can beautify your lips.
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I'm excited to jump into today's episode
to really understand what makes a
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beautiful lip and how plastic
surgeons can make lips more beautiful.
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This is really an episode
for everyone of every age,
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male or female. Lips
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are a central beauty feature on
the face and very popular for a
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little boosting reshaping
or other modification.
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If we look at the makeup industry,
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lipstick is the single most
inflation and recession proof product
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for good reason.
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This is a little less true right now
since we're all wearing masks in the
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pandemic. But we all still want
to look good both to ourselves.
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And when we get on those zoom
meetings and on FaceTime.
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Everyone always thinks about
lip augmentation and have
this image in their head
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of big, full bee stung lips.
Dr. Bass, when it comes to lips,
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is it true that size matters?
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Well size is a big part of it.
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Enlargement or augmentation of the lip,
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this was a big starting place in
the aesthetic treatment of the lip.
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Even before we had modern
injectable fillers,
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various things were implanted or
injected into the lip to build a
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bigger size, uh, in
modern plastic surgery.
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Things like Goretex was
slipped into the lip to
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build the size. Silicone
was injected in the lip,
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many, many other things
historically in plastic surgery.
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So this is definitely something that is
captivated interest over many decades
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back in the 1990s, when,
uh, in the early nineties,
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when collagen injections
were the available filler,
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one of the principle and most
popular uses was for lip augmentation
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in the era of modern fillers
like Restylane and Juvederm.
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This became longer lasting
and even more popular.
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It's a treatment that's popular in young
adults and in a number of decades of
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older adults going,
going forward from there.
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The question always is how big is too big?
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Should the lips look obviously
bulging the bee stung look or
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just imbalance with other features?
That's a question of personal taste,
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more than anything like
everything in plastic surgery.
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I personally think finesse in
some understatement works best,
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but how much or how big is definitely
partly a product of the projection of the
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rest of your features and
the look you're going for.
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So bigger is better at
least up to a certain point.
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Is that the end of the story
for lip injections and fillers?
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Not really. In fact, it's, it's just
the beginning, actually in my view,
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it's a secondary issue.
Size is part of it,
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but the most important feature
of a beautiful lip is shape.
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The lip has curves, bulges, dimples,
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and peaks.
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The beauty of injectable fillers
is the incredible shape control
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that we have using them, which
far exceeds that, which we see in
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surgery on the lip,
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based on the amount and
exact location of placement,
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we can really control the shape,
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the size and the gestalt
that the lip projects.
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Can you talk about some of the
shapes and styles? In other words,
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what makes a beautiful lip?
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So again, it's not an across the board,
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big size or uniform size.
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The lip is always curving and
contouring as you transition from
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one part to another.
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And those shape differences need to be
maintained for the lip to look natural
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and for the lip to look attractive.
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The upper lip and the lower lip
have completely different shapes.
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And so again,
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just uniformly augmenting
the upper or the lower
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takes away. Some of that distinction
and looks unnatural. Natural.
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The upper lip is
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a tapers towards the side,
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fills towards about two thirds in from the
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side, and then has a little bit of
an empty space before the central
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pucker or tubercle. That's the
central part of the upper lip.
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Now here, I'm talking about
the pink part of the lip,
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what we call the Vermilion
in medical terms.
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That's not the only part
of the lip though. We have
white lips skin of our lip,
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and we have the white roll, which
is the transition zone, that little,
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that little zone of thicker skin
in between the pink portion of
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the lip and the white portion
of the lip. In the white roll,
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we have something called cupids bow
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peaks. And in the white lip,
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we have philtral columns.
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We have similar roll of
skin to the white roll
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that go down from the nostrils
to the Cupid bow's peaks.
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So all of those shapes should be
visible and they need to be in balance.
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Lower lip shape is a little simpler.
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The classic description of the lower
lip shape is a double pillow look
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so fullest again, about
two thirds of the way in,
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from the side with a little less
fullness, right in the center,
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a simpler shape, but still
a very important shape for
the lip to look natural.
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There are also considerations of
the size of the upper and lower lip
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relative to each other.
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The lower lip typically
looks bigger than the upper
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lip. The upper lip will be
two thirds to three quarters,
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the size of the lower lips.
So it's a little bit smaller,
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not half the size, but two
thirds to three quarters.
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The final consideration in lip
shape is symmetry improvement.
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A lot of people have small
asymmetries on the face.
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Almost all of us have very
small asymmetries. All of us do,
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but many people have moderate
asymmetries on the face
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that manifest in the lip as a difference
in length, a difference in fullness.
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And these symmetry differences can
be minimized using injected fillers.
