Rich and sensuous lips can be created through several different procedures. There are three basic ways to enlarge the lips: injection, "advancement" of lip tissue and implantation.

Collagen or injections of other filler materials would seem to be the simplest way to increase the lip size, but there are serious drawbacks. There is a limit to the amount of enlargement, the injections are painful, the result is temporary -- even fleeting (a few weeks) and it may even be dangerous, as the material can get into the bloodstream and cause serious problems.

Collagen disappears quite rapidly because the body has an enzyme called collagenase that breaks it down. In other tissues there are cells that manufacture new collagen to replace what has been destroyed, but injected collagen obviously has no cells to replenish it. When collagen injected into the skin, it is put into a layer called the dermis that seems to hold it there for a while because the body's own collagen resides there. But when it is injected into the lips it can be reabsorbed in as little as three weeks because there is no dermis in lip tissue.

One reason to use it might be to allow someone to decide if they want larger lips before having a permanent operation. Yet even that may not be safe, as there have been warnings that collagen injected into the lips can get into the blood vessels there and travel to other places in the body causing permanent damage. The only real use for collagen in the lips is enhancement of the small defining ridge between the red part of the lip (the vermilion) and the neighboring skin called the vermilion border. This serves to outline the lips and accentuate them.

There are other substances being used as injectable implants such as Alloderm and a type of collagen derived from cadavers, but these too eventually disappear. The use of injectable silicone, a permanent material, is now banned by the FDA. At this time there is a new substance being developed as a tissue filler by a the Protein Polymer Corporation that may be very long lasting, but it is not yet approved by the FDA and even upon approval may not be applicable to the lips.

Fat injections are also used quite extensively to enlarge the lips, but I think it is a bad idea. Fat is withdrawn from the abdomen or buttock and injected. Preferably, the fat is first centrifuged to concentrate the smallest cells that have the best chance of survival. Nevertheless, much of the fat eventually dissolves and the procedure must be repeated. Unfortunately, when the fat dissolves, it may do so irregularly leaving small lumps.

The only real advantage of the injection methods is that there is no recovery period, so that a model who needs an immediate lip enhancement for a photo shoot can have injections and look presentable the next day.

Permanent lip enlargement is preferable. There are several techniques from which to choose.

The first involves a method of "advancing" tissue from inside the lip to push the lip outward. It is a complex operation and leaves some scars which appear to be a long line of "W's." Here too there is a limitation to the amount of enlargement that is possible and a lot of skill is required to make it look even and natural.

The best operations involve implantation of some material, either artificial or from the patient's own body to plump up the lips. The procedure involves making two very small incisions inside the corners of the mouth. Then a tunnel is made just underneath the reddish part of the lip (called the vermillion) and the implant, which is as long as the lip and as thick as desired, is drawn through. This fills out the lip and gives a very natural appearance.

There are several choices for implant materials. Among them there are Softform from the Collagen Corporation and Gortex (a nylon-like synthetic similar to that used in ski jackets). The problem with these materials is that not only are they not derived from the patient's own tissues, they tend to feel firm. They make the lip harder than normal, and the outside edges of the implant can often be felt.