Oct. 22, 2024
Luscious Lips
As we get older, our lips naturally change. They lose their plumpness, the space between the nose and upper lip gets longer, and the pink part of the lip starts to wrinkle and lose its color.
Filler can definitely make your lips look fuller, but it's more about the shape than the size but there are other options for the lip as well. A lip flip uses Botox to relax the muscles in the upper lip and rotate the lip. Botox can also be used to fix a gummy smile.
Lip lift surgery shortens your upper lip and makes your lips look fuller, shorter, and shapelier. It’s a good option for people who want a more permanent change.
With so many choices out there, it can be tough to figure out what's best for you. Dr. Bass explains how your lips change as you age, what your options are, and how to decide which one is right for you.
Learn more about Botox, dermal fillers, and laser peels
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 Park Avenue
Plastic Surgery Class,
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a podcast where we explore controversies
and breaking issues in plastic surgery.
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I'm your co-host, Doreen Wu,
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a clinical assistant at Bass
Plastic Surgery in New York City.
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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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educator, and technology innovator.
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The title of today's
episode is Luscious Lips.
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We've talked about lips before on
the podcast. What is our focus today,
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Dr. Bass, and why are we going there?
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Lips are the most
popular area for fillers.
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A beautiful lip is very, very
appealing. So this is a big topic.
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We focused a lot on lip
shape in our previous episode
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and what we do with fillers
to promote a youthful,
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beautiful shape because there's
this very complex shape to the
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lip.
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And we discussed that in some
depth in that earlier episode.
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Certainly when we're trying to
create a fuller lip filler is a
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mainstay,
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and it's more about shape than
about the magnitude or size
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per se.
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So what else should we think
about with regard to the lip?
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Well, I wanted to speak a little
bit about how the lip ages and what
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kinds of issues need to be addressed.
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And this brings up other kinds of
treatments besides injectable fillers,
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which have a role in
addressing the aging lip,
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but also in enhancing lip
appearance in young people.
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Can you lay out some of these
issues for our listeners?
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Well,
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let's start by thinking about the skin
surface and move to deeper changes after
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that.
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So skin of the lip and the vermilion,
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the pink part,
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that has issues as we age of
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texture, smoothness and
eventually wrinkles.
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And there's a whole range of treatments
to chase this from makeup to home
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skincare products, chemical peels,
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various laser treatments
including laser peels and RF
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microneedling, all for skin smoothing.
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And more recently,
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there are superficial
fillers that can be used to
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chase wrinkles on the
lips and even to create a
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smoother vermilion
where you get that rough
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surface to the pink part of the lips
and some of the superficial fillers
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can even help with that.
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And these issues were often seen
earlier in the skin around the
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eyes and the mouth,
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and it probably affects those areas
disproportionately at any given age
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compared with the skin on
the remainder of the face.
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But these were really issues that apply
to skin all over the face as well as
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skin on the neck, décolletage, hands,
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and on the body as well.
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So sometimes we're only treating the
focused areas around the eyes or mouth,
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but often we're doing a
global facial treatment.
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Even when we treat the entire face,
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we're still going to adjust our
parameters, how the treatment's done.
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Fine tuning for the degree
of aging in each individual
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zone of the face.
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What are some other aging
changes associated with the lip?
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The lip loses volume as we age,
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becoming on average 41% less in thickness.
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In one MRI study looking at women's lips,
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comparing 20 to 30 year olds
with people 65 to 80 years old.
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This study was performed by a plastic
surgeon named Patrick Tonnard,
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who's in Ghent, Belgium.
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The same study showed
that the lip becomes 19%
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longer in the older group of women.
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So that lip length or what
we call filter length,
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the lip length right down the center
from the bottom of the nose to the
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top of the pink, that
increases and becomes longer.
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Just like when people get older, they
say you're long in the tooth. Well,
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that's the result of gums
recessing and exposing more of our
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teeth. This is something different.
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And while lip aging is not
extremely well understood,
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these two changes,
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loss of thickness or volume,
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put another way and increase
in lip length point to
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most of the goals of what we're trying
to chase and treating aging lips
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and those techniques are
then adapted and applied to
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enhancing lip shape in younger people.
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The volume loss in lengthening
results in a roll in of
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vermilion, the pink part of the lip.
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This is accompanied by straightening
of the shape of the upper lips.
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So the curviness that we have in
youth with bulges and depressions
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becomes straighter and more uniform.
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Underlying bony volume loss
further contributes to roll
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in and sagging.
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And the debate has always been whether
it's volume loss or skin sagging.
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But common sense and a growing body of
data suggests that there are multiple
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factors that add up to contribute to the
magnitude of the aging changes that are
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seen.
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Understanding the causes and these
changes is all well and good, Dr. Bass,
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but I'm most interested in hearing how
plastic surgeons are able to address
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these changes.
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Well, for loss of visibility of the
vermilion, there are multiple approaches,
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and it's kind of like the reconstructive
ladder in plastic surgery that we've
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talked about a lot on the podcast.
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It starts simple and the options
become increasingly involved.
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So the simplest thing
is makeup techniques,
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things like over lining,
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and if you do a little bit
of that to give a little
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increase to the appearance
of the size of the lip,
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that's okay.
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If you do that in a overblown
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way, kind of looks
unnatural. So that's good.
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If you only need a little,
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as we said at the beginning of this
episode, filler is the big one.
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It's the most popular area to treat
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at any age in any country.
Lip is number one,
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and unfortunately it's also the
least durable area in terms of how
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long that filler lasts.
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Nowadays we have lip specific fillers,
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fillers that have been formulated
to have the softness flexibility,
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but also the fullness specifically
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to inject in the lip area
for enhancement of lip
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shape.
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Another option that people
try either alone instead of
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filler or sometimes in addition
to filler is what's called
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the lip flip.
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And so this is taking Botox
or another neuromodulator and
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injecting it in the lip,
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and the idea is to relax the muscle,
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allowing the lip to roll out further,
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showing more of the vermilion.
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Now there's an important
fine point here because
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the muscle around the lips
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is called the orbicularis oris.
This muscle has two layers.
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The superficial layer is
circumferentially oriented,
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but the deeper layer is more
vertically oriented and it's that
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deeper layer that needs to
be injected. For a lip flip,
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we often inject the superficial
portion to the extent that we can
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separate which one we're injecting,
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which may or may not be true to try to
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reduce vertical lip lines.
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The final option is the lip lift,
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and this is a surgical
procedure that shortens the lip
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and rolls out the vermilion.
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What is the right choice
amongst all these options?
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How do I know what's right for me?
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Well, obviously it depends on the
individual filler, what most people use,
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along with minor makeup enhancement.
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While there's been a lot of
media play about lip flip,
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I find the effect modest and
focus more on Botox and other
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neuromodulators for some
softening of those dynamic
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vertical wrinkles in the upper lip.
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Lip lift is surgical,
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which means there's recovery and
you're making a permanent change,
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but that provides a robust correction.
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It's a very powerful technique
and it has durability
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at the same time as giving us more
vermilion show and making the lip
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look fuller.
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We're addressing that increase
in lip length that occurs with
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aging at the same time.
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So is the lip lift for aging lips?
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It's good in the aging. It gives a
fuller looking lip and a shorter lip,
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which is a younger looking lip,
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but it's also for younger people
who want to roll out more vermilion,
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make the lip more
prominent or shape the lip.
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So the use in young people is really to,
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in a durable way,
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increase vermilion show
and fullness of the lip.
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How is the lip lift performed? Give
me a general overview of the steps.
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So a wedge of skin is removed
at the top of the upper
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lip just beneath the nostrils.
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This is then carefully repaired
with sutures to hide the incision
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at the crease between
the nose and the lip.
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What does the recovery look
like and what are the risks?
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So there's always some swelling,
typically a little bruising,
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and that's going to settle
basically over two to three
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weeks.
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But the incision is still healing.
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The scar is maturing there.
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That's going to be red for
a lengthy period of time,
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two to three months for
the lip to fully soften.
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And scar maturity is at least six months.
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And the risk with a
procedure like this is it's
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permanent. If you don't
like the look or shape,
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you can't put the skin you took out back.
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It could be revised
shape, could be adjusted,
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but that points up that it's
better to remove the skin
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conservatively because
if you really had to,
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you could come back and take
more, but once you take it out,
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you can't put it back.