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However, we can't eliminate them
because there are many things that are
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responsible for that asymmetry.
And just for starters,
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the skin envelope is
different on the two sides,
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and that limits the ability to
completely remove the asymmetry.
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This is likely a question
that many people have.
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What happens to the lip
during the aging process?
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That's a really important question.
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And like almost every
other part of our body,
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as we age our lip loses
some of its its real power,
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beauty and appeal, and it loses
it for several different reasons.
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We lose some of the curviness, uh,
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the lip thins or become
smaller. And again,
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this applies to both upper and lower lip.
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We see less of that Vermilior
pink portion of the lip.
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This is caused by multiple
factors that cause
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the Vermilion to roll in and less
of it be rolled out where it can
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be seen, uh,
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bone loss as we age lengthening of
the upper lip and intrinsic volume
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loss in the lip, all contribute
to loss of Vermilion show.
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We also lose definition of the white roll,
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including cupids bow peaks
and philtral columns.
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And we start to develop
fixed and dynamic wrinkles.
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And what I mean by that fixed wrinkles
or wrinkles you see when the lip is in
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repose. And when you animate
you talk, you smile, you eat,
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dynamic wrinkles are the wrinkles that
form when the muscle is buckling the
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skin because it's in action.
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What role can Botox and
fillers do to combat that?
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So there are a number of treatments
for these aging changes that Botox and
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other neuromodulators and
fillers help us with. Um,
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we do treatments to restore the volume,
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to restore the shapes that are
lost using injectable fillers.
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We can put injectable fillers into
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the wrinkles superficially in the
skin. That helps us to an extent,
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it blunts the appearance
of the fixed wrinkles.
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And it also stiffens
the skin a little bit,
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which blunts the dynamic wrinkling.
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The main treatment for
dynamic wrinkling is Botox,
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which can soften the amount of
buckling, the upper lip skin undergoes.
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When we talk smile or animated, uh,
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there are a couple of other
things that Botox, Dysport,
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Xeomin in Jeuveau are being used
for. One is the gummy smile.
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That's not really an aging change,
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but people who show not
only their full teeth,
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but some of their gums when they smile,
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that's sometimes seen as an
unattractive smile, again,
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not really an aging change, but
you can relax the muscle a little.
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So it doesn't pull up quite as hard
and get more of a full tooth smile.
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Uh,
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or you can even relax things
further and come to just that
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trace of a smile. The Mona Lisa smile.
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Another treatment using Botox and
neuromodulators that's really popular
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and really useful is what's
called the lip flip by
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relaxing certain portions
of the upper lip muscles.
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You can promote rolling
out of the Vermilion.
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Remember I said the Vermilion or pink
part of the lip rolls in and we see less
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of it as we age, but by relaxing
certain parts of the muscle,
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we can get that lip to roll back out,
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showing us a little more of the Vermilion.
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We've been talking about
non-surgical options so far.
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What can plastic surgeons do in
the operating room to help the lip.
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Operating on the lip is something
that's very central to plastic surgery.
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Uh, this comes from the reconstructive
legacy of plastic surgery,
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treating trauma to the lip and treating
things like cleft lip and cleft palette,
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cosmetic treatments of the lip
though using plastic surgery
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are also a mainstream item.
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One of the treatments for
cosmetic treatment of the lip,
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if the lip is overly large, rather
than too small is lip reduction.
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There's
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less surgical lip augmentation
these days than there used to be
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because the risks of implanted
materials in the lip,
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Goretex silicone implants
and other types of,
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of lip augmentation in the long run end up
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being riskier and also having distinctly
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less precision and shape control
than injected fillers have.
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So lip augmentation using surgery is,
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is not as common as it
was 20 or 30 years ago.
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The mainstream treatment
for surgery of the lip,
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which is really an aging lip
treatment is the lip lift
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and the other main treatment
being done on lips. And in fact,
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in the entire perioral area
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of the upper and lower lip are a
variety of wrinkle treatments using
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energy based devices like
laser peels, non ablative,
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laser radio frequency, microneedling,
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and chemical peels to
peel down the wrinkles
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and even up the skin. So
that it's smoother flatter.
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So this is a treatment not for dynamic
wrinkling, which is again, Botox,
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but a treatment for fixed wrinkling,
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which many people have in their lips, the,
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the so-called smokers lines
or lipstick bleed lines,
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which mostly in actuality
are from sun damage.
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The lip lift surgery takes out a wedge
of skin located just under the nostrils.
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That's where the incision tries to hide.
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And lip lift surgery involves a
lot of differences in technique,
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depending on what each individual needs,
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and it can accomplish
several different things.
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The lip lift can roll out the Vermilion.
