This year, one company has expanded a line of implants that helps women -- and a few men -- face the world with bigger lips. But the side effects may be less than appealing. And the federal government has yet to weigh in on whether the implants are safe for use in lips.
Neither fact is stopping the growth of the procedure, however.
The American Society of Plastic Surgeons reports that in 2000, its members performed at least 18,589 "lip augmentation" procedures that didn't involve injections of material such as collagen. That was the first year the society counted implant procedures.
By comparison, there were 230,000 liposuctions in 2000, 172,000 eyelid surgeries and 50,600 nose jobs.
"The desire for fuller lips reflects the idea that youth is beauty," explains Dr. Vail Reese, a San Francisco dermatologist who runs a Web site (www.skinema.com) that examines celebrity skin.
"During adolescence, the lips are proportionately larger than other features. Their size then recedes over the years as other features like the nose or chin become more prominent. So, when movie stars like Angelina Jolie or Julia Roberts give a pouty smile, it's teen beauty they're grinning about," Reese adds.
Dr. William P. Adams Jr., an assistant professor of plastic surgery at the University of Texas Southwestern Medical Center, uses implants that are about 4.8 millimeters by 11 centimeters. They're made of a synthetic material called "expanded polytetrafluoroethylene" better known as Gore-Tex. In addition to lining winter jackets, a different form of the material is used to repair hernias and blood vessels.
Acellular human matrix, a kind of preserved skin, is also used to make lip implants.
The implants, which can be removed, are typically placed in both the upper and lower edges of the mouth, expanding the tissue and muscle that make up human lips.
The Food and Drug Administration has not approved the use of lip implants, nor has it given the OK for collagen injections as a way to increase lip size, says FDA spokeswoman Sharon Snider.
However, she adds, the FDA doesn't forbid doctors from performing such surgeries. Instead, she says, "the company that makes the products cannot advertise and promote them for an unapproved use."
The implants that Adams uses now come in three sizes to fit various types of mouths, he says.
Lip implants only require a local anesthetic to numb the mouth area, Adams says. Side effects can include bleeding and infection but are uncommon, he adds.
Implants aren't the only way to make lips bigger. Plastic surgeons sometimes inject collagen or body fat into lips, but those techniques aren't always ideal, Adams says.
"The problem is that they don't last a long time. The best scenario is that they have about two or three months, then they need to need to be re-injected," Adams says. "Some people have allergies to collagen, and can't do it."
Injections of fat can also be troublesome because the lips may become lumpy as the fat redistributes itself, he says.
In another procedure, for those who aren't easily made queasy, doctors attach extra layers to the lips, using skin from cadavers.
Adams cautions lip implants do require extensive recovery time. Patients can get collagen injections and go out to dinner the same night, he said, but people with new lip implants may have two to three days of swelling, and not be able to eat normally for two weeks.
There is disagreement about the exact period of recovery, however. According to emedicine.com, lips will swell for 4-6 weeks after surgery.
"It takes about three to four months before the patients say that they don't notice their implants anymore," Adams says.
So, will every implant patient give actress Angelina