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Registration Lip Augmentation Program
8654 Nottingham Place
la Jolla, CA 92037
USA
Phone: 858-550-9533
fax: 858-550-9533
Email registration: annkatz@yahoo.com

If you would like to be a patient of Dr. Katz, you can arrange an appointment at the same phone number or address above.

Smiles

Treatment Techniques

Treatment Options

· Hyaluronic Acid
· Collagen
· Semi Permanent Fillers
· Fat from Liposuction
· Grafts

Injection techniques involve using tiny (30 gauge half inch long) needles to fill and recontour the lip with a substance like hyaluronic acid, collagen or fat to create a fuller appearance and to maximize dental esthetics. Injection techniques demonstrate less risk because the procedure is usually temporary, have fewer side-effects and the lips revert to their original dimensions over a few months. The procedures are easily reversible unlike flaps and grafts, and other dental, periodontal orthodontic or orthognathic procedures used to achieve the same effects.

The following are the different types of materials used:

Hyaluronic Acid

These products are currently the most popular filler materials for lip augmentation because they are non-allergenic, non-immunogenic and do not transfer disease from their source to the patient.
Hyaluronic acid is a natural substance that is found in all living organisms. High concentrations are found in soft connective tissue and in the fluid surrounding the eye. It is also present in saliva, some cartilage and joint fluids, and in skin tissue.
In skin tissue, hyaluronic acid is a jelly-like substance that fills the space between collagen and elastin fibres. The role of hyaluronic acid in skin is to:

provide a mechanism of transport of essential nutrients from the bloodstream to living skin cells
hydrate the skin by holding in water
act as a cushioning and lubricating agent against mechanical and chemical damage

Over time, either through the natural process of aging or through exposure to environmental factors such as pollutants and sunlight, the body's natural store of hyaluronic acid is degraded and destroyed.

In the last 30 years synthetic forms of hyaluronic acid have been developed and used to correct disorders in the fields of rheumatology, ophthalmology, and wound repair. More recently, synthetic forms of hyaluronic acid are being manufactured for use in facial augmentation. Brand names of manufactured hyaluronic gels or NASHA’s (non-animal stabilised hyaluronic acid) for this purpose include Hylanew®, Hylanew Plus®, Hylaform® Restylane®, Perlane®, Juvederm®, Rofilan Hylan® and AcHyal®.

Tiny quantities of hyaluronic acid are injected through very fine needles, boosting the skin's own hyaluronic acid. The treatment takes 20 minutes to an hour, including essential local anesthesia to prevent discomfort. The effects last on average for 4 months.

Hyaluronic Acid Products Comparison Table
Name of Injectable	Description	Purpose	Possible Side Effects/Risks	Results	Regulatory Status
Restylane	Non-animal derived hyaluronic acid	Soft tissue filler that adds volume	Redness, swelling, rare allergic reaction	Immediate, may last up to 3 months in the lip	FDA approved for filling moderate to severe wrinkles around the nose and mouth. All other use considered off label.
Hylanew	Non-animal derived hyaluronic acid	Soft tissue filler that adds volume	Redness, swelling, tenderness, especially at sight of injection; acne-like formations are rare	Immediate, may last up to 1 year in nasio-labial folds; 3-4 months in the lips	In use in Canada and Europe. Not FDA approved for any use in the U.S.
Perlane	Non-animal derived hyaluronic acid	Soft tissue filler that adds volume	Pain, redness, swelling, itching, discoloration, and tenderness at the point of injection	Immediate may last up to 4 months subsequent injections may require less	In use outside U.S. Not FDA approved for any use in the U.S.
Captique	Non-animal derived hyaluronic acid	Soft tissue filler that adds volume	Bruising, swelling, rare allergic reaction	Immediate, may last up to 3 months	FDA approved for filling moderate to sever facial wrinkles and folds around the nose and mouth
Hylaform	Hyaluronic acid extracted from rooster combs	Soft tissue filler that adds volume	Redness, swelling, people with sensitivities to avian products may have an allergic reaction	Vary, may last up to 3 months	FDA approved for filling moderate to severe wrinkles around the nose and mouth. All other use considered off label.
Hylaform Plus	Hyaluronic acid extracted from rooster combs. Contains large hyaluronic gel acid particles	Soft tissue filler that adds volume	Redness, swelling, people with sensitivities to avian products may have an allergic reaction	Vary, may last longer than 4 months	FDA approved for filling moderate to severe wrinkles around the nose and mouth

Collagen

Bovine Collagen

Bovine Collagen is made from cow skin and, although it is purified, it may cause allergic reactions and requires a sensitivity test beforehand. The results are temporary and only last one to three months because the body breaks down the material.

