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Chapter Seven The Lips The Shape What Can Be Done Chin Surgery Lip Surgery The Paris Lip

The Paris Lip

As I mentioned at the beginning of this chapter, some patients are not at all interested in surgical procedures to improve the appearance of their lips; what they want is the extremely popular, nonsurgical procedure of a series of collagen injections. Blame it on pop and movie stars like Barbara Hershey, Julie Roberts and Madonna if you will, but the world is beating a path to the doorways of cosmetic surgeons in search of the luscious lips that one marketing whiz has dubbed “The Paris Lip”.

Collagen, as I explained earlier, is a natural product of the dermis layer of human skin. However, The Collagen Corporation of California has two manufactured collagen products on the market called Zyderm, and more recently, Zyplast. Both are injectable biological compositions mixed with anesthetic fluid. Zyderm is used for fine lines around the eyes. Zyplast is a firmed form of collagen used for deeper wrinkles, like frown lines and pronounced lip-cheek grooves. I use Zyplast on the lips of those patients in search of a luscious look.

It’s a simple enough procedure. We have the patient settle back into a chair, the same way she would at the dentist’s office. (Most, but not all, luscious lip patients are female.) A small mark is made with a felt-tip pen to identify the center of her Cupid’s bow, where the red and flesh-colored segments of the upper lip join. We have the patient rub a small amount of topical anesthetic on the mucous membrane just inside her upper lip; it numbs the area and makes the injection more tolerable. Occasionally, we use an injectable anesthetic to make it a totally painless procedure; this causes the area to swell up temporarily.

Lidocaine is a synthetic anesthetic extracted from cocaine. The manufacturers of injectable collagen recognize the need for at least a small amount of local anesthetic so the procedure won’t be too painful, but the presence of lidocaine and collagen means each patient must be tested for allergic reaction before undergoing the procedure. We are cautious, too, in injecting patients who have a history of recurrent cold sores on their lips. An injection could activate the virus that would cause another sore to develop. Children and women who are pregnant should not have their lips injected, because not enough research has been done to verify whether it is a safe procedure for them.

Once the mark on the Cupid’s bow has been made, it will serve as a reference point during the procedure to make sure that the surgeon creates luscious - and symmetrical - lips. The needle is inserted near the commissure, or corner, of one side of the upper lip and collagen is injected in a line that follows exactly the vermilion border. The vermilion border is an excellent site for improving the shape of the Cupid’s bow, especially when it is somewhat flat in appearance naturally. The injections raise the bow and “push out” or evert the lip so that it looks fuller. (This could change if a patient has specifically requested injections in the red or flesh-colored segments, depending on what kind of proportion we are trying to achieve in the lips.)

Technique varies from surgeon to surgeon, but I prefer an injection that is neither too near the surface, nor too deep, called linear threading. If the injection is shallow, you can see the line of collagen just below the skin. If it’s too deep, it won’t be as long-lasting. I slide the tiny needle paralled to the level I want the collagen deposited; it might take two or more injections along the vermilion border to complete one side of the lip. The procedure is repeated on the other side of the upper lip, starting at the top of the Cupid’s bow and working down toward the commissure. With each injection, the area affected swells up a bit, so the mark in the middle helps to maintain symmetry even when one side of the lip is swollen and the other side is not.

Injecting collagen into the lips is really “millimeter surgery for millimeter results.” Half a cc will generally suffice for a straightforward Paris Lip procedure. Because collagen has a local anesthetic in it, the lips must be over-injected to compensate for the fact that swelling caused by the anesthetic itself will dissipate within twenty-four hours. Some patients want a dramatic look, but I caution against having so must injected that it looks unnatural. (Tell this to Julia Roberts, who seems to like lips that look like cocktail wieners.) And, for all I’ve said about it, a tiny bit of asymmetry is not a bad thing; most people have naturally asymmetric features. The injections have to be repeated about every three months, which can vary with the individual, because collagen is a natural substance that dissipates within the body.

Perhaps the best thing about collagen injections to the lips is that the procedure only takes about fifteen minutes, and by the time you get home, most of the reactionary swelling will have disappeared. You can put on your party clothes and go out and show off your new, luscious lips.

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