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The mouth modified: Saline-filled permanent lip implants present customizable options

Article-The mouth modified: Saline-filled permanent lip implants present customizable options

Key iconKey Points

  • The latest in permanent lip implant is fillable
  • Implant specifications and technique as well as other permanent augmentation options are discussed

Photograph of VeraFil implant with filler tube and tether sutures attached. Theimplant is flat for insertion and is thenfilled with saline after placement (insert).
Facing tough competition from ever-improving temporary fillers, the latest in permanent lip implants offers an intriguing twist — it's fillable. The saline-filled implant, called VeraFil (Evera Medical, Foster City, Calif.), provides physicians with the ability to adjust the amount of saline in the implant, thus customizing the fullness of the lip. The device has an outer membrane composed of thin, expanded polytetrafluoroethylene (Gore-tex) that is bonded, only at the ends, to a silicone inner membrane. Once implanted, the saline volume is adjusted via a removable fill tube and a self-sealing microvalve.

Joseph Niamtu, D.M.D., who recently published a study on the VeraFil implant, says the implantation process is simple and offers the advantage of saline, which provides the same natural texture of the lips.

24-year-old female patient before (left) and six weeks after (right) placement of upper and lower VeraFil implants.
"The benefit of the saline implant is that it will always be pliable because it's liquid and is more inherent to the natural feeling of the lip tissue," says Dr. Niamtu, D.D.S., a Richmond, Va.-based oral and maxillofacial surgeon specializing in facial cosmetic surgery. LIP FLEX According to Dr. Niamtu, implantation with VeraFil is easy, and the ability to customize them is a big advantage. "The implants are very easy to place — you make a tunnel through the lip in the same way you place any lip implant, and then when you inflate it with saline, you have control of the size. I call them the 'five-minute lips.'"

Same patient exhibiting normal animation after implant placement. (Reprinted with permission from Niamtu J. Experience and Evaluation of a New, Saline-Filled Implant for Cosmetic Lip Augmentation. Am J Cosmet Surg. 2007:24. )
In a study involving 25 implants, Dr. Niamtu reported no mechanical failure or displacement, and no incidence of extrusion or infection. Two implants were removed or repositioned due to improper placement. As of last June, Dr. Niamtu reported that 102 implants had been in place for more than a year, with 32 in place for more than 18 months. There was one confirmed infection and one suspected infection, as well as one case of dehiscence through the incision. One implant shifted and needed to be replaced, and there were no cases of late extrusions.

Dr. Niamtu cautions that patient selection for lip implants is important and advises against using them in smokers or patients who make a living with their lips, such as scuba divers or woodwind or brass musicians.

SELECTIVE UPTAKE The new implants do have a place in the market, particularly because they give the physician the ability to shape the lip according to the patient's wishes, says Andrew Jacono, M.D., F.A.C.S. "The [VeraFil implant] represents an advance in technology and it's good to have a certain amount of customization," says Dr. Jacono, head of Facial Plastic and Reconstructive Surgery at North Shore University Hospital Manhasset and assistant clinical professor in the Division of Facial Plastic and Reconstructive Surgery at The New York Eye and Ear Infirmary.

That's not to say he uses them, however.

"It's not that I don't think this is a good product, or at least potentially good, but my perspective is that the lips are a very thin, soft and movable portion of your face," he says. "I think when it comes to using a synthetic foreign body in a movable part of the face such as the lips, which are constantly moving – kissing, speaking, chewing and smiling, there is a real risk of having a significant problem."

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