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It can help elevate and sharpen
the corner of the mouth.
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As we age our typical youthful upturned
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corners start to sag down.
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And that takes us from the
smiley face to the frownie face.
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So lip lift can help us boost
that back in position and
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the length of the white lip,
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the height from the nostrils to
the Vermilion increases as we age,
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a long lip is an old looking lip and a
shorter lip is a younger looking lip.
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So by taking that wedge of skin out,
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you can shorten the
height of the white lip,
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creating a more youthful appearance.
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The main pitfall of the
lip lift is the scar.
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Or if it's not artistically done,
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you can create an exaggerated
or unnatural look,
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a lip that's too upturned or
upturned in an unnatural portion
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or direction.
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Lip lift is something that's done
everywhere in the United States,
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particularly popular on the west
coast of the United States, but
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common and popular in the
Northeast and everywhere else
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at this stage of the game as well.
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Speaking of pitfalls, what
are the pitfalls with fillers?
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How can they be avoided?
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So there are a number of
pitfalls with fillers,
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but the good news is they're
relatively easy to avoid.
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If you're working with an experienced
injector who has good technical and
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artistic skills. And, um,
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so it's something we don't
need to be afraid of.
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We always see the unnatural examples
and we don't see all the beautiful work
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that just walks past us looking good,
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but has definitely been treated with
plastic surgery and injectable fillers.
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So one of the biggest pitfalls
is enlarging the lip without
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maintaining the curves and shape
that are natural to the lip.
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Either pumping up the lip
across the entire length,
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creating sort of a sausage like
look or just pumping up the
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corners of the lip, which is a very
fast and dirty injection technique.
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You put the needle in once at each corner
of the upper lip and scored in a bunch
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of filler that creates a,
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an intrinsically unnatural look. Now,
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there are so many folks who have that
look and it's in so many of the fashion
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magazines that I've actually had patients
come into the office and ask for that.
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And if you like that look for
some reason, that's okay. Uh,
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but it's important to recognize that
is an intrinsically unnatural look that
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that humans who have not been
treated don't possess, um,
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the outer portion of the upper lip
should be tapering towards the corner.
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It should not be fullest
at the corner, uh,
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in times past and
particularly with collagen,
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which was a much softer injectable
and the current injectables,
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most of the injecting in the
lip was on the white rolls,
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that transition zone between
the pink and white lip.
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And that's, what's responsible
for giving people a duck
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billed look,
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there are portions of the white
roll that can be injected and look
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good. But if that's overdone or it's
done all the way across the lip,
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you end up with a duck billed
look, which again is unnatural.
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And most people are trying to avoid.
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What about when it comes to Botox?
What are some of the pitfalls there?
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Yeah, so Botox in certain
areas of the face,
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we're trying to get target
muscles completely asleep because
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00:18:22,400 --> 00:18:26,470
that's aesthetically desirable and
there's no functional consequence
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00:18:27,430 --> 00:18:31,869
in the area around the mouth
and the lip, a little is good,
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but more is not better.
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We need to maintain a good level
of function so you can speak
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swallow, drink, seal the lip, uh,
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and overdoing it in this area
will make unnatural motion
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and eventually, uh, the
inability to function adequately.
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So we have to accept that we can get
some nice effects with Botox in the oral
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area. It's an advanced injection
area, not for beginning injectors,
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00:19:02,020 --> 00:19:06,770
but it's really an excellent, excellent
treatment for many features in,
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in the lip and perioral area.
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But we have to accept the
limitations and not overdo it.
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I never realized all of the
complexity surrounding the lip.
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It was really interesting to hear the
different ways in which plastic surgery
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can help people achieve beautiful lips.
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This episode has definitely given me
a lot to think about if you think of
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other trends in plastic surgery that
you would like us to explore in upcoming
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00:19:33,600 --> 00:19:36,920
episodes, feel free to reach
out, see you next time.
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This is Doreen Wu,
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00:19:39,160 --> 00:19:43,710
thanking you for joining Dr. Bass and
me for this discussion of beautiful lips
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00:19:43,711 --> 00:19:47,590
and plastic surgery. Be sure to
join us next time for our episode,
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discussing new FDA regulations
for breast implants that went into
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00:19:52,591 --> 00:19:53,470
effect October 2021.
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00:19:53,471 --> 00:19:58,390
Stream the episode to find out
about new consent processes
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00:19:58,609 --> 00:20:02,700
and the new black box warning on
breast implants in the United States.
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00:20:03,550 --> 00:20:07,580
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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00:20:07,670 --> 00:20:12,220
Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:20:12,980 --> 00:20:14,820
educator, and technology innovator.