Product Names	Description	Purpose	Possible Side Effects/Risks	Results	Regulatory Status
Zyderm/ Zyplast	Collagen injection made from purified cow skin	Fills wrinkles, lines and scars on face and around lips	Allergic reaction. Requires skin test prior to procedure.	Immediate, lasts up to 4 months	FDA approved

Human Derived Collagen

A group of human-derived collagen products are currently available in the United States. The tissue, harvested using sterile techniques from donors or grown in a laboratory, are processed to form an injectable human collagen matrix.

The following table compares the human derived collagen products:

Product Names	Description	Purpose	Possible Side Effects/Risks	Results	Regulatory Status
Cymetra (Micronized Alloderm)	Injectable human tissue collagen matrix derived from cadaver tissue, screened for contami-nation.	Filler for lips, nasolabial folds, deep wrinkles and lines.	Bruising	Multiple treatments needed; lasts 2 months	FDA approved
CosmoDerm/ CosmoPlast	Derived from human tissue that has been purified and grown in a laboratory Doesn't need a skin test.	Approved for frown lines, crow's feet, forehead lines, smile lines, vertical lip lines, marionette lines, lip border and for certain scars. Cosmoderm is used for superficial lines, while Cosmoplast is used for more pronounced wrinkles	Bruising	Immediate,lasting up to six months depending on the area treated	FDA Approved
Fascian	Injectable derived from donor-fascia (connective tissue made of collagen) of the thigh muscle	Stimulates collagen formation, adds bulk	Bruising	Lasts up to 6 months	FDA approved
Autologen	Injectable collagen prepared from the patient's skin. Small pieces of skin are harvested from the patient, processed and prepared for injection or frozen for later use.	An alternative to traditional collagen injections	Bruising, time consuming and expensive	2 or 3 treatments over a 6 to 8 week period to produce collagen; not permanent	Not Required
Plasmagel	Plasma emulsion (protein) made of patient's blood and Vitamin C complex	Soft tissue filler to add volume	Bruising	Lasts up to 3 months	Not required

Semi Permanent Fillers

Sculptra is made of poly-L-lactic acid, the same material as resorbable sutures are made from. This is the longest lasting approved filler material available in the USA. The filler is usually given in two sessions to compensate for shrinkage.

Artecoll, is a new material with long lasting results. It is mainly composed of tiny synthetic “beads” (polymethyl methacrylate) which stimulate the body to produce new collagen and connective tissue to surround each microsphere. This makes it a long lasting solution.

This table compares the semi-permanent fillers:

Injectable	Description	Purpose	Possible Side Effects/Risks	Results	Regulatory Status
Artecoll	75% percent bovine collagen and 25% polymethyl-methacrylate microspheres (non-silicone, carbon–based polymers)	Artecoll's manufacturer claims the injectable is permanent, as the microspheres do not absorb into the body. The body forms collagen around the microspheres that adds bulk	Lumping, granulomas (localized skin reactions to foreign bodies, which can appear as hardness or a rash), micro-spheres can possibly move to other areas of the body	Immediate, need to wait 3 months between injections	FDA advisory panel recommended approval with conditions 2/03. Contraindication for lip augmentation.
Radiance (Bioform)	Calcium hydroxyla-patite (a substance found in bone and teeth, made into an injectable paste) Reported to last 2-5 years.	Little risk of allergic reaction. The body forms collagen around the microspheres that adds bulk.	Clumping, lumping, granulomas, micro-spheres may move to other areas of the body. If injected next to bone, formation of bone can occur.	Immediate according to manu-facturer	FDA approved only for vocal cord paralysis and urinary incontinence. All other use considered off label
Sculptra	Synthetic polylactic acid contained in micro-spheres	Restores lost facial volume in people with HIV. The body forms collagen around the micro-spheres.	Redness, bruising, lumping and granulomas	Immediate, and typically last two years according to manu-facturer	Approved by FDA with condition that it be used to reconstruct HIV patients suffering from facial lipoatrophy. In use outside the U.S. as New Fill, to fill wrinkles.

