These lengths should extend from the wet line to within 1 cm of the labial alveolar sulcus. If an implant also is used, it may be placed later in a stage procedure, or simultaneously, if placed anterior to the Z-plasty and anterior to the wet line. If the latter approach is chosen, undermining of the lip will be limited at the time of surgery. Other materials used for implantation include galea, the patient's own dermis, breast capsule, and deepithelialized flaps. These have been used with variable success and have been described in the medical literature.
Some patients truly are poor candidates for lip augmentation by any of the methods discussed.
Camouflage may be a better option for these patients. Long-lasting options include tattooing the vermilion border of the lip with a darker color or even extending the pigment beyond the natural borders to give the appearance of larger and fuller lips. These techniques can be outstanding options for most patients who are poor candidates for lip augmentation, and they may be used with other techniques. Many incisions may be used to implant materials in the upper and lower lip. In addition, the surgeon must decide how much of the lip is to be augmented horizontally and vertically.