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00:20:15,119 --> 00:20:17,619
The commentary in this
podcast represents opinion.
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00:20:17,960 --> 00:20:20,369
This podcast does not
present medical advice,
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00:20:20,710 --> 00:20:24,730
but rather general information about
plastic surgery that does not necessarily
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00:20:24,790 --> 00:20:27,890
relate to the specific conditions
of any individual patient.
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00:20:28,230 --> 00:20:32,890
No doctor patient relationship
is established by listening
to or participating
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00:20:33,030 --> 00:20:33,863
in this podcast,
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00:20:34,119 --> 00:20:38,240
consult your physician to advise you
about your individual healthcare.
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If you enjoyed this episode,
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00:20:40,140 --> 00:20:44,280
please share it with your friends and
be sure to subscribe to our podcast on
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00:20:44,281 --> 00:20:48,160
Apple Podcasts, Google, Spotify, Stitcher,
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or wherever you listen to podcasts.
00:00:00,550 --> 00:00:04,480
Welcome to another episode of
Park Avenue Plastic Surgery Class,
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00:00:04,900 --> 00:00:08,760
the podcast where we explore controversies
and breaking issues in plastic
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00:00:08,761 --> 00:00:11,200
surgery. This is your cohost Doreen Wu.
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00:00:11,900 --> 00:00:16,000
I'm joined by Dr. Lawrence Bass Park
Avenue plastic surgeon, educator,
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00:00:16,260 --> 00:00:17,560
and technology innovator.
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00:00:18,150 --> 00:00:22,950
This episode title is kiss and
tell revealing all the ways plastic
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00:00:23,110 --> 00:00:24,870
surgeons can beautify your lips.
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00:00:26,090 --> 00:00:30,110
I'm excited to jump into today's episode
to really understand what makes a
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00:00:30,111 --> 00:00:33,950
beautiful lip and how plastic
surgeons can make lips more beautiful.
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00:00:34,580 --> 00:00:38,540
This is really an episode
for everyone of every age,
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00:00:39,050 --> 00:00:39,940
male or female. Lips
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00:00:41,500 --> 00:00:46,460
are a central beauty feature on
the face and very popular for a
13
00:00:46,461 --> 00:00:50,979
little boosting reshaping
or other modification.
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00:00:52,200 --> 00:00:54,020
If we look at the makeup industry,
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00:00:54,380 --> 00:00:58,810
lipstick is the single most
inflation and recession proof product
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00:01:00,000 --> 00:01:00,833
for good reason.
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00:01:01,770 --> 00:01:05,700
This is a little less true right now
since we're all wearing masks in the
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00:01:05,980 --> 00:01:10,459
pandemic. But we all still want
to look good both to ourselves.
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00:01:10,800 --> 00:01:13,860
And when we get on those zoom
meetings and on FaceTime.
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00:01:15,080 --> 00:01:19,390
Everyone always thinks about
lip augmentation and have
this image in their head
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00:01:19,850 --> 00:01:24,590
of big, full bee stung lips.
Dr. Bass, when it comes to lips,
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00:01:24,770 --> 00:01:26,110
is it true that size matters?
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00:01:27,180 --> 00:01:28,950
Well size is a big part of it.
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00:01:29,540 --> 00:01:32,270
Enlargement or augmentation of the lip,
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00:01:32,671 --> 00:01:36,580
this was a big starting place in
the aesthetic treatment of the lip.
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00:01:37,410 --> 00:01:40,380
Even before we had modern
injectable fillers,
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00:01:41,250 --> 00:01:46,100
various things were implanted or
injected into the lip to build a
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00:01:46,101 --> 00:01:50,470
bigger size, uh, in
modern plastic surgery.
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00:01:50,490 --> 00:01:55,460
Things like Goretex was
slipped into the lip to
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00:01:55,670 --> 00:01:59,660
build the size. Silicone
was injected in the lip,
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00:02:00,570 --> 00:02:04,060
many, many other things
historically in plastic surgery.
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00:02:04,320 --> 00:02:09,139
So this is definitely something that is
captivated interest over many decades
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00:02:12,070 --> 00:02:16,190
back in the 1990s, when,
uh, in the early nineties,
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00:02:16,340 --> 00:02:19,550
when collagen injections
were the available filler,
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00:02:19,690 --> 00:02:24,550
one of the principle and most
popular uses was for lip augmentation
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00:02:25,610 --> 00:02:29,389
in the era of modern fillers
like Restylane and Juvederm.
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00:02:30,430 --> 00:02:33,790
This became longer lasting
and even more popular.
