Have you thought of introducing a new paradigm of treatment?

Five questions and answers on lip augmentation and dentistry

by Robert Gordon, DDS

WHAT IS LIP AND PERIORAL AUGMENTATION?

It is any alteration or enhancement of the oral facial area, either surgical or nonsurgical. This area extends from the lips to the outer ring of the nasolabial fold. The most popular lip and perioral augmentations are noninvasive. These include injectable fillers such as Juvéderm, Restylane, and Botox^® on and around the lips.

Can I perform lip augmentation as a dentist?

Yes. The statutes define dentistry as “the healing art that is concerned with the examination, diagnosis, treatment planning, and care of conditions within the human oral cavity and its adjacent tissues and structures.” Each state differs, yet more states are incorporating exact verbiage on the use of Botox and filler in the states statutes. Currently dentists, physicians, physician assistants, and nurses can perform lip augmentation.

If you are asking yourself if you can incorporate lip augmentation, you are a little late. Thousands of dentists are performing lip and perioral augmentations nationwide. The questions one should now be asking are why haven’t I been exposed to this information before, how can I get educated, and do I want to incorporate this into my practice?

Why would I, a dentist, perform lip augmentation?

This is the million-dollar question, or what I like to call the "vermilion-dollar question.” First, one needs to be aware that lip augmentation is a multimillion-dollar industry. In particular, minimally invasive procedures are growing at an exponential rate.

The top five minimally invasive cosmetic procedures in 2005 were:

1. Botox injections at 3,294,782, up 16 percent from 2004
2. Laser hair removal at 1,566,909, up 11 percent from 2004
3. Hyaluronic acids (Hylaform, Restylane) at 1,194,222, up 35 percent from 2004
4. Microdermabrasion at 1,023,931, a decrease of 7 percent over 2004
5. Chemical peels at 556,172 in 2005, down 50 percent from 2004.

The growth in minimally invasive procedures can be attributed, in part, to the new injectable wrinkle fighters entering the market. More consumers are considering injectables to prolong or avoid facelifts, forehead lifts, and eyelid surgeries. The demand for cross-linked hyaluronic acid injectable fillers like Restylane^® and Hylaform^® jumped 927 percent in 2004. Botox^® injections increased 4 percent in 2004 and 280 percent since 2000. Source: The American Society for Aesthetic Plastic Surgery (ASAPS)

Lip and perioral augmentation can certainly add value to your practice. A treatment of perioral Botox can range from $300 to $600. A lip augmentation can range from $600 to $1,100. Oral facial Botox cosmetic treatment and most filler treatments are a renewable income. This is because the effect wears off in about five to eight months, meaning that augmentation patients return for continued treatment. In my practice I coordinate their continued augmentation treatments with their oral hygiene visits. Ask yourself how many of your patients are already having this service done. They are all potentially your patients.

When I introduced lip augmentation into my practice, I saw an immediate return. I learned that patients with whom I’d had a rapport for years were going to nurses or physicians to get their lips or face augmented. Nine out of 10 times their experiences were painful. I explained that, as a dentist, I could perform the same treatment with complete lip anesthesia so they wouldn’t feel a thing. Also, I’m trained in lip and teeth esthetics and could give them a great complimentary look. After all, the lips are the curtains for the teeth. It wasn’t long before many of my dental patients were also augmentation patients. Soon I had dermatologists, plastic surgeons, and other augmenters contacting me about my techniques and for help on their blocks. This led me to write the book, “Vermilion Dollar Lips.”

The first year of offering augmentation services to my patients, I returned a $63,000 increase in my annual revenue, and this was from internal marketing only. This wasn’t the only benefit of incorporating lip augmentation into my practice; my new lip patients began to ask for veneers and other dental work. I was able to offer something my neighboring doctors could not. In short, my cosmetic practice experienced a large influx of new cases.

But I almost forgot to mention the most important result of lip augmentation in my practice - it’s fun! I look forward to reading and learning new skills and seeing the direct results in my patients’ smiles (no pun intended).

Three groups benefit from cosmetic dentists who perform lip augmentations:

Patients
Community
Profession

Patients:

As we discussed, dentists are oral facial experts. No other medical specialists have as much didactic and hands-on experience of the lips as dentists. Our education trains us intimately with the vascular, nerve, muscle, and skeletal components of the lips.

Other medical specialists analyze the lips from the outside. Dentists are in the unique position to treatment plan from the inside out. We are able to offer the potential lip-augmentation patient a sound differential diagnosis, which includes orthodontic, orthognathic, and dental reconstruction, and this provides for a more complete treatment plan. Some of the worst lip jobs happen because the patient should have been offered another mode of treatment to produce fuller or sculpted lips.

Community:

Every day there are people in America seeking lip augmentation, and the numbers are rising. Dentists are in the unique position to add to the community in education and application in regard to the lip and perioral area. This gives patients more choices in treatment options and raises the bar of quality to the community.

