Correcting Problems with Permanent Lip Fillers

Have you had a lip enhancement with permanent filler? Did it look fine initially but now you’re experiencing problems?

Late-onset complications with permanent filler injections are not uncommon and can be difficult to treat, however an eight-year study by Ocean Clinic Marbella gives fresh hope to those suffering.

The study looked at the best way to remove the filler and reconstruct the lips. It involved 11 patients who had received Aquamid injections between 2-10 years previously (not at Ocean Clinic). It has now been published in the highly respected medical journal, Aesthetic Plastic Surgery.

Common Complications with Permanent Lip Filler

Polyacrylamide hydrogel (branded Aquamid) has been in use as a permanent filler since 2001. It is considered inherently safe, however problems can occur later on after apparently successful implantation.  

Migration - that is filler moving from its original position - is a common complication, which can develop even years after the injection. In the patients treated by Ocean Clinic’s Head Surgeon Dr. Kaye and his team, migration was seen in the mucosa, which is the membrane lining of the lips and also in the facial skin around the lips.

The filler was visible as yellowish accumulations; lumps and bump, leading to general unevenness and asymmetry of the lips. This was exacerbated by fibrosis (excess scar tissue forming around the filler).

These problems resulted in not only an undesirable aesthetic but also pain, tenderness and - in two patients - infection. One patient also suffered with a burning sensation in their upper lip.

Fixing Issues with Permanent Lip Filler

Because it is not possible to aspirate the filler  (remove through suction) in cases where it has diffused different skin layers, surgery is the only option. Dr. Kaye used a lip reduction technique known as the ‘bikini reduction’ - so called because of the shape of the incisions (see below diagram).

Says Dr. Kay: “Through the bikini access, the gel and the surrounding scar tissue were removed by sharp scissor dissection. Complete dissection of muscle and mucosa had to be performed to excise the majority of the polyacrylamide gel.

“Because the product extended in most cases into the mucosa and musculature, leading to volume loss after removal, individual modifications of the described technique had to be performed to give the upper lip the favorable shape of an M and the lower lip the shape of a W, while maintaining a good volume relationship between the lips.”

In order to restore volume to the lips and create the best aesthetic result possible, fat was taken from patients’ abdomens and transplanted into their lips, in eight out of the 11 cases.

The Results

Dr. Kaye and his team removed as much of the Aquamid deposits as possible from all 11 patients, however residues of the gel close to the mucosa had to be left in eight cases to avoid compromising the blood supply.

The majority of the patients declared themselves to be satisfied or very satisfied with the aesthetic result one year after the initial operation.

The shape of the patients’ lips were observed by two independent plastic surgeons after one-year postoperatively and no dynamic asymmetries were detected. The patients who had fat transfer to the lips continued to have satisfactory volume.

Concludes Dr. Kaye: “Volume reduction and restoration of a harmonic relation between the upper and lower lips can be achieved using a modified bikini technique.

“Autologous fat grafting to the lips is a useful tool to correct volume deficits and asymmetries and can often be performed successfully within a single-stage operative session.”

Want your permanent lip filler removed? Contact Ocean Clinic for a consultation on 951 775 518.

Veneers - Porcelain or Composite?

Heard about dental veneers but unsure about the difference they could make to your teeth? Ocean Clinic’s cosmetic dentistry expert Dr. Paul Arts explains how both types of veneer work...

Veneers are made to make your teeth look better, nothing more and nothing less. They consist of a thin layer of either porcelain or composite that covers the frontal, visible side of your teeth. Colour, shape and, to a certain extent, the position can be changed. Veneers do not weaken your teeth.

Veneers are made of porcelain or composite. Composite can be done in one session, whereas porcelain takes two to four sessions as the porcelain veneers are made in the dental laboratory. Porcelain veneers are more laborious and hence cost more.

Often, before making the veneers, a digital design and/or a simulation of the treatment in wax on study models is required.

In most cases, little or nothing is taken away from your teeth. The composite veneers are made by laying a thin layer onto your teeth followed by finishing/polishing. For porcelain veneers impressions or a scan of your teeth are made, on which the dental technician can fabricate the veneers.

It takes approximately a week to 10 days before they return from the dental laboratory. In the meantime you might need provisional veneers. When the porcelain veneers are delivered, they will be tried in and placed on your teeth.

The main differences between porcelain and composite are:

PORCELAIN                      

-Keep colour life-long
-Life span 15-20 years
-Stronger, less chipping
-Difficult to repair       
-Two, three or four sessions
-€ 500-600 each
-Stunning  

COMPOSITE

-Will gradually become darker

-Life span 6-10 years

-May chip when biting something hard
-Easy to repair
-One session
-€ 175-250 each
-Beautiful

It may be difficult to choose between porcelain and composite. There are no fixed rules to choose one above the other. Discuss the pros and cons with your dentist.

You can find out more about cosmetic dentistry on our website. To arrange a consultation with Dr. Paul Arts contact Ocean Clinic Marbella on 951 775 518.

Ocean Clinic Facelift Study Published in Top Scientific Journal

Research carried out by plastic surgeons from Ocean Clinic Marbella around new facelift techniques has been published in JPRAS, a highly respected scientific journal.

The study, entitled “The Liquid Facelift” looked at how water jet-assisted liposuction could be applied to the face - this technique had only previously been used on the body.

Head Surgeon Dr. Kai Kaye worked together with Dr. Sonja Kästner and Plastic Surgery Resident Dr. Felix Paprottka on the research project, which involved 25 patients.