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00:02:34,740 --> 00:02:39,710
It's a treatment that's popular in young
adults and in a number of decades of
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00:02:40,080 --> 00:02:43,350
older adults going,
going forward from there.
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00:02:45,050 --> 00:02:47,950
The question always is how big is too big?
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00:02:48,330 --> 00:02:52,900
Should the lips look obviously
bulging the bee stung look or
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00:02:53,050 --> 00:02:58,020
just imbalance with other features?
That's a question of personal taste,
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00:02:58,130 --> 00:03:02,600
more than anything like
everything in plastic surgery.
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00:03:03,800 --> 00:03:07,360
I personally think finesse in
some understatement works best,
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00:03:07,980 --> 00:03:12,240
but how much or how big is definitely
partly a product of the projection of the
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00:03:12,241 --> 00:03:15,520
rest of your features and
the look you're going for.
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00:03:16,630 --> 00:03:20,000
So bigger is better at
least up to a certain point.
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00:03:20,500 --> 00:03:23,400
Is that the end of the story
for lip injections and fillers?
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00:03:24,300 --> 00:03:28,760
Not really. In fact, it's, it's just
the beginning, actually in my view,
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00:03:28,990 --> 00:03:32,200
it's a secondary issue.
Size is part of it,
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00:03:32,700 --> 00:03:36,550
but the most important feature
of a beautiful lip is shape.
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00:03:37,490 --> 00:03:41,470
The lip has curves, bulges, dimples,
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00:03:41,770 --> 00:03:42,603
and peaks.
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00:03:43,890 --> 00:03:48,230
The beauty of injectable fillers
is the incredible shape control
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00:03:49,060 --> 00:03:53,590
that we have using them, which
far exceeds that, which we see in
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00:03:55,380 --> 00:03:56,670
surgery on the lip,
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00:03:57,440 --> 00:04:00,470
based on the amount and
exact location of placement,
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we can really control the shape,
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00:04:02,690 --> 00:04:06,390
the size and the gestalt
that the lip projects.
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00:04:07,460 --> 00:04:11,680
Can you talk about some of the
shapes and styles? In other words,
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00:04:12,030 --> 00:04:13,430
what makes a beautiful lip?
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00:04:14,530 --> 00:04:17,430
So again, it's not an across the board,
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big size or uniform size.
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00:04:20,970 --> 00:04:25,670
The lip is always curving and
contouring as you transition from
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00:04:25,770 --> 00:04:26,950
one part to another.
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00:04:27,930 --> 00:04:32,540
And those shape differences need to be
maintained for the lip to look natural
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00:04:33,060 --> 00:04:34,140
and for the lip to look attractive.
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00:04:35,480 --> 00:04:39,260
The upper lip and the lower lip
have completely different shapes.
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00:04:39,920 --> 00:04:40,753
And so again,
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00:04:40,810 --> 00:04:45,140
just uniformly augmenting
the upper or the lower
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00:04:45,950 --> 00:04:49,850
takes away. Some of that distinction
and looks unnatural. Natural.
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00:04:52,500 --> 00:04:55,040
The upper lip is
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00:04:57,430 --> 00:04:59,310
a tapers towards the side,
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00:05:01,390 --> 00:05:06,390
fills towards about two thirds in from the
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00:05:06,420 --> 00:05:10,779
side, and then has a little bit of
an empty space before the central
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00:05:12,160 --> 00:05:16,779
pucker or tubercle. That's the
central part of the upper lip.
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00:05:18,160 --> 00:05:21,620
Now here, I'm talking about
the pink part of the lip,
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00:05:22,060 --> 00:05:24,220
what we call the Vermilion
in medical terms.
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00:05:24,920 --> 00:05:29,730
That's not the only part
of the lip though. We have
white lips skin of our lip,
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00:05:30,070 --> 00:05:34,970
and we have the white roll, which
is the transition zone, that little,
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00:05:36,250 --> 00:05:41,180
that little zone of thicker skin
in between the pink portion of
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00:05:41,181 --> 00:05:45,060
the lip and the white portion
of the lip. In the white roll,
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00:05:45,500 --> 00:05:49,650
we have something called cupids bow
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00:05:50,220 --> 00:05:54,080
peaks. And in the white lip,
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we have philtral columns.
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00:05:56,020 --> 00:06:00,690
We have similar roll of
skin to the white roll
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00:06:00,760 --> 00:06:04,529
that go down from the nostrils
to the Cupid bow's peaks.
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00:06:05,510 --> 00:06:09,490
So all of those shapes should be
visible and they need to be in balance.
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00:06:11,260 --> 00:06:13,410
Lower lip shape is a little simpler.