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The big issue with the
lip lift is the scar.
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This usually looks good,
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but it's based on your individual
wound healing. Everyone worries a lot
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about facelift scars, the incision
that's in front of the ear,
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but that area of facial
skin is much more forgiving
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than the upper lip.
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There's a lot of talk about
imperceptible lip lift scars,
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and you can always show an example
of a patient who's a good healer,
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who got a really faint
or imperceptible scar,
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but not everybody heals
that way. And again,
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that's honestly more about your
biology than it is about the surgeon.
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Once you put an incision someplace,
you can never 100% remove it.
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That being said,
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there are a lot of treatment
options today to help take a less
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than ideal scar and make
it much more favorable.
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We inject anti-inflammatory medicines.
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We do compression or apply scar gels,
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and we use fractional lasers on scars.
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But my general advice about the
lip lift is if you can't accept
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even a minimal scar, don't do it.
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Now, Dr. Bass, you mentioned shaping.
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What kind of shaping is
possible with the lip lift?
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As I said, mostly we're rolling
the lip out centrally to show more
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vermillion, but depending on
the shape of the excision,
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which areas from side to side are a little
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taller, where we're removing more skin
and which areas are a little shorter,
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where we're removing less,
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that's going to affect which parts
of the lip are pulled up and how
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much, which parts are
rolled out and how much
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there are other steps at
deeper levels that facilitate
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control of these issues.
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And typically it's mostly
central where the effects are.
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There are some techniques
that focus extra,
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especially centrally to
accent the cupid's bow.
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Some people have beautiful shape there
and others it's a lot flatter and if
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you're trying to really accent that,
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there are ways of fashion in
your lift to try to amplify
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that effect. On the other hand,
particularly in aging lips,
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there's sometimes the
outer part of the upper lip
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is hanging or hooded or the corner of
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the mouth is drooping.
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This is sort of the smiley face that
we have in youth turning into a frowny
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face. That's another aging change.
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And by having more excision laterally,
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sometimes extending around to the side
of the nostrils and not just the bottom
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of the nostrils allows adjustment of
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those outer portions of the lip.
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Dr. Bass, what should our listeners
take away from today's episode?
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Nowadays we have multiple options for
lip fullness and we always like having
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options. It gives us different ways to go,
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what might work better
for us individually,
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but it also makes life more
complex because it means
we have to make a decision.
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Lip lift has a big role,
especially in the aging lip,
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but increasingly in younger
people who want durability
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00:15:28,190 --> 00:15:32,840
and shape. The big concern
with the lip lift is the scar,
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which may not be imperceptible
depending on how you heal,
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and the lip continues to
be a very popular area.
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Everyone has their own aesthetic,
but everyone wants a beautiful lip.
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Very well put.
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00:15:48,830 --> 00:15:52,010
Thank you Dr. Bass for sharing
your insight and expertise with us.
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00:15:53,390 --> 00:15:57,050
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:15:57,500 --> 00:15:59,030
Follow us on Apple Podcasts,
245
00:15:59,030 --> 00:16:01,100
write a review and share
the show with your friends.
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00:16:01,520 --> 00:16:04,610
Be sure to join us next time to avoid
missing all the great content that's
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00:16:04,610 --> 00:16:08,150
coming your way. If you want to
contact us with comments or questions,
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00:16:08,150 --> 00:16:09,230
we'd love to hear from you.
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00:16:09,530 --> 00:16:13,790
Send us an email at podcast@drbass.net
or DM us on Instagram
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00:16:14,570 --> 00:16:14,660
@drbassnyc.
00:00:00,690 --> 00:00:03,330
Welcome to Park Avenue
Plastic Surgery Class,
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00:00:03,630 --> 00:00:07,800
a podcast where we explore controversies
and breaking issues in plastic surgery.
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00:00:08,220 --> 00:00:09,780
I'm your co-host, Doreen Wu,
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00:00:09,990 --> 00:00:13,140
a clinical assistant at Bass
Plastic Surgery in New York City.
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00:00:13,620 --> 00:00:18,060
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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00:00:18,360 --> 00:00:20,460
educator, and technology innovator.
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00:00:20,970 --> 00:00:23,880
The title of today's
episode is Luscious Lips.