Fat from Liposuction

Fat harvested from the abdomen or buttocks is purified and then injected through small needles. As with collagen, results are temporary but fat injections have the advantage over collagen of no possibility of an allergic reaction.

Grafts

The most common substances used for grafts are ALLODERM®, GOR-TEX®, SOFTFORM® and DERMIS FAT. These procedures are all performed under local anesthetic through tiny incisions in the lip. In all instances the incisions are almost never noticeable. Most lip enhancement procedures take only about 45 minutes and can be performed in an oral surgery doctor’s office or in an outpatient surgical center.

ALLODERM®is made of human collagen tissue, which has been purified to minimize the risk of spreading disease and rendered non-immunogenic. It does not require a skin test prior to the procedure. Small incisions are made inside the corners of the mouth, the ALLODERM® is inserted through the body of the lips and the incisions are stitched closed. Because the material is re-absorbed by the body, results are expected to last 6 months to a year at most. Some swelling is expected but it disappears within three to five days. Complete healing occurs after two months, at which time the ALLODERM® softens and is indistinguishable form the rest lip.

GORE-TEX® a biocompatible material, was previously used in vascular bypass surgeries but since the late 80’s, doctors have also been using it for facial and dental implants. When implanted in the lips, GORE-TEX® increases fullness and redness and is permanent, unlike ALLODERM®. A small incision is made at the inside corner of each lip the Gore-Tex implant is "threaded" through the lip. The implant is then trimmed and the incisions sutured up. There is a risk of infection and kinking of the implant, however, the implant material can easily be removed.

SoftForm® implants are made out of the same material as GORE-TEX® and has been shown to produce better results with fewer complications. SoftForm® does not shrink and is never absorbed into the body. Unlike the GORE-TEX® implant, SoftForm® is more tubal in form and is hollow, allowing your tissue to network and grow "into it". Scar tissue forms on either end of the implant which allows it to remain in place and also allows it to easily be removed if it becomes infected. This type of lip augmentation is permanent but reversible. Insertion involves a small incision in the inside of the lip through which the material is inserted with a special needle. The process is repeated three times in the upper lip, so that three implants are inserted, while usually two implants are inserted in the lower lip.

The dermis-fat graft procedure involves harvesting a wedge of skin with fat attached to from another part of the body, typically the groin area or abdomen through a small incision. Again, small incisions are made and the tissue is threaded through the body of the lip. The tissue continues to nourish the fat after it has been transplanted and brings the body's own blood supply to ensure the graft's survival.

Occasionally, unusual scarring and distortion can occur and another, corrective procedure is required. Although the lips retain their new shape for a long time some patients have complained of hardness. This procedure is not generally recommended.

Local flap procedures involve using intra-oral tissue to enlarge the lips. An incision is made inside the mouth to push the tissue upward, and outward, into the lip. Alternatively, the incision is along the upper lip line. The skin above the Cupids Bow of the lip is removed, and the lip is then stitched along the line of the incision. This is not a popular procedure because the incision may leave an unsightly scar.
A local flap procedure is often performed in conjunction with a graft implants like ALLODERM®, GOR-TEX® or SOFTFORM®. There is a lot of swelling and numbness associated with this procedure and in some cases, drooling. Such symptoms are very pronounced in the first three weeks but should diminish over the following three weeks. Stitches are removed in 10 to 14 days.

Not all esthetic lip problems can be fixed by lip augmentation. The underlying dental orthopedics should always be addressed before promising a desirable outcome. Elongated lips that look very flat, are improved with a lip lift. A drooping commissure is more suited to a mouth lift than any augmentation procedure. Conversely, if you feel that your lips are too big, a reduction procedure involving an incision under your nose and along the lip line to remove some tissue can decrease lip size.

The untrained professional risks an undesirable esthetic outcome that diminishes dental esthetics. The most common undesirable esthetic outcome seen when a patient is injected by an untrained individual is a lip ptosis that may resemble a fish mouth, duck’s beak or a tire that hide the teeth and distort the smile.

You would not go to a dentist for a skin disease like acne or athletes foot even though the dentist may have the knowledge to treat these conditions. Similarly the dentist should not become a cosmetologist.

However don’t go to anyone but a dentist to improve “the actors and the stage of your smile.”

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