Ulthera for Silicone Lip Correction (2012)

Sir:FigureThere are two potentially distressing issues with using liquid silicone for facial rejuvenation—not the least of which is its purity. Many practitioners use low-grade silicone instead of U.S. Food and Drug Administration–approved ophthalmologic silicone. Second, and most importantly, as facial structures surrounding the areas of silicone injections undergo their normal process of atrophy, the areas injected with silicone become disproportionately large and unnatural appearing. Because silicone in general is an irreversible procedure, the patient can become permanently distorted. The situation is exacerbated by ongoing aging of adjacent facial structures and an increased gravitational pull on the weight of the silicone/scar mass. The liquid silicone beads become encased in scar tissue, and this scar is extensively intertwined within the subcutaneous tissues. In the lip, this would be the lip muscle, where the silicone not only makes the lips larger but influences how they move when the patient speaks or smiles. Removing silicone from the lips is difficult at best. Any surgical intervention to remove the silicone also removes muscle tissue and leaves a trail of postoperative scarring in its place. The recovery from this surgery can be painfully long, with profound swelling continuing for months. Some physicians use steroid injections to soften the scar, but the result is rarely a normal-size or aesthetically shaped, supple lip. Until now, there have been few options for those wanting to reverse the aesthetic damage done with silicone. The good news is that there may be a less obtrusive yet highly effective procedure available. I recently treated a young woman with silicone lip deformity using Ulthera and was successful in reducing lip volume, including the unnatural anterior projections, without the downtime that is typically associated with surgery (Fig. 1). Ultrasound therapy—the hallmark of Ulthera—heats collagen and creates microthermal “burns.” The presumed mechanism here is a scar remodeling; scar volume, through redistribution of scar collagen, becomes less bulky. Presumably, the lips massage the scar into a more linear and compact configuration. The lips move more naturally as well, with no additional scarring associated with conventional surgery. How long this effect lasts is yet to be determined.Fig. 1: The patient is shown before (left) and 6 months after (right) revision of facial fat grafting (by means of regional reduction and addition) and reduction of silicone lip augmentation, both performed by another physician.Using a dental block eliminates any discomfort during the procedure. With each treatment, Ulthera ultimately influences the shape of the collagen, resulting in the scar tissue becoming malleable and eventually adopting a more functional shape. Much like a potter with a clay pot, while the clay is still wet, it can take a different shape depending on the potter's hands. Similarly, Ulthera reverses the “hardening of the clay” formerly present in the lips. As the mouth moves, the effects of Ulthera essentially help reshape the lips. Several sessions are necessary, but lips show an improvement immediately, with more positive changes evident at 2 weeks and beyond. Apart from discovering Ulthera to be a cosmetically viable option, by far the greatest advantage is dodging the postoperative trauma associated with surgical “correction.” Andrew N. Kornstein, M.D. Museum Mile Surgery Center, 1050 Fifth Avenue, New York, N.Y. 10028, [email protected] DISCLOSURE The author has no financial interest in any of the products, devices, or drugs mentioned in this article. PATIENT CONSENT The patient provided written consent for the use of her images.