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00:00:24,900 --> 00:00:28,140
We've talked about lips before on
the podcast. What is our focus today,
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00:00:28,140 --> 00:00:29,940
Dr. Bass, and why are we going there?
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00:00:30,960 --> 00:00:34,350
Lips are the most
popular area for fillers.
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00:00:34,980 --> 00:00:39,690
A beautiful lip is very, very
appealing. So this is a big topic.
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00:00:40,230 --> 00:00:45,090
We focused a lot on lip
shape in our previous episode
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00:00:45,630 --> 00:00:49,500
and what we do with fillers
to promote a youthful,
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00:00:49,500 --> 00:00:54,060
beautiful shape because there's
this very complex shape to the
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00:00:54,270 --> 00:00:55,103
lip.
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00:00:55,650 --> 00:00:59,460
And we discussed that in some
depth in that earlier episode.
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00:01:00,330 --> 00:01:04,350
Certainly when we're trying to
create a fuller lip filler is a
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00:01:04,360 --> 00:01:05,400
mainstay,
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00:01:06,600 --> 00:01:11,490
and it's more about shape than
about the magnitude or size
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00:01:11,490 --> 00:01:12,323
per se.
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00:01:12,990 --> 00:01:15,720
So what else should we think
about with regard to the lip?
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00:01:16,410 --> 00:01:21,060
Well, I wanted to speak a little
bit about how the lip ages and what
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00:01:21,070 --> 00:01:23,940
kinds of issues need to be addressed.
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00:01:24,420 --> 00:01:28,590
And this brings up other kinds of
treatments besides injectable fillers,
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00:01:28,860 --> 00:01:31,440
which have a role in
addressing the aging lip,
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00:01:31,800 --> 00:01:35,430
but also in enhancing lip
appearance in young people.
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00:01:36,240 --> 00:01:38,790
Can you lay out some of these
issues for our listeners?
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00:01:39,900 --> 00:01:40,050
Well,
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00:01:40,050 --> 00:01:45,030
let's start by thinking about the skin
surface and move to deeper changes after
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00:01:45,030 --> 00:01:45,400
that.
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00:01:45,400 --> 00:01:50,070
So skin of the lip and the vermilion,
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00:01:50,070 --> 00:01:52,800
the pink part,
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00:01:52,800 --> 00:01:55,320
that has issues as we age of
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00:01:55,470 --> 00:01:59,310
texture, smoothness and
eventually wrinkles.
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00:01:59,320 --> 00:02:04,260
And there's a whole range of treatments
to chase this from makeup to home
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00:02:04,260 --> 00:02:06,510
skincare products, chemical peels,
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00:02:06,510 --> 00:02:10,960
various laser treatments
including laser peels and RF
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00:02:10,960 --> 00:02:14,190
microneedling, all for skin smoothing.
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00:02:15,210 --> 00:02:16,620
And more recently,
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00:02:16,620 --> 00:02:21,060
there are superficial
fillers that can be used to
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00:02:21,070 --> 00:02:25,290
chase wrinkles on the
lips and even to create a
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00:02:25,290 --> 00:02:29,070
smoother vermilion
where you get that rough
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00:02:30,240 --> 00:02:34,740
surface to the pink part of the lips
and some of the superficial fillers
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00:02:35,040 --> 00:02:36,750
can even help with that.
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00:02:38,880 --> 00:02:43,440
And these issues were often seen
earlier in the skin around the
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00:02:43,440 --> 00:02:45,120
eyes and the mouth,
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00:02:45,510 --> 00:02:50,460
and it probably affects those areas
disproportionately at any given age
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00:02:50,460 --> 00:02:53,460
compared with the skin on
the remainder of the face.
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00:02:54,030 --> 00:02:58,770
But these were really issues that apply
to skin all over the face as well as
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00:02:58,780 --> 00:03:02,770
skin on the neck, décolletage, hands,
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00:03:02,770 --> 00:03:04,690
and on the body as well.
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00:03:05,290 --> 00:03:09,670
So sometimes we're only treating the
focused areas around the eyes or mouth,
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00:03:10,030 --> 00:03:13,150
but often we're doing a
global facial treatment.
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00:03:14,440 --> 00:03:16,870
Even when we treat the entire face,
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00:03:16,900 --> 00:03:21,850
we're still going to adjust our
parameters, how the treatment's done.
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00:03:22,210 --> 00:03:26,440
Fine tuning for the degree
of aging in each individual
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00:03:26,710 --> 00:03:28,660
zone of the face.
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00:03:29,620 --> 00:03:32,780
What are some other aging
changes associated with the lip?
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00:03:34,060 --> 00:03:37,360
The lip loses volume as we age,
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00:03:38,020 --> 00:03:42,910
becoming on average 41% less in thickness.
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00:03:43,510 --> 00:03:47,830
In one MRI study looking at women's lips,
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00:03:47,830 --> 00:03:52,780
comparing 20 to 30 year olds
with people 65 to 80 years old.
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00:03:53,500 --> 00:03:57,940
This study was performed by a plastic
surgeon named Patrick Tonnard,
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00:03:57,940 --> 00:03:59,290
who's in Ghent, Belgium.
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00:04:00,610 --> 00:04:04,660
The same study showed
that the lip becomes 19%
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00:04:04,690 --> 00:04:07,540
longer in the older group of women.
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00:04:08,200 --> 00:04:11,470
So that lip length or what
we call filter length,
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00:04:11,740 --> 00:04:16,360
the lip length right down the center
from the bottom of the nose to the
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00:04:16,360 --> 00:04:21,100
top of the pink, that
increases and becomes longer.
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00:04:21,100 --> 00:04:25,450
Just like when people get older, they
say you're long in the tooth. Well,
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00:04:25,630 --> 00:04:30,520
that's the result of gums
recessing and exposing more of our
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00:04:30,520 --> 00:04:32,560
teeth. This is something different.
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00:04:33,070 --> 00:04:36,520
And while lip aging is not
extremely well understood,
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00:04:37,780 --> 00:04:39,580
these two changes,
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00:04:39,940 --> 00:04:43,390
loss of thickness or volume,
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00:04:43,600 --> 00:04:48,550
put another way and increase
in lip length point to
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00:04:48,550 --> 00:04:53,410
most of the goals of what we're trying
to chase and treating aging lips
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00:04:54,040 --> 00:04:58,420
and those techniques are
then adapted and applied to
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00:04:58,420 --> 00:05:01,330
enhancing lip shape in younger people.
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00:05:03,940 --> 00:05:08,440
The volume loss in lengthening
results in a roll in of
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00:05:08,440 --> 00:05:10,660
vermilion, the pink part of the lip.
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00:05:11,320 --> 00:05:15,160
This is accompanied by straightening
of the shape of the upper lips.
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00:05:15,160 --> 00:05:19,240
So the curviness that we have in
youth with bulges and depressions
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00:05:19,930 --> 00:05:22,900
becomes straighter and more uniform.
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00:05:23,650 --> 00:05:28,270
Underlying bony volume loss
further contributes to roll
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00:05:28,270 --> 00:05:30,550
in and sagging.
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00:05:31,540 --> 00:05:36,040
And the debate has always been whether
it's volume loss or skin sagging.
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00:05:36,040 --> 00:05:40,990
But common sense and a growing body of
data suggests that there are multiple
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00:05:40,990 --> 00:05:45,550
factors that add up to contribute to the
magnitude of the aging changes that are
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00:05:45,550 --> 00:05:46,383
seen.
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00:05:48,040 --> 00:05:52,420
Understanding the causes and these
changes is all well and good, Dr. Bass,
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00:05:52,630 --> 00:05:56,380
but I'm most interested in hearing how
plastic surgeons are able to address
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00:05:56,380 --> 00:05:57,220
these changes.
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00:05:58,340 --> 00:06:02,930
Well, for loss of visibility of the
vermilion, there are multiple approaches,
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00:06:03,260 --> 00:06:06,800
and it's kind of like the reconstructive
ladder in plastic surgery that we've
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00:06:06,800 --> 00:06:09,560
talked about a lot on the podcast.
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00:06:10,400 --> 00:06:15,230
It starts simple and the options
become increasingly involved.
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00:06:15,860 --> 00:06:19,280
So the simplest thing
is makeup techniques,
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00:06:19,280 --> 00:06:20,900
things like over lining,
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00:06:21,380 --> 00:06:26,150
and if you do a little bit
of that to give a little
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00:06:26,150 --> 00:06:30,260
increase to the appearance
of the size of the lip,
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that's okay.