They utilised water jet-assisted liposuction (WAL) to enhance three aspects of the facelift surgery they carried out:

• WAL was used to help separate facial skin from the underlying soft tissue in order that it could be pulled taught and reattached. Using water is gentler than alternative methods and keeps surrounding vessels and nerves largely intact.
• WAL was used to harvest fat from other areas of the body to be transferred to the face. This method prevents fat cells rupturing during collection and provides better quality fat for transplantation.
• WAL was used to contour the face, removing excess fat from areas such as the eyes and chin. Gentle removal of facial fat aids better healing, reducing postoperative bruising and swelling.

The Results

To assess the success of the WAL techniques, patients were observed by two independent surgeons and also asked to rate their own satisfaction levels. The patients, who had a median age of 56 years, were graded over a one-week follow-up period for the following criteria:

• Discomfort during the procedure - no discomfort was experienced by patients, who were treated under intravenous sedation.
• Intraoperative bleeding - no bleeding was observed during the procedure
• Postoperative swelling and bruising - only minor swelling and bruising was present after the procedure.
• Skin necrosis - no skin death was detected post surgery.
• Requirement for revision surgery - none of the patients had to be operated on again.

In the patient survey, performed to analyse their perception of the esthetic results, respondents indicated a high satisfaction rate.

Dr. Kaye says: “We are delighted with the results of this study. The use of the WAL technique has been proven to offer a number of benefits for facelift patients. Going forward, we will be applying WAL in all our facelift surgeries, delivering Ocean Clinic patients superior results.

“However, myself and the team hope that this technique will also be adopted by other plastic surgeons. We believe knowledge-sharing among peers is vitally important, which is why we sought to have the study published, and will also present the techniques at a number of medical conferences, including our own MIPSS congress in June.”

Visit our website for more information about facelift surgery at Ocean Clinic Marbella or call 951 775 518 to book a consultation.

Innie or Outie? Why Belly Button Procedures Are On The Up

Did you have your belly button pierced in the 90s? Does it now look a little less appealing? As the women who sported this era’s trend hit their mid-thirties, plastic surgeons are seeing an increase in requests for umbilicoplasty.

Celebrities like Britney Spears and Beyonce drove the craze for navel piercings, but as women age, have babies or gain and lose weight, they might find their piercings have become distorted.  

According to RealSelf, there's been a 21% increase in people asking for navel surgery in the UK compared to last year. The uptick can also be seen in the United States, where 12% more people are expressing interest in umbilicoplasty compared to 2017.

Another factor thought to be fuelling the trend in belly button procedures is the fashion fo gym clothing. The #fitspo (fitness inspiration) brigade on Instagram are forever showing off their toned tummies in lycra sportswear and yoga pants, making the rest of us want to get in on the act.

As such, demand for belly button surgery includes procedures to both repair and reshape, and to improve aesthetics by turning ‘outies’ into ‘innies’. People are also seeking to change the orientation of their navels (horizontal to vertical) to give the illusion of a more toned abdomen.

Whatever your goals, umbilicoplasty is a relatively straightforward procedure to carry out, can be performed under local anesthetic and requires little downtime. Find out more...

Changing the shape and size of your belly button

From a cosmetic perspective, the belly button is an important part of our anatomy. Its shape and size has an effect on the overall appearance of the abdomen. If you feel your belly button is too large and gaping, it can be made smaller by removing extra belly button skin and tightening the bordering abdominal skin around the belly button.

If you think your belly button is too small (perhaps because loose skin is hanging over and covering it), its appearance can be improved by removing some of the surrounding abdominal skin and gently stretching the belly button tissue to reach the enlarged border. This technique can also be used to repair the hangover left by piercings. Meanwhile, scar tissue from piercings can be cut away and stitched to leave just a fine scar.

A belly button that is off centre is another factor that can detract from the appearance of the stomach (sometimes this happens as a result of tummy tuck), but this can also be corrected. Sutures placed underneath can help pull it into optimal position.

Sutures can also be used to create a belly button that is vertically-oriented (stretched from above and below) in order to makes the torso look longer and the abs leaner.

Changing a belly button from an ‘outie’ to an ‘innie’

Got a sticky-out belly button but would prefer to have one that’s concave? Umbilical hernia repair can give you the navel you desire. So-called ‘outie’ belly buttons are caused by tissue, usually fat, protruding through a small hole in the abdominal wall. This makes the belly button bulge outward.

You can have an umbilical hernia from birth or sometimes an 'outie' can appear later in life due to pregnancy or heavy exertion. The procedure to fix it is a little more complicated than an umbilicoplasty, involving repairing the hole in the abdominal wall.

In addition to creating a more aesthetically pleasing midriff, repairing an umbilical hernia can have medical benefits by preventing the small intestine from potentially pushing out of the abdomen.

Although the surgery does not take long to perform, anyone undergoing this procedure must avoid any form of exertion or exercise that could put pressure on the weakened area for a number of weeks.

Dealing with other tummy concerns

If your dissatisfaction with your tummy goes further than the appearance of your navel, you might want to consider a tummy tuck. An abdominoplasty will rid you of excess fat, loose skin and tighten up lax tummy muscles, as well as give you an ideally shaped and sized belly button.

If you have an umbilical hernia or have suffered diastasis rectus abdominus (separation of the abdominal muscles) as a result of pregnancy, these conditions can be corrected at the same time as the tummy tuck is carried out.

If you’d like discuss your suitability for umbilicoplasty or abdominoplasty, contact Ocean Clinic Marbella for a consultation.