Vogue
The Aging Lip
Since I’m there anyway, she goes ahead and examines my whole body for suspicious moles, a good idea but also a bore. I'm sorry to admit that in the excitement of having a cosmetic-surgery consultation, I’ve completely forgotten that being healthy is more important than looking good. Finally Wexler turns off the lights and peers at my face through a large magnifying glass with a built-in ultraviolet light. She shakes her head disapprovingly. “Sun damage”, she says.
She holds up a mirror so I can see for myself. I recoil in horror. Seen magnified five times, the skin on my cheeks is a veritable mountain range of scaly, discolored cells. I’m definitely going to need a deep peel, maybe even two. “Give it to me straight, Doc”, I say, bracing myself for the bad news. Wexler explains that my skin isn't quite as awful as it looks and can actually be improved if I follow her instructions. She gives me a Donna Karan moisturizer with an SPF of 20 (Wexler consulted on Karan’s skin-care line), which I promise to use faithfully for the rest of my life, as well as a small jar of alpha hydroxy cream, which I’m to put on every evening before I go to bed. In the near future I will also have a very light chemical peel (more of a wash, really), which will help enhance the action of the alpha hydroxy cream. Is that all? Frankly, I’m disappointed.
I broach the subject of collagen injections. Wexler kindly points out that as I don’t actually have any wrinkles, I won’t be needing collagen injections in my face. This news kind of bums me out. A few of my friends have already started on collagen, and—I don’t know, maybe it’s like needing your first bra—I want to keep up.
My lips, however, are a different story. I've already done a bit of research on the subject and know that besides having lips that are unacceptably thin by today's beauty standards, I'm suffering from what Thomas Romo III, M.D., director of facial, plastic, and reconstructive surgery at Lenox Hill Hospital and the New York Eye and Ear Infirmary, calls "the aging lip”, This is the polar opposite of the “youthful lip”, which has “poochiness”, says Romo.“The lip is a mucous membrane over a muscle surrounded by the vermilion border; in the youthful lip, the vermilion border and the outside of that is plump because of fat. In the aging lip, the fat and muscle become atrophic”. Meaning, in layperson’s terms, they slowly wither away. This aging process begins in the 30s and only gets worse. What do we have to look forward to? “The skin over the top of the lip buckles and you get those vertical lines”. Oh, yes. And then you have a lipstick mess when it “bleeds” into those little lines. Better to put a halt to the whole process now.
My investigations turned up several possibilities. The simplest procedure is collagen injections, tiny amounts injected into the vermilion border, never into the lip itself. “The danger is that you could inject the collagen into a blood vessel, causing blockage and damage to the lip”, says Romo. The drawbacks to collagen are, one, it doesn't last very long—six to eight weeks, according to Romo—and two, it is a foreign substance. A small percentage of the population is allergic to collagen, which is made of sterilized cowhide. Before having injections, you need a collagen test, which is nothing more than a tiny amount of collagen injected into your arm—you watch it for two weeks for redness, then repeat the test. The downside: You have to wait a month before you can start your injections, and by then you could change your mind and opt for a new haircut instead.
On the other hand, if you really want to get fancy, Romo mentioned a company that will actually make collagen out of your own skin. “If you have a face-lift or tummy tuck, and you have an extra piece of skin, why throw it in the garbage?” he asks. “Instead, the physicians send it to this company and they'll make it into collagen that you can inject anywhere”.
That didn’t sound like a good idea, since I wasn’t planning to have a face-lift or tummy tuck anytime soon.
The next possibility is the “fat transfer”. This sounds like every woman’s idea of heaven, because you take fat out of the places you don’t want it and put it into the places where it can do the most good. First, the dermatologist or plastic surgeon “harvests” some fat, which means sticking a needle in your belly or thigh and sucking some out. Then the fat is washed and “decanted,” eliminating blood cells and ruptured fat cells. (Romo hinted that some dermatologists skip this procedure, giving fat transfers a bad name.) Then the doctor injects the whole fat cells into the vermilion border, the idea being that some of these fat cells will actually live. (The take rate is 30 to 50 percent, according to Romo.) Here's the creepy part: “The fat is injected with one needle stick on each side of the mouth—I make a little tunnel,” says Striker. Here’s the good part: Since the fat transfer can last for up to a year, it’s more cost-effective than collagen, and you can't be allergic to your own fat.