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00:06:14,430 --> 00:06:19,279
The classic description of the lower
lip shape is a double pillow look
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00:06:20,100 --> 00:06:23,440
so fullest again, about
two thirds of the way in,
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00:06:23,990 --> 00:06:28,120
from the side with a little less
fullness, right in the center,
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00:06:29,560 --> 00:06:33,279
a simpler shape, but still
a very important shape for
the lip to look natural.
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00:06:34,089 --> 00:06:38,670
There are also considerations of
the size of the upper and lower lip
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00:06:39,029 --> 00:06:39,950
relative to each other.
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00:06:40,330 --> 00:06:45,190
The lower lip typically
looks bigger than the upper
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00:06:45,191 --> 00:06:48,550
lip. The upper lip will be
two thirds to three quarters,
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00:06:48,730 --> 00:06:53,180
the size of the lower lips.
So it's a little bit smaller,
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00:06:53,640 --> 00:06:58,300
not half the size, but two
thirds to three quarters.
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00:06:59,560 --> 00:07:03,660
The final consideration in lip
shape is symmetry improvement.
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00:07:04,580 --> 00:07:07,860
A lot of people have small
asymmetries on the face.
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00:07:07,920 --> 00:07:11,930
Almost all of us have very
small asymmetries. All of us do,
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but many people have moderate
asymmetries on the face
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00:07:17,700 --> 00:07:22,310
that manifest in the lip as a difference
in length, a difference in fullness.
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00:07:23,050 --> 00:07:27,830
And these symmetry differences can
be minimized using injected fillers.
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00:07:28,340 --> 00:07:33,300
However, we can't eliminate them
because there are many things that are
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00:07:33,330 --> 00:07:37,260
responsible for that asymmetry.
And just for starters,
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00:07:37,520 --> 00:07:40,740
the skin envelope is
different on the two sides,
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00:07:41,400 --> 00:07:45,420
and that limits the ability to
completely remove the asymmetry.
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This is likely a question
that many people have.
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00:07:50,040 --> 00:07:52,410
What happens to the lip
during the aging process?
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00:07:53,430 --> 00:07:55,290
That's a really important question.
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00:07:55,470 --> 00:07:58,210
And like almost every
other part of our body,
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00:07:58,350 --> 00:08:03,090
as we age our lip loses
some of its its real power,
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00:08:03,390 --> 00:08:08,280
beauty and appeal, and it loses
it for several different reasons.
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00:08:08,300 --> 00:08:11,520
We lose some of the curviness, uh,
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00:08:11,540 --> 00:08:15,120
the lip thins or become
smaller. And again,
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00:08:15,121 --> 00:08:17,200
this applies to both upper and lower lip.
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We see less of that Vermilior
pink portion of the lip.
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00:08:22,110 --> 00:08:26,990
This is caused by multiple
factors that cause
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00:08:27,010 --> 00:08:31,870
the Vermilion to roll in and less
of it be rolled out where it can
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00:08:31,871 --> 00:08:33,550
be seen, uh,
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00:08:33,660 --> 00:08:38,429
bone loss as we age lengthening of
the upper lip and intrinsic volume
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00:08:38,620 --> 00:08:42,910
loss in the lip, all contribute
to loss of Vermilion show.
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00:08:44,170 --> 00:08:46,580
We also lose definition of the white roll,
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00:08:46,581 --> 00:08:49,620
including cupids bow peaks
and philtral columns.
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And we start to develop
fixed and dynamic wrinkles.
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And what I mean by that fixed wrinkles
or wrinkles you see when the lip is in
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00:08:57,961 --> 00:09:02,390
repose. And when you animate
you talk, you smile, you eat,
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00:09:02,630 --> 00:09:07,630
dynamic wrinkles are the wrinkles that
form when the muscle is buckling the
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00:09:07,950 --> 00:09:10,710
skin because it's in action.
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What role can Botox and
fillers do to combat that?
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00:09:15,550 --> 00:09:20,490
So there are a number of treatments
for these aging changes that Botox and
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00:09:20,491 --> 00:09:24,690
other neuromodulators and
fillers help us with. Um,
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00:09:25,270 --> 00:09:28,530
we do treatments to restore the volume,
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to restore the shapes that are
lost using injectable fillers.
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00:09:34,020 --> 00:09:36,200
We can put injectable fillers into
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the wrinkles superficially in the
skin. That helps us to an extent,
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00:09:45,240 --> 00:09:47,980
it blunts the appearance
of the fixed wrinkles.
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00:09:48,200 --> 00:09:50,850
And it also stiffens
the skin a little bit,
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00:09:51,300 --> 00:09:54,090
which blunts the dynamic wrinkling.