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00:06:32,180 --> 00:06:35,870
If you do that in a overblown
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00:06:35,870 --> 00:06:40,610
way, kind of looks
unnatural. So that's good.
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00:06:40,610 --> 00:06:42,050
If you only need a little,
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00:06:43,430 --> 00:06:48,020
as we said at the beginning of this
episode, filler is the big one.
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00:06:48,560 --> 00:06:52,430
It's the most popular area to treat
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00:06:53,780 --> 00:06:57,890
at any age in any country.
Lip is number one,
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00:06:58,580 --> 00:07:03,560
and unfortunately it's also the
least durable area in terms of how
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00:07:03,570 --> 00:07:05,300
long that filler lasts.
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00:07:06,110 --> 00:07:09,050
Nowadays we have lip specific fillers,
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00:07:09,050 --> 00:07:13,220
fillers that have been formulated
to have the softness flexibility,
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00:07:13,220 --> 00:07:18,050
but also the fullness specifically
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00:07:18,050 --> 00:07:22,730
to inject in the lip area
for enhancement of lip
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00:07:22,730 --> 00:07:23,563
shape.
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00:07:25,850 --> 00:07:30,680
Another option that people
try either alone instead of
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00:07:30,680 --> 00:07:35,570
filler or sometimes in addition
to filler is what's called
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00:07:35,580 --> 00:07:36,620
the lip flip.
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00:07:36,620 --> 00:07:40,940
And so this is taking Botox
or another neuromodulator and
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00:07:40,940 --> 00:07:42,620
injecting it in the lip,
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00:07:42,650 --> 00:07:47,540
and the idea is to relax the muscle,
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00:07:48,050 --> 00:07:52,730
allowing the lip to roll out further,
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00:07:52,760 --> 00:07:54,890
showing more of the vermilion.
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00:07:55,550 --> 00:07:58,490
Now there's an important
fine point here because
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00:08:00,800 --> 00:08:04,670
the muscle around the lips
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00:08:05,600 --> 00:08:10,010
is called the orbicularis oris.
This muscle has two layers.
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00:08:10,010 --> 00:08:14,270
The superficial layer is
circumferentially oriented,
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00:08:14,840 --> 00:08:19,640
but the deeper layer is more
vertically oriented and it's that
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00:08:19,650 --> 00:08:23,000
deeper layer that needs to
be injected. For a lip flip,
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00:08:23,810 --> 00:08:28,430
we often inject the superficial
portion to the extent that we can
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00:08:28,440 --> 00:08:30,980
separate which one we're injecting,
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00:08:30,980 --> 00:08:35,390
which may or may not be true to try to
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00:08:35,400 --> 00:08:37,970
reduce vertical lip lines.
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00:08:39,920 --> 00:08:42,950
The final option is the lip lift,
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00:08:43,250 --> 00:08:47,390
and this is a surgical
procedure that shortens the lip
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00:08:48,200 --> 00:08:50,120
and rolls out the vermilion.
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00:08:51,770 --> 00:08:54,650
What is the right choice
amongst all these options?
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00:08:54,680 --> 00:08:56,160
How do I know what's right for me?
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00:08:57,570 --> 00:09:02,520
Well, obviously it depends on the
individual filler, what most people use,
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00:09:02,520 --> 00:09:04,770
along with minor makeup enhancement.
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00:09:05,580 --> 00:09:08,520
While there's been a lot of
media play about lip flip,
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00:09:08,610 --> 00:09:12,660
I find the effect modest and
focus more on Botox and other
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00:09:13,320 --> 00:09:17,850
neuromodulators for some
softening of those dynamic
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00:09:17,850 --> 00:09:22,320
vertical wrinkles in the upper lip.
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00:09:22,320 --> 00:09:23,930
Lip lift is surgical,
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00:09:23,930 --> 00:09:28,170
which means there's recovery and
you're making a permanent change,
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00:09:28,650 --> 00:09:31,890
but that provides a robust correction.
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00:09:32,640 --> 00:09:36,420
It's a very powerful technique
and it has durability
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00:09:38,340 --> 00:09:43,290
at the same time as giving us more
vermilion show and making the lip
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00:09:43,290 --> 00:09:44,280
look fuller.
