Give 'Em Some Lip

Created on 20th September 2011

Dubbed the ‘London Lip Queen', Dr Rita Rakus outlines her approach to lip augmentation

Lip procedures should not be about making something look bigger, but making someone look better: that's the opinion of Dr Rita Rakus who has built a reputation for creating the most beautiful lips in the business.

Angelina Jolie's naturally beautiful mouth has done for lips what Jennifer Lopez did for the derriere a few years ago - everybody wants that soft full pouting look. But the big question is how to avoid the ‘trout pout', the phenomenon of actresses and models that have gone too far in their attempts to look sexy and now resemble a certain fish with their massively over-stuffed lips.

To Dr Rakus this is the most important point about lip enhancement: don't overdo it. "You can always build on it," says Dr Rakus.

Sultry, not sulky
Dr Rakus schedules two separate lip injection sessions a few weeks apart so patients can see the effect of minimal pumping.

‘'At least half of them don't need a second round of injections,'' Dr Rakus says. On the other hand some ask for a third session. These patients, she said, have what she calls ‘‘reverse anorexia'': they imagine their lips are too thin even after they have been plumped. ‘'But my reputation for subtlety is on the line,'' Dr Rakus believes. ‘'If they want a ‘trout pout', I tell them they'll have to go to someone else.''

The options
The main choice with lip plumping is between short- and long-term treatments. Fillers described as ‘semi-permanent' can give off the wrong message to prospective patients because these are not temporary fillers, like Restylane® and Juvéderm Ultra® which are safely reabsorbed back into the body. Semi-permanent fillers work differently: some of the filler injected lasts only temporarily (this ‘semi' part is gradually absorbed back into the body) but the rest will remain in your lips (the ‘permanent' part).

According to Dr Rakus, the amount that is left behind is not easy for the practitioner to predict. "The material left in the lips stimulates the creation of scar tissue to add further volume to the lips, but there can be over-stimulation, because the effect is not controllable. Also, if silicone is used as a filler, it can ulcerate up to five years later."

There are disturbing stories of women left with large uneven lumps in their lips; the only option left to them is to have them literally dug out by a doctor. Other women have reactions to the foreign body, and may end up with infections and open sores.

"The patient's own fat can be good as a filler, but this is very doctor dependent because the procedure is more difficult to do well," says Dr Rakus. This is also another unpredictable option as how quickly and to what extent the fat is absorbed into the body can vary from patient to patient.

Lip surgery is another, now less popular, option. "The lips are slit at both ends, and a plastic material such as Gore-Tex is threaded through. But you can't get an artistic, natural look," explains Dr Rakus. Another negative is that if there are complications, the lip implant can be difficult to remove. "Sometimes," warns Rakus, "you see it poking out a tiny bit at the lip comers."

The most popular method for lip enhancement and the one championed by Dr Rakus is non-permanent or temporary injectable dermal fillers based on hyaluronic acid, which is found naturally in the body so the product is very safe; it is absorbed in the body after a certain length of time but can also be dissolved if the effect is not to the patient's liking.

Dr Rakus' trade secrets
The real secret of a good lip job, according to Dr Rakus, is to view the mouth as a whole rather than just focusing on the lips. "Most women want their mouths ‘freshened up'," says Dr Rakus. "If you simply pump up the lips, they can look worse, not better. I'll fill out the nasal-labial lines (running from nose to mouth corners) and small lines around the lips, lift up the droop at the mouth corners, even up a lopsided lip, and add volume when needed. It's about taking away age.

"You can also inject into the vermilion border, the tube-like structure that edges the lips, to enhance definition. For younger women, this alone is often enough. Fillers can be combined with Botox to lift up a mouth that has drooped with age."

Another trick is to use anaesthetic cream rather than a totally numbing dental block which can cause the lips to swell so it is harder to get a precise idea of how much filler is needed.

"Lips are a little temperamental," explains Dr Rakus. "You can have a reasonable idea of the result, but you never really know until you start injecting. It's like being an artist."
CS&AM