The options get more permanent, and weirder, from here.
Gore-Tex supposedly is all the rage in Hollywood, "A long hollow needle is passed from the corner of the lip to the upper middle of the lip," says Steven Herman, M.D., plastic surgeon on staff at Albert Einstein College of Medicine. “A Gore-Tex strip is fed through the needle, then you trim the ends. Patients love it.” The strip is permanent, but there is a slight chance of complications. Like infection. (No problem, according to Herman. “You just slide the strip out”), Or extrusion—in other words, the strip breaking through the skin. (I don't know about you, but the last thing I need is a strip of Gore-Tex hanging out of my lip).
Next we move on to lip advancement. “I don't like to do it, because it can leave a scar,” says Romo. On the other hand, if you are someone who has only two millimeters of lip, particularly the upper, you may have no choice. How can you tell if you fall into the two-millimeter-lip category? From what I can tell from talking to plastic surgeons, you probably have a horsy smile with lots of gum showing. The news only gets worse: “This is congenital. If you have a small lip when you’re young, by the time you age, you may have no lip,” says Romo. The solution: The surgeon makes an incision across the top of the lip, cuts out the skin above it, pulls up the lip, and sews the lip onto the cut skin. Not surprisingly, Romo says, “it looks artificial”.
Finally, there's what surgeons call the dermal fat graft and what I’ve dubbed the cut-and-paste method: The surgeon removes a strip of skin tissue (Romo takes it from the pubic area, unless you have an extra piece of tissue lying around from a breast reduction or tummy tuck that you haven't sent to be made into collagen yet), dermabrades the skin and hair off, and then, using scissors (!), cuts the tissue into the shape of a lip. Then he makes three vertical cuts in the lip and slips in the dermal fat graft. This has a 50 to 75 percent take rate, according to Romo.
In need of a dose of common sense, I call Striker back. “I say, what’s wrong with something temporary?” he asks. “Nothing is permanent, including your heart. And besides, fashion changes. Marlene Dietrich had thin lips. What if she came back?”
Good question, And so, by the time I arrive in Wexler's office, I am favoring collagen injections. I have my first collagen test, which freaks me out a bit—when I touch the pea-size drop of collagen, it’s hard, definitely a foreign substance. Do I really want to go through with this?
I have a month to decide. In the meantime, I get busy with my new skin routine. The results are immediate. The next day, my skin has a sort of dewy freshness that it’s been missing since I discovered nightclubs about ten years ago. In fact, that evening, one of my male friends remarks that I must be in love because my skin is glowing. I am in love, but I don't have the heart to tell him that the glow is due to skin cream, not my new inamorato.
Then I make my first big mistake: telling everyone that I’m going to have my lips done. No one really knows anything about cosmetic surgery, least of all your friends who haven't had it yet. "After the collagen goes away, your lips are going to be baggy” and “Needles--it’s going to hurt like hell” are a couple of my favorite comments.
Naturally, the day of the “operation” I'm a little nervous. Like, I imagine, most people about to undergo their first cosmetic-surgery procedure, I’m wondering why I’m doing this and whether the results will be worth it. I needn’t have worried. I love my new lips. The add a certain balance to my face, eliminating, I believe, the necessity for a nose job, thereby saving me thousands in plastic-surgeon fees— although when Wexler first held up the mirror to show me the results, for one brief second I saw an uncanny resemblance to Donald Duck.
Luckily, I got over it. Wexler said the results would be subtle— apparently, the super-plumped-up Barbara Hershey lip look is out—and she was right. In fact, they were so subtle that despite the kindness of strangers, none of my friends even noticed that I'd had my lips done, including my boyfriend. Everyone now says that I should get more collagen put into my lips, but I totally disagree. After all, the whole point of cosmetic surgery is to look better, not like you've had it done.
Nevertheless, after two months my lips have gone down and I find I’m thinking about doing another procedure. Maybe I’m turning into a plastic-surgery junkie after all. I think I’ll try the fat transfer next.