PermaLip takes on the ‘trout’ mouth

Special to the Los Angeles Times

“Trout pout” — overly plumped lips that are ubiquitous on Hollywood’s red carpets — can afflict any woman who has tried to enhance naturally thin lips.

But a technique from Europe that’s rolling out across cosmetic surgery practices in Beverly Hills and beyond aims to counteract the billowy, bee-stung lips that are the result of having fillers, collagen and fat injected into the area. PermaLip, an Food and Drug Administration-approved implant that looks like a clear-colored piece of elastic, is now being used in practices in Florida, Texas, New York and California.

To insert it, the surgeon makes two tiny slits at each end of the lip, and slides the implant in. It is designed to be permanent but can also be removed or switched to a larger or smaller one.

“We’ve been offering it for the past year, and have had nothing but success with it,” said Dr. Davis Nguyen, who specializes in facial plastic and reconstructive surgery with practices in Beverly Hills and Malibu. “It’s an alternative to the pain and costs of repeated injections.”


Not that PermaLip is inexpensive: the procedure costs around $4,000 for both lips but doctors weigh that against the average $800 every four or six months typically spent on refreshing injected lips.

The procedure takes about half an hour in a doctor’s office, under local anesthesia. Nguyen says he has been doing on average three procedures a week, and has seen no adverse reactions.

Still, plastic surgeons advise caution with any type of surgical implant, no matter how seemingly small. Dr. Richard Fleming, a Beverly Hills cosmetic surgeon who traces Hollywood’s obsession with pouty lips back to Barbara Hershey’s collagen-enhanced pucker in the 1988 tearjerker “Beaches,” says that lip implant patients could possibly run the risk of infection down the road. And there is some bruising immediately afterward.

“The lips take a longer time to heal this way than through conventional fillers,” he said. “But because PermaLip comes in different lengths and sizes, it does look and feel very natural.”

Doctors say the procedure is especially useful in countering thinning that results from aging, which is hard to treat with fillers.

Because the material from which PermaLip is made is inert, the chances of infection, bleeding and complication are low, said Dr. Jonathan Sykes, president of the American Academy of Facial Plastic and Reconstructive Surgery. But there is a downside. Although the implant comes in different shapes and sizes, opportunities for customization remain limited, leading to a potentially less-than-natural result.

“With an implant, you can’t inflate or augment certain areas relative to others as you could do with injectables,” Sykes said. “It might work well for some people, but it has real limitations in a lot of my patients. When the result of a filler is less than ideal, you have the fallback of the material reabsorbing and becoming less pronounced. If you take out an implant, there is the risk of scarring.”