WHAT HAPPENS TO FREE FAT GRAFTS AFTER 20 YEARS IN PATIENTS WHO GAIN WEIGHT?

An index for quantitative assessment of lip augmentation

BACKGROUND

Lip dimensions and their relation to the whole face have been discussed mainly in the dental literature. There have been few attempts to scientifically measure the degree of lip augmentation, regardless of method.

OBJECTIVES

The authors describe a Lip Index that will allow reliable, quantitative analysis of the human lip complex, which is necessary to assess the efficacy and duration of attempts at lip augmentation.

METHODS

The authors developed a Lip Index as the basis for objective measurements of the effect and duration of lip augmentation with dermal fillers. Measurements may be taken directly from the patient, from standardized photos, or from the computer screen. Using a metric ruler, the height of the vermilion in the middle of the Cupid's bow is first measured (in mm) on the frontal view. The point of maximum protrusion of the vermilion is then measured (in mm) on a standardized side view perpendicular to a vertical line connecting the base of the columella to the fold demarcating lower lip and chin. Vermilion height multiplied by horizontal protrusion directly correlates with the central volume of the lips, upper and lower.

RESULTS

The easily applied ruler provided consistent measures before and after the injection of dermal fillers or soft implants. Adding upper and lower lip indices resulted in the Overall Lip Index for each patient, which was found to be approximately 50 in average females of Caucasian descent, about 100 in females of Asian descent, and nearly 200 in females of African descent.

CONCLUSIONS

The Lip Index allows for the practical evaluation of the clinical effects and duration of dermal filler injectables or implants. Quantitative assessments of results over time are easy to calculate, without the need for complex measurements or sophisticated analyses.

Avoiding and treating dermal filler complications

All fillers are associated with the risk of both early and late complications. Early side effects such as swelling, redness, and bruising occur after intradermal or subdermal injections. The patient has to be aware of and accept these risks. Adverse events that last longer than 2 weeks can be attributable to technical shortcomings (e.g., too superficial an implantation of a long-lasting filler substance). Such adverse events can be treated with intradermal 5-fluorouracil, steroid injections, vascular lasers, or intense pulsed light, and later with dermabrasion or shaving. Late adverse events also include immunologic phenomena such as late-onset allergy and nonallergic foreign body granuloma. Both react well to intralesional steroid injections, which often have to be repeated to establish the right dose. Surgical excisions shall remain the last option and are indicated for hard lumps in the lips and visible hard nodules or hard granuloma in the subcutaneous fat.

ArteFill: A Third-Generation Permanent Dermal Filler and Tissue Stimulator

The technical and physiologic shortcomings associated with prior generations of polymethylmethacrylate (PMMA) dermal fillers have been reduced significantly since their original market introduction in 1989. For example, the PMMA microspheres in the third-generation product ArteFill meet the new limit set by the FDA of less than 1 particle below 20 micrometers per 100 microspheres (< 1% by the number). Therefore, it is expected that the already low granuloma rate following injections with second-generation product Artecoll (1:5000) will be reduced further with injections of ArteFill. In the authors' experience, both Artecoll and ArteFill have proven to be safe, predictable, and effective dermal fillers. It is anticipated that Artefill will receive FDA approval in late 2006 and will be marketed internationally.