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00:09:44,670 --> 00:09:49,440
We're addressing that increase
in lip length that occurs with
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00:09:49,440 --> 00:09:51,300
aging at the same time.
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00:09:51,990 --> 00:09:54,840
So is the lip lift for aging lips?
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00:09:55,590 --> 00:10:00,240
It's good in the aging. It gives a
fuller looking lip and a shorter lip,
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00:10:00,240 --> 00:10:01,920
which is a younger looking lip,
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00:10:01,920 --> 00:10:06,570
but it's also for younger people
who want to roll out more vermilion,
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00:10:06,570 --> 00:10:09,540
make the lip more
prominent or shape the lip.
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00:10:10,470 --> 00:10:14,940
So the use in young people is really to,
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00:10:15,660 --> 00:10:17,370
in a durable way,
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00:10:18,270 --> 00:10:21,450
increase vermilion show
and fullness of the lip.
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00:10:22,770 --> 00:10:26,670
How is the lip lift performed? Give
me a general overview of the steps.
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00:10:27,600 --> 00:10:32,280
So a wedge of skin is removed
at the top of the upper
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00:10:32,280 --> 00:10:34,890
lip just beneath the nostrils.
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00:10:35,550 --> 00:10:39,930
This is then carefully repaired
with sutures to hide the incision
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00:10:40,260 --> 00:10:43,380
at the crease between
the nose and the lip.
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00:10:44,310 --> 00:10:47,340
What does the recovery look
like and what are the risks?
167
00:10:48,030 --> 00:10:51,450
So there's always some swelling,
typically a little bruising,
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00:10:51,960 --> 00:10:56,520
and that's going to settle
basically over two to three
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00:10:56,520 --> 00:10:57,353
weeks.
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00:10:57,600 --> 00:11:01,890
But the incision is still healing.
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00:11:01,890 --> 00:11:03,600
The scar is maturing there.
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00:11:03,600 --> 00:11:07,260
That's going to be red for
a lengthy period of time,
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00:11:09,750 --> 00:11:12,810
two to three months for
the lip to fully soften.
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00:11:12,810 --> 00:11:16,770
And scar maturity is at least six months.
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00:11:18,120 --> 00:11:22,770
And the risk with a
procedure like this is it's
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00:11:22,770 --> 00:11:25,860
permanent. If you don't
like the look or shape,
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00:11:25,890 --> 00:11:28,770
you can't put the skin you took out back.
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00:11:28,980 --> 00:11:32,610
It could be revised
shape, could be adjusted,
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00:11:33,210 --> 00:11:36,600
but that points up that it's
better to remove the skin
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00:11:36,630 --> 00:11:40,320
conservatively because
if you really had to,
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00:11:40,320 --> 00:11:44,520
you could come back and take
more, but once you take it out,
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00:11:44,520 --> 00:11:45,780
you can't put it back.
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00:11:46,980 --> 00:11:50,370
The big issue with the
lip lift is the scar.
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00:11:50,880 --> 00:11:52,290
This usually looks good,
185
00:11:52,300 --> 00:11:57,160
but it's based on your individual
wound healing. Everyone worries a lot
186
00:11:57,160 --> 00:12:01,060
about facelift scars, the incision
that's in front of the ear,
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00:12:01,690 --> 00:12:06,250
but that area of facial
skin is much more forgiving
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00:12:07,000 --> 00:12:08,350
than the upper lip.
189
00:12:09,100 --> 00:12:13,840
There's a lot of talk about
imperceptible lip lift scars,
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00:12:14,110 --> 00:12:17,830
and you can always show an example
of a patient who's a good healer,
191
00:12:17,840 --> 00:12:21,310
who got a really faint
or imperceptible scar,
192
00:12:21,940 --> 00:12:24,490
but not everybody heals
that way. And again,
193
00:12:24,490 --> 00:12:29,170
that's honestly more about your
biology than it is about the surgeon.
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00:12:29,680 --> 00:12:34,000
Once you put an incision someplace,
you can never 100% remove it.