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The main treatment for
dynamic wrinkling is Botox,
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00:09:58,620 --> 00:10:03,290
which can soften the amount of
buckling, the upper lip skin undergoes.
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00:10:04,080 --> 00:10:07,490
When we talk smile or animated, uh,
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00:10:07,491 --> 00:10:10,160
there are a couple of other
things that Botox, Dysport,
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00:10:11,380 --> 00:10:16,040
Xeomin in Jeuveau are being used
for. One is the gummy smile.
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00:10:16,041 --> 00:10:17,720
That's not really an aging change,
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00:10:17,860 --> 00:10:21,720
but people who show not
only their full teeth,
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00:10:21,900 --> 00:10:24,040
but some of their gums when they smile,
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00:10:24,700 --> 00:10:29,270
that's sometimes seen as an
unattractive smile, again,
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00:10:29,330 --> 00:10:33,270
not really an aging change, but
you can relax the muscle a little.
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00:10:33,330 --> 00:10:38,260
So it doesn't pull up quite as hard
and get more of a full tooth smile.
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00:10:39,500 --> 00:10:39,940
Uh,
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00:10:39,940 --> 00:10:44,580
or you can even relax things
further and come to just that
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00:10:44,830 --> 00:10:47,450
trace of a smile. The Mona Lisa smile.
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Another treatment using Botox and
neuromodulators that's really popular
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and really useful is what's
called the lip flip by
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relaxing certain portions
of the upper lip muscles.
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You can promote rolling
out of the Vermilion.
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Remember I said the Vermilion or pink
part of the lip rolls in and we see less
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of it as we age, but by relaxing
certain parts of the muscle,
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we can get that lip to roll back out,
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showing us a little more of the Vermilion.
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We've been talking about
non-surgical options so far.
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What can plastic surgeons do in
the operating room to help the lip.
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Operating on the lip is something
that's very central to plastic surgery.
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Uh, this comes from the reconstructive
legacy of plastic surgery,
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treating trauma to the lip and treating
things like cleft lip and cleft palette,
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cosmetic treatments of the lip
though using plastic surgery
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are also a mainstream item.
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One of the treatments for
cosmetic treatment of the lip,
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if the lip is overly large, rather
than too small is lip reduction.
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There's
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less surgical lip augmentation
these days than there used to be
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because the risks of implanted
materials in the lip,
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Goretex silicone implants
and other types of,
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of lip augmentation in the long run end up
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being riskier and also having distinctly
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less precision and shape control
than injected fillers have.
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So lip augmentation using surgery is,
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is not as common as it
was 20 or 30 years ago.
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The mainstream treatment
for surgery of the lip,
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which is really an aging lip
treatment is the lip lift
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and the other main treatment
being done on lips. And in fact,
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in the entire perioral area
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of the upper and lower lip are a
variety of wrinkle treatments using
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energy based devices like
laser peels, non ablative,
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laser radio frequency, microneedling,
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and chemical peels to
peel down the wrinkles
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and even up the skin. So
that it's smoother flatter.
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So this is a treatment not for dynamic
wrinkling, which is again, Botox,
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but a treatment for fixed wrinkling,
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which many people have in their lips, the,
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the so-called smokers lines
or lipstick bleed lines,
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which mostly in actuality
are from sun damage.
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The lip lift surgery takes out a wedge
of skin located just under the nostrils.
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That's where the incision tries to hide.
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And lip lift surgery involves a
lot of differences in technique,
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depending on what each individual needs,
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and it can accomplish
several different things.
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The lip lift can roll out the Vermilion.
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It can help elevate and sharpen
the corner of the mouth.
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As we age our typical youthful upturned
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corners start to sag down.
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And that takes us from the
smiley face to the frownie face.
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So lip lift can help us boost
that back in position and
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the length of the white lip,
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the height from the nostrils to
the Vermilion increases as we age,
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a long lip is an old looking lip and a
shorter lip is a younger looking lip.
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So by taking that wedge of skin out,
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you can shorten the
height of the white lip,
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creating a more youthful appearance.
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The main pitfall of the
lip lift is the scar.
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Or if it's not artistically done,
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you can create an exaggerated
or unnatural look,
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a lip that's too upturned or
upturned in an unnatural portion
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or direction.
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Lip lift is something that's done
everywhere in the United States,
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particularly popular on the west
coast of the United States, but
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common and popular in the
Northeast and everywhere else
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at this stage of the game as well.
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Speaking of pitfalls, what
are the pitfalls with fillers?
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How can they be avoided?
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So there are a number of
pitfalls with fillers,
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but the good news is they're
relatively easy to avoid.
