Long-term Analysis of Lip Augmentation With Superficial Musculoaponeurotic System (SMAS) Tissue Transfer Following Biplanar Extended SMAS Rhytidectomy

Abstract

IMPORTANCE To our knowledge, long-term, objective results of lip augmentation using superficial musculoaponeurotic system (SMAS) tissue transfer beyond 1 year have not been previously described. OBJECTIVE To evaluate the efficacy, longevity, and safety of lip augmentation using SMAS tissue transfer. DESIGN, SETTING, AND PARTICIPANTS A retrospective single-blind cohort study was designed to evaluate all patients who underwent surgical lip augmentation using SMAS following rhytidectomy between January 1, 2000, and November, 16, 2015, at a private facial plastic surgery practice in Birmingham, Alabama. Preoperative photographs of each patient served as controls and were compared with postoperative photographs at 3 months, 1 year, and 5 years after lip augmentation. A total of 104 images (from 26 individual patients) were reviewed by 12 blinded observers using a validated lip augmentation grading scale. EXPOSURES Lip augmentation using SMAS. MAIN OUTCOMES AND MEASURES Median lip volumes of all patients at each postoperative interval (3 months, 1 year, and 5 years) compared with preoperative lip volumes. Secondary outcome measures included postoperative complications. RESULTS A total of 423 patients were identified who underwent surgical lip augmentation using SMAS. Sixty patients with approximately 5 years or more of postoperative photographs were reviewed for complications. Twenty-six patients had 3-month, 1-year, and 5-year postoperative follow-up photographs and were included in the photographic evaluation. The mean age of these patients at the time of surgery was 54.6 years (range, 41.2-80.6 years. Fifty-nine of the 60 patients (98.3%) were female. Two of 60 patients (3.3%) with 5 years or more of postoperative follow-up developed complications requiring intervention. Both the superior lip and the inferior lip showed statistically significant increases in volume at 3 months, 1 year, and 5 years (P Յ .004 for the superior lip after 5 years; P Յ .001 for all other comparisons) after SMAS lip augmentation. The greatest median increase was observed in the superior lip at 3 months, while the smallest median increase was observed for the inferior lip at 5 years. The degree of increase in median volume seemed to weaken slightly over time, but remained statistically significant even at 5 years. CONCLUSIONS AND RELEVANCE SMAS lip augmentation is an effective and safe method for lip augmentation that can yield natural, long-lasting results with minimal risk. The degree of augmentation tends to fade slightly over time, but remains significant for at least 5 years postoperatively. LEVEL OF EVIDENCE 3.

A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness

“…Whether the goal is to restore the senile lip to its previous youthful glory or mimic the pouty appearance of the social media starlet, lip augmentation has become an increasing trend . Popular cosmetic procedures designed for augmentation range from temporary injectable dermal fillers (ie, hyaluronic acid) to structural fat grafting and soft alloplastic implants . Although dermal fillers for lip enhancement are relatively low cost and generally safe, aesthetic guidelines to direct the clinician in lip augmentation remain elusive and are primarily based on patient preference and surgeon eye …”

“…6 Popular cosmetic procedures designed for augmentation range from temporary injectable dermal fillers (ie, hyaluronic acid) to structural fat grafting and soft alloplastic implants. [7][8][9][10] Although dermal fillers for lip enhancement are relatively low cost and generally safe, aesthetic guidelines to direct the clinician in lip augmentation remain elusive 8,9,11 and are primarily based on patient preference and surgeon eye. 6 Quantitative tools used to evaluate fullness include quantifying proportions in lip volume with 2-dimensional analysis using anthropometric measurements from patient photographs, 11 digital morphs, 12 and proportions of the vermillion height to other measurements in the lower facial third.…”

Association of Increasing Nasal Tip Projection With Lip Position in Primary Rhinoplasty

“…The increased upper lip projection, along with a less acute nasolabial angle, is characteristic of a more youthful appearance (Figure 3). 9 The perioral aging process has been well described in the literature; however, the treatment options have remained limited. As the patient ages, there is flattening of the Cupid's bow and loss of definition of the philtral columns.…”

Adjunctive Procedures in Facelifting

“…When performing an SMAS lift, harvesting SMAS for implantation as a permanent lip implant has shown to be very successful and reliable in improving long-term volume, showing significant persistence to at least 5 years. 17 The SMAS that is harvested is tapered, defatted, and fed through a small tunnel with a curved tendon passer in the same fashion as a plastic implant but with the advantage of having a natural feel and result. Most patients undergoing facelift would benefit from this simple and cost-effective procedure (►Fig.…”