KEEPING FIT : Big Mouths Paying Plastic Surgeons for Lip Service

How would you like a fat lip?

What used to be a threat from bullies is now a promise made by plastic surgeons.

Use a sexier adjective if you prefer: succulent, voluptuous, pouty. But however you describe them, full lips are all the rage these days. And if you don’t happen to come by them naturally, plastic surgeons have several techniques to give them to you anyway, temporarily or permanently.

“Women come into my office with pictures of actresses and say ‘Those are the lips I want,’ ” says Dr. Michael Niccoli of Cosmeticare in Santa Ana and Long Beach. The most popular role model, lipwise, is Kim Basinger of “Batman” fame, he says.

Yvonne Strock of Huntington Beach, a patient consultant for Niccoli, can easily identify with the lip-augmentation patients she deals with. After seeing “Batman” last year, she decided to try the Basinger look for herself.

“My lips weren’t really thin, but I wanted to have a nice rim on them, a little bit more of a pouty look,” she says.

Susan Doan of Newport Beach had a different reason for seeking lip augmentation. “I’m almost 50,” she says, “and I wanted to get rid of the fine lines around my lips.”

Diana Wansley, also of Newport Beach, says she decided to have her lips done after noticing all the images of full-lipped women in movies, on TV and in magazines. “I liked the way they looked and decided I wanted to try it too,” she says. “My lips were not small, by no means, but I wanted them to look bigger.”

“I’m kind of vain,” says Doan. “I already look good, but I wanted to look better. After I had it done, I noticed that I felt good. I was even talking better, enunciating more clearly. I tend to want to show my mouth off.”

Doan says the man in her life “thinks I’m silly to be doing this. He thinks I look fine the way I am. And he keeps telling me we could use the money to go to Cabo (San Lucas, Mexico) or something. But I figure, why not do both?”

Wansley had her lip treatment done last year. Since then, she’s gotten married. “My husband’s philosophy is ‘If it’s something you want to do, do it, but I like you the way you are,’ ” she says. She hasn’t gone back for another treatment, and her lips have now returned to normal, but Wansley says she’d like to go back to the full-lipped look as soon as she can spare the money.

All three chose the most popular option: collagen injections.

Collagen is a naturally occurring protein and an important component of the body’s connective tissues. But for lip lifts, Niccoli says, doctors use sterilized collagen from cows instead of humans. And there’s a slight possibility the body will reject the bovine collagen. So the process begins with a test dose in the patient’s arm, followed by a four-week waiting period. If there is no negative reaction in that time, Niccoli says, the lip injections can be given.

Collagen is the least expensive of the lip-augmentation options, costing $200 to $400 per injection, depending on how much collagen is used. The lips swell for a few hours afterward, but they soon retreat to their intended size. Although some patients want novocaine or other anesthetics to reduce the pain of the injections, others prefer to go without.

Another treatment is usually required about two months later to maintain the increased lip size, followed by another four months later and further injections every six months for as long as the patient wants to maintain the look. “If the treatments are not continued, the lips will become smaller again, although there will still be some increase in size due to scar tissue,” Niccoli says.

For those who react badly to collagen, another option is injecting the lips with the patient’s own body fat, extracted from other parts of the body. Since the fat is not only human but from the patient’s own body, there is no chance of rejection, Niccoli says.

Fat injections are more expensive, costing between $1,000 and $4000 depending on how many treatments are necessary. “Fat is a little more painful, because you have to overcorrect,” Niccoli says. “I somewhat discourage that procedure. Because of the overcorrection, some people have to stay home from work for a week or 10 days afterward because their lips are so swollen.”

Fat lasts longer, but that can have advantages and disadvantages. With collagen, Niccoli says, some irregularities in shape may occur, but they disappear as the collagen is absorbed into the body. With fat injections, however, “you could be left with a permanent deformity,” he says.

The same is true with silicone injections, which have been banned by the U.S. Food and Drug Administration but which Niccoli says some doctors still use illegally.

To avoid problems, Niccoli recommends that patients make sure their surgeon is board-certified. “Anybody can do plastic surgery legally as long as they have an MD,” he says. “But they may not have much training beyond a weekend seminar. You want somebody who has the appropriate residency training and experience.”

Don’t be shy about asking to see photos of other patients who’ve had the procedure or asking to talk with those patients, Niccoli says.

For those who prefer a permanent lip enlargement, he says, there’s a procedure called lip advancement. “This is a treatment for what we call poor show of the lip,” he says. “We remove some of the normal skin around the lip and rotate the lip upward to give more lip exposure. It’s a one-time surgical procedure, and it’s really popular in my practice.”

Lip advancement costs $2,000 to $4,000 per lip and can be done under local or total anesthesia. Patients can’t eat normally for about a week after the surgery, Niccoli says.

The surgery also carries the risk of deformity or unsatisfactory results, which may or may not be corrected by further surgery, he says.