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A lip implant aims to restore a more youthful and aesthetically pleasing look to the perioral region. This activity reviews the evaluation and management of patients interested in lip implants and explains the role of the inter-professional team in improving care for patients who undergo such procedures. Objectives: Identify the anatomical structures, indications, and contraindications of lip implants. Describe the equipment, personnel, preparation, and technique relating to lip implants. Review the appropriate evaluation of patients considered for lip implants. Explain inter-professional team strategies for improving care coordination and communication to advance lip implants and improve outcomes. Access free multiple choice questions on this topic.

Full lips are a feature of a youthful and attractive appearance of the lower face while thinning of the visible red lip is a hallmark of natural aging. Lip augmentation is used to improve the dimensional relationship of the lips to the patient's face by increasing vermilion height, creating pout (effacement), softening of perioral lines and wrinkles, adding volume, and reducing excess visible dentition. The ideal lip augmentation procedure should provide aesthetically pleasing results that are natural in appearance and feel, be reversible and/or replaceable, be adjustable, and have a low complication rate. A variety of lip augmentation techniques have been described, including both non-filling (e.g., lip lift, mucosal advancement) and filling techniques (e.g., injectable fillers, fat augmentation, implants). Currently, filler with hyaluronic acid injection represents the primary agent used for lip augmentation by most plastic surgeons. However, lip implantation using alloplastic implants represents an alternative lip augmentation technique that is cost-effective (in comparison to repeated injectable filler applications), long-lasting, and provides aesthetically pleasing results with relatively few complications. Herein, we will focus our discussion on lip augmentation using permanent alloplastic implants.[1][2]

Lip implants represent a lasting, low-risk option for augmenting the lips with high satisfaction rates; however, the patient undergoing lip implantation should be aware of the potential associated risks, which include[3][6][14]: Malposition (7 to 10%): The most common complication of lip implantation is malposition, which is likely due to uneven tunneling in the submucosal plane or asymmetry in placement. Extrusion (less than 1%): extrusion of an implant may occur if severe asymmetry and wound breakdown occur. This extrusion is avoidable by using the correct size implant, maintaining proper dissection planes, maintaining a small/narrow submucosal pocket, and using sound suture technique to close the commissure incisions. Instructing the patient to avoid heavy manipulation of the implanted area (e.g., talking, chewing, massaging) for the first several days after implantation may also help prevent malposition/extrusion. Need for revision/size adjustment (1 to 10%) Capsular Contracture (1%): expanded polytetrafluoroethylene implants, in particular, have been shown to shrink and contract with time, leading to an irregular and often asymmetric contour. As a result, their use has gone mostly out of favor. Infection (less than 1%): Infection is rare, but it may result from any type of implant.; this can typically be treated with systemic antibiotics, though it may require implant removal if the infection is severe. Dissatisfaction (1%) Dissatisfaction requiring removal (4%) Prolonged edema and ecchymosis (majority resolves between 1 to 2 weeks)

It is imperative to identify risk factors and perform a thorough assessment of the patient before performing a limp implant. A team approach is an ideal way to limit the complications of this procedure. Before surgery, the patient should have the following done: Evaluation by a surgeon experienced in selecting the appropriate patient for the surgery Evaluation by the primary care physician and anesthesiologist to ensure that the patient is fit for anesthesia Following surgery, the patient should be evaluated and monitored by a perioperative nursing specialist providing support and patient education as well as coordination of follow-up care. An interdisciplinary team comprised of an experienced surgeon, anesthesiologist, and surgical assistants, and operative nurses should perform the lip implant for the best outcomes. Close follow-up during the initial post-operative period, either by a wound care nurse and/or clinician experienced in the post-operative care of lip implants should monitor the patient for possible complications, including bleeding or infection. It is also crucial the team works together to counsel the patient on avoiding strenuous activity, heavy lifting, or bending over during the first several days post-operatively to prevent such complications. Patients should also avoid aggressive manipulation of the perioral region until 7 to 14 days postoperatively. [Level V] Coordinated interprofessional team care involving physicians, specialists, and specialty-trained nurses is essential to achieving positive results in lip implant procedures. [Level V]

Recovery after lip implantation is relatively quick and easy. Adequate pain medication is appropriate, as patients often report mild peri-oral pain for 1 to 2 days postoperatively. To minimize edema and ecchymosis, the patient should place ice packs around the mouth/lips intermittently for the first 24 to 72 hours, sleep with the head elevated for one week,  and avoid vigorous activity for two weeks. A low dose of corticosteroid taper may help lessen bruising and swelling as well. Patients should be instructed to avoid aggressive manipulation of the perioral region for 7 to 14 days to mitigate migration/extrusion of the implant and to decrease inflammation. Patients are asked to return at 1 and 2 weeks for wound assessment and residual suture removal, respectively.  Some authors advocate that "oral exercises" (e.g., wide mouth opening, smiling, puckering lips) be performed daily from 3 weeks to 3 months post-operatively, helping with overall healing and to create a more natural look and feel to the implant. The majority of bruising and swelling should resolve by two weeks, though photographic documentation should potentially wait until around three months postoperatively for cases of residual bruising and swelling.

Close follow-up during the initial post-operative period, either by a wound care nurse and/or clinician experienced in the post-operative care of lip implants, should monitor the patient for possible complications including bleeding, bruising, or infection. The nurses should work with the surgeon and an open line of communication should be present. The nurses should assist with patient education, monitoring, and follow-up care. [Level 5]