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If you're working with an experienced
injector who has good technical and
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artistic skills. And, um,
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so it's something we don't
need to be afraid of.
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We always see the unnatural examples
and we don't see all the beautiful work
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that just walks past us looking good,
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but has definitely been treated with
plastic surgery and injectable fillers.
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So one of the biggest pitfalls
is enlarging the lip without
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maintaining the curves and shape
that are natural to the lip.
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Either pumping up the lip
across the entire length,
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creating sort of a sausage like
look or just pumping up the
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corners of the lip, which is a very
fast and dirty injection technique.
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You put the needle in once at each corner
of the upper lip and scored in a bunch
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of filler that creates a,
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an intrinsically unnatural look. Now,
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there are so many folks who have that
look and it's in so many of the fashion
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magazines that I've actually had patients
come into the office and ask for that.
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And if you like that look for
some reason, that's okay. Uh,
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but it's important to recognize that
is an intrinsically unnatural look that
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that humans who have not been
treated don't possess, um,
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the outer portion of the upper lip
should be tapering towards the corner.
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00:17:24,530 --> 00:17:28,800
It should not be fullest
at the corner, uh,
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in times past and
particularly with collagen,
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which was a much softer injectable
and the current injectables,
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most of the injecting in the
lip was on the white rolls,
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that transition zone between
the pink and white lip.
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And that's, what's responsible
for giving people a duck
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billed look,
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there are portions of the white
roll that can be injected and look
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good. But if that's overdone or it's
done all the way across the lip,
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you end up with a duck billed
look, which again is unnatural.
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And most people are trying to avoid.
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What about when it comes to Botox?
What are some of the pitfalls there?
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Yeah, so Botox in certain
areas of the face,
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we're trying to get target
muscles completely asleep because
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that's aesthetically desirable and
there's no functional consequence
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in the area around the mouth
and the lip, a little is good,
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but more is not better.
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We need to maintain a good level
of function so you can speak
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swallow, drink, seal the lip, uh,
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and overdoing it in this area
will make unnatural motion
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and eventually, uh, the
inability to function adequately.
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So we have to accept that we can get
some nice effects with Botox in the oral
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area. It's an advanced injection
area, not for beginning injectors,
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00:19:02,020 --> 00:19:06,770
but it's really an excellent, excellent
treatment for many features in,
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in the lip and perioral area.
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But we have to accept the
limitations and not overdo it.
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I never realized all of the
complexity surrounding the lip.
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It was really interesting to hear the
different ways in which plastic surgery
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can help people achieve beautiful lips.
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This episode has definitely given me
a lot to think about if you think of
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00:19:29,761 --> 00:19:33,480
other trends in plastic surgery that
you would like us to explore in upcoming
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00:19:33,600 --> 00:19:36,920
episodes, feel free to reach
out, see you next time.
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This is Doreen Wu,
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00:19:39,160 --> 00:19:43,710
thanking you for joining Dr. Bass and
me for this discussion of beautiful lips
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00:19:43,711 --> 00:19:47,590
and plastic surgery. Be sure to
join us next time for our episode,
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discussing new FDA regulations
for breast implants that went into
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00:19:52,591 --> 00:19:53,470
effect October 2021.
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00:19:53,471 --> 00:19:58,390
Stream the episode to find out
about new consent processes
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00:19:58,609 --> 00:20:02,700
and the new black box warning on
breast implants in the United States.
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00:20:03,550 --> 00:20:07,580
Thank you for joining us in this episode
of the Park Avenue Plastic Surgery
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Class podcast with Dr. Lawrence
Bass Park Avenue plastic surgeon,
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00:20:12,980 --> 00:20:14,820
educator, and technology innovator.
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00:20:15,119 --> 00:20:17,619
The commentary in this
podcast represents opinion.
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00:20:17,960 --> 00:20:20,369
This podcast does not
present medical advice,
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00:20:20,710 --> 00:20:24,730
but rather general information about
plastic surgery that does not necessarily
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00:20:24,790 --> 00:20:27,890
relate to the specific conditions
of any individual patient.
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00:20:28,230 --> 00:20:32,890
No doctor patient relationship
is established by listening
to or participating
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00:20:33,030 --> 00:20:33,863
in this podcast,
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00:20:34,119 --> 00:20:38,240
consult your physician to advise you
about your individual healthcare.
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00:20:38,500 --> 00:20:39,960
If you enjoyed this episode,
296
00:20:40,140 --> 00:20:44,280
please share it with your friends and
be sure to subscribe to our podcast on
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00:20:44,281 --> 00:20:48,160
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00:20:48,460 --> 00:20:50,680
or wherever you listen to podcasts.