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00:12:34,780 --> 00:12:35,740
That being said,
196
00:12:35,740 --> 00:12:40,450
there are a lot of treatment
options today to help take a less
197
00:12:40,450 --> 00:12:43,870
than ideal scar and make
it much more favorable.
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00:12:44,590 --> 00:12:47,020
We inject anti-inflammatory medicines.
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00:12:47,530 --> 00:12:50,920
We do compression or apply scar gels,
200
00:12:51,250 --> 00:12:54,430
and we use fractional lasers on scars.
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00:12:54,790 --> 00:12:59,770
But my general advice about the
lip lift is if you can't accept
202
00:12:59,770 --> 00:13:02,260
even a minimal scar, don't do it.
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00:13:03,550 --> 00:13:05,830
Now, Dr. Bass, you mentioned shaping.
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00:13:06,160 --> 00:13:08,410
What kind of shaping is
possible with the lip lift?
205
00:13:09,580 --> 00:13:14,530
As I said, mostly we're rolling
the lip out centrally to show more
206
00:13:14,530 --> 00:13:18,670
vermillion, but depending on
the shape of the excision,
207
00:13:19,840 --> 00:13:23,830
which areas from side to side are a little
208
00:13:24,670 --> 00:13:29,650
taller, where we're removing more skin
and which areas are a little shorter,
209
00:13:29,650 --> 00:13:31,360
where we're removing less,
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00:13:31,690 --> 00:13:36,340
that's going to affect which parts
of the lip are pulled up and how
211
00:13:36,340 --> 00:13:40,900
much, which parts are
rolled out and how much
212
00:13:42,490 --> 00:13:46,930
there are other steps at
deeper levels that facilitate
213
00:13:47,260 --> 00:13:49,360
control of these issues.
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00:13:50,890 --> 00:13:55,360
And typically it's mostly
central where the effects are.
215
00:13:55,630 --> 00:13:59,080
There are some techniques
that focus extra,
216
00:13:59,080 --> 00:14:03,700
especially centrally to
accent the cupid's bow.
217
00:14:06,430 --> 00:14:10,870
Some people have beautiful shape there
and others it's a lot flatter and if
218
00:14:10,870 --> 00:14:12,580
you're trying to really accent that,
219
00:14:12,580 --> 00:14:17,350
there are ways of fashion in
your lift to try to amplify
220
00:14:17,350 --> 00:14:21,820
that effect. On the other hand,
particularly in aging lips,
221
00:14:22,360 --> 00:14:26,020
there's sometimes the
outer part of the upper lip
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is hanging or hooded or the corner of
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the mouth is drooping.
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This is sort of the smiley face that
we have in youth turning into a frowny
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face. That's another aging change.
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And by having more excision laterally,
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sometimes extending around to the side
of the nostrils and not just the bottom
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of the nostrils allows adjustment of
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those outer portions of the lip.
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Dr. Bass, what should our listeners
take away from today's episode?
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Nowadays we have multiple options for
lip fullness and we always like having
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00:15:07,490 --> 00:15:11,750
options. It gives us different ways to go,
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what might work better
for us individually,
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but it also makes life more
complex because it means
we have to make a decision.
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Lip lift has a big role,
especially in the aging lip,
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but increasingly in younger
people who want durability
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00:15:28,190 --> 00:15:32,840
and shape. The big concern
with the lip lift is the scar,
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which may not be imperceptible
depending on how you heal,
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00:15:38,030 --> 00:15:41,450
and the lip continues to
be a very popular area.
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Everyone has their own aesthetic,
but everyone wants a beautiful lip.
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Very well put.
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Thank you Dr. Bass for sharing
your insight and expertise with us.
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00:15:53,390 --> 00:15:57,050
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:15:57,500 --> 00:15:59,030
Follow us on Apple Podcasts,
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00:15:59,030 --> 00:16:01,100
write a review and share
the show with your friends.
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00:16:01,520 --> 00:16:04,610
Be sure to join us next time to avoid
missing all the great content that's
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00:16:04,610 --> 00:16:08,150
coming your way. If you want to
contact us with comments or questions,
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00:16:08,150 --> 00:16:09,230
we'd love to hear from you.
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00:16:09,530 --> 00:16:13,790
Send us an email at podcast@drbass.net
or DM us on Instagram
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00:16:14,570 --> 00:16:14,660
@drbassnyc.