Optimizing the Lip Aesthetic Ratio Using Surgically Placed Silastic Implants for Lip Augmentation

Abstract

Introduction: Lip augmentation can be achieved using dermal fillers, biological tissues (fat, fascia, scar tissue, Alloderm), and a permanent soft silastic implant. Patients choosing the permanent lip implant were evaluated for aesthetic outcome, patient satisfaction, complications, and the use of dermal fillers postoperatively. Materials and Methods: Retrospective review of lip implant augmentation was performed in a single private practice. Analysis of aesthetic outcomes, adverse effects, methodology to determine optimal lip implant size, surgical technique caveats, and the use of dermal fillers before and after lip implant placement was carried out. Aesthetic outcomes and patient satisfaction were assessed by direct patient questioning and surgeon observation. Results: A total of 100 lip implant augmentation patients with 192 implants (92 combined upper and lower lips, 4 upper lip only, 4 lower lip only) were placed by the author between May 2011 and September 2021. From a patient satisfaction standpoint, 97% were happy with the final lip augmentation outcome. There was a complication incidence of 8%, with implant asymmetry the most common. Some patients (7%) underwent dermal fillers, both polymethylmethacrylate to the vermillion border and hyaluronic acid filler to the bulk of the lip to provide additional lip enhancement. Discussion: Silastic lip implant satisfies the following factors for lip augmentation: precise, accepted by the host, modifiable, natural feel, readily reversible, and permanency. The author’s quantitative method uses primarily the “golden ratio” (1:1.62) as the most impactful metric of size determination of the upper and lower lip followed by two-third incisor dental show. Most patients (94%) used lip dermal fillers prior to surgery to assess satisfaction with lip augmentation. Our results revealed larger lip implant size placement (4- and 5-mm diameter implants) compared with the largest study published. Lip bulk augmentation with hyaluronic acid fillers injected superficial to the implant capsule may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome. It is best to be an advanced filler injector and to use a microcannula for filler placement. Conclusions: The soft silastic lip implant procedure is a simple surgical procedure with a high patient satisfaction rate and low complication rate. Knowledge of lip aesthetic mathematical ratios and degree of dental show is imperative. Additional lip enhancement to lip bulk and vermillion border using both temporary and permanent dermal fillers may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome.