Lip Procedures

The lips are one of the most expressive features of the face, and small changes in their size, shape, or proportion can have a big impact on overall facial harmony. San Francisco plastic surgeon Dr. Evan Ransom utilizes the latest techniques in lip procedures – from non-surgical fillers to surgical lip lifts, reductions, and revisions – tailored to each patient’s anatomy and aesthetic goals.

Whether you would like fuller lips, a shorter upper lip, a more balanced lip size, or correction of a previous lip procedure, Dr. Ransom will work closely with you to design a natural-looking result that fits your face. As a face specialist, Dr. Ransom understands the important role that the lips play in facial aesthetics. In addition, he knows that the size, shape, and proportion of the lips has an intimate relationship with patients’ identities.

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Lip Augmentation

In most cases, the desired procedure is lip augmentation (enlargement). Making the lips bigger can be achieved with temporary fillers, permanent fillers or grafts, or by complex surgical rearrangement of the lip tissues. Dr. Ransom recommends that all patients seeking lip augmentation for the first time start with temporary fillers before considering more permanent approaches. Temporary injectable fillers used for lip enlargement are generally composed of hyaluronic acid (“HA”) gel (the active ingredient in Restylane®, Juvederm®, and Belotero Balance®). Treatment involves carefully planned placement of small amounts of the filler material to highlight the lips’ natural curves and replenish the lips’ youthful volume. Dr. Ransom does this in the office, using topical anesthesia and/or local block techniques to enhance patient comfort.

If a permanent change to the lips is desired, Dr. Ransom can use the patient’s own fat cells (autologous fat grafting) or perform a surgical procedure designed to make the lips bigger, through rearrangement of the lip tissue. With autologous fat grafting, the fat cells are carefully placed at key anatomic points using tiny injection cannulas; this highlights the natural structure of the lips while adding or restoring volume. For patients who desire a significant and permanent increase in lip volume, Dr. Ransom can perform a surgical procedure called V to Y lip augmentation. This technique uses the patient’s own lip tissue, which, by rearrangement and precise suture placement, allows for an increase in the size of the red part (vermillion) of the lips (either upper or lower or both). Dr. Ransom does not perform silicone injections due to the abundance of problems with this technique.

Lip Lift

Careful examination shows that, in some patients, the upper lip elongates significantly with age. This makes the cutaneous (skin) part of the upper lip appear much longer than the mucosal (vermillion, or “red”) part of the lip. In severe cases, the “red” lip almost disappears entirely. These changes are related to gravity and loss of elasticity in the skin, but also may be related to bone volume loss in the maxilla (upper jaw) – a particular issue after menopause. Regardless of the exact mechanism, Dr. Ransom can correct this problem by performing an upper lip lift.

The lip lift is a minor surgical procedure that can be performed with local anesthesia or under light sedation, depending on patient preference. This may be performed alone or with other surgical or non-surgical aesthetic procedures, such as rhytidectomy (facelift or neck lift) and laser resurfacing. In cases where the patient desires a fuller upper lip, in addition to the lip lift, a lip augmentation can be performed with injectable fillers, the patient’s own fat cells, or through a surgical procedure. The end result is a more youthful and proportional lip, with a reappearance of the “red part” of the lip and a brighter, more natural smile.

Lip Reduction

Patients sometimes feel that their lips are not in aesthetic harmony with the rest of their facial features. These patients may seek lip reduction surgery alone or in combination with other aesthetic enhancements or treatment for aging changes. Lip reduction is a delicate procedure which removes small amounts of the lip tissue in the upper and/or lower lips and results in a reshaping of the lip tissue.

Dr. Ransom hides the incisions in the soft lip tissues and uses the smallest sutures possible in repairing the lips. The result, after healing, is virtually invisible incisions. Dr. Ransom works closely with all his patients to make sure that their result meets their expectations, and is sensitive to each patients’ unique desires.

Revision Lip Augmentation

Unfortunately, lip augmentation injections and surgery does not always give the desired result or go as planned. The most common reasons for revision lip augmentation or lip reduction is asymmetry of the lips caused by poor technique, formation of scar tissue or granuloma (excessive inflammation or foreign body reaction), and contour deformities from infection after injections or surgery. When temporary fillers have been used, such as hyaluronic acid, treatment is simple. This involves carefully placed, very small injections of the enzyme that digests hyaluronic acid (called hyaluronidase). Dr. Ransom does this in the office, and depending on the severity of the defect, may require more than one visit to appropriately measure the patient’s response.

If a permanent implant material or filler has been used, treatment can be more involved. With solid implants, surgery involves removal of the implant and repair of the lip contour. Dr. Ransom is a specialist in revision lip augmentation surgery and is able to perform the revision surgery with incisions inside the lips so there are no external scars. For patients who have had silicone injections, surgical removal of the silicone particles alone is not possible. In these cases the lips must be carefully reshaped by specific excisions of the scar tissue or granulomas formed by the body in response to the foreign material (silicone gel). Dr. Ransom can perform this surgery in the office with local anesthesia and nerve blocks.

Who is a candidate?

Candidates for lip procedures include:

• Lip augmentation: Anyone who is interested in enlarging their lips or creating a more supple or sensuous lip contour. Dr. Ransom advises patients who are interested in lip augmentation to first try out the temporary soft tissue fillers.
• Lip lift: Typical patients have a very long cutaneous portion of the upper lip (skin-colored part) and/or a very short part of the wet lip (the red part).
• Lip reduction: Anyone who is interested in reducing the size of the lips is a candidate for lip reduction.
• Revision lip augmentation: Anyone who has undergone a procedure to increase the size of the lips, but is unsatisfied with the results, is a candidate for revision lip augmentation.

The only contraindications for lip augmentation and lip reduction are active infection (including “cold sores”), or inflammatory and autoimmune conditions that cause blistering or open sores in the mouth or lips. These require adequate treatment before the procedure can be performed. Dr. Ransom will show you during your consultation the parts of the lip and demonstrate the possible changes available with a variety of lip procedures.

Dr. Ransom sees patients from all over Bay Area for lip procedures, including Mill Valley/Marin County, Napa/Sonoma, San Rafael/Petaluma, Hillsborough, San Mateo, Menlo Park, Orinda, Palo Alto, Piedmont, Walnut Creek and the world.

Dr. Ransom

Dr. Evan Ransom is an Ivy League-educated and Ivy League trained Facial Plastic and Reconstructive Surgeon. He is a Double Board Certified Head and Neck Surgeon and Facial Plastic and Reconstructive Surgery and fellowship-trained in facial plastic, reconstructive, and laser surgery. His practice is in the San Francisco Bay Area, serving patients from San Francisco, Oakland, Marin County, Palo Alto, Silicon Valley, Walnut Creek, the East Bay, and all over Northern California.