Profession:

I like to begin my seminars with a quote from Dr. Klein, a world leader in noninvasive facial procedures:

“While dermatologic and esthetic journals deal with substances for implantation, these journals do not, in themselves, hold information regarding the proper goal of lip enhancement. Instead, the answer is found in the dental literature where many articles have addressed the proper height, size, and location of the lips as produced by dental restorations.”

Dr. Arnold Klein, Professor
University of California School of Medicine, Department of Dermatology

The leading authorities in facial augmentation recognize dentistry’s role in the craft and are inviting us to join them. Our specialties such as orthodontics, oral surgery, and oral biology are the basis for other, nondental practitioners to use in the perioral augmentation practices.

Dentists are the experts of the oral facial area. If we choose not to incorporate lip augmentations into our practices, we should be informed about what is happening to our patients’ lip and perioral areas. When we perform soft-tissue exams of the head, neck, and oral-facial area, we need to be aware that some lumps in the lips or nasolabial fold may not be pathogenic and may be the result of injectable fillers. We should also be aware that a slight asymmetry of a patient’s face or smile might be the result of improper Botox placement, not a stroke.

Dentistry is ever expanding its borders. Long gone are the days of daily extractions and amalgam fillings. We are ushering in a new era of cosmetics that truly benefits our community and profession. Lip and perioral augmentation is a natural extension of our practice because the lips are the curtains for our smiles. A significant number of medical specialists agree and the ones who do not are hard pressed to give legitimate reasons why they don’t.

How can I become educated and informed on lip augmentation and its risks?

• A lot of teachers out there are teaching minimally invasive facial augmentation. Some manufacturers of filler products require that you become certified in their product before they sell it to you, others do not. Some companies have lists of providers, although they may not be the best educators for dentists. This leads to my next point.
• Becoming certified and learning how to perform lip and perioral augmentation are two separate entities. There is a lack of uniform instruction on lip augmentation in the esthetic community. This is because of the many types of practitioners who perform augmentation. Like anything else, one doesn’t stop at a manufacturer’s certification. Continued education on new techniques and materials foster a sound esthetic practice. Ultimately, we as practitioners are trusted to govern ourselves, with professional organization as a component.
• I suggest that interested dentists join organizations that have a common interest in lip augmentation. DALPA, the Dental Association for Lip and Perioral Augmentation, is a new group whose goal is to unify dentists in this area (www.Dalpa.us). Organize study groups within your community. This is an evolving area of practice and I am amazed at the resources and techniques that augmenting dentists have developed.

Risks

The lip augmentation procedure is very safe. Cross-linked hyaluronic acid (HA) is used for most fillers, including Juvéderm and Restylane. Cross-linked HA is biocompatible, with a 0.06 percent adverse reaction to treatment. The major reaction is hypersensitivity, occurring in one out of 5,000 patients. The theory is that most hypersensitivity reactions are caused by injection technique and the speed of injection rather than authentic immune reactions. Botox therapy’s major risk is that of unwanted parasthesia in the lips, which can be avoided easily through proper training.

The most significant risk with lip and perioral augmentation is a poor esthetic result. Remember, this is an elective cosmetic procedure. You don’t want to jump into it without training. The good news is that dentists can be quickly trained. I train many augmenters, and the dentists are always the quickest to pick up on the art and science. In all fairness, I believe this is the result of the dentists’ education and hard earned hand skills.

Insurance

I don’t comment on insurance or coverage because of the legalities of such issues. Suffice it to say more insurance carriers are including this procedure in their normal dental practice coverage. I recently reviewed and updated my policy and, to my surprise, the questionnaire had a line asking if I incorporated oral facial fillers or Botox into my practice.

Remember, the effects last about six months, so if there is a less-than-optimal result (and believe me, even the best of us have those days) it is only temporary.

What is the future of lip augmentation in dentistry?

Today’s dentists are becoming more cosmetically savvy because of the social demands for exquisite lips, which delves further into the psychosocial realm of a clearly defined esthetic connection between the lips and teeth. Dentists are all too aware of the psychosocial connection between teeth and esthetics, and the contemporary dentist is now confronted with a paradigmatic change in the practice of dentistry that focuses on lip enhancement. We work with lips and the perioral area every day, redefining smiles through sophisticated treatments in cosmetic dentistry. We anesthetize, retract, and suture lips when patients present with oral/facial trauma.

Dr. Robert W. Gordon has a passion for art and facial esthetics. With a background in Fine Arts, he lectures to oral/facial augmenters on his classification, diagnostic and reconstructive lip and perioral augmentation techniques. Dr. Gordon also maintains two private practices concentrating on cosmetic lip and perioral augmentation in St. Petersburg, Fla. While practicing predominantly cosmetic dentistry, he became aware of the intimate correlation of dentistry and cosmetic and perioral augmentation. This led him to author his book, Vermilion Dollar Lips, a textbook that addresses the science and art of lip and perioral augmentation. For more information, visit VermilionDollarLips.com or e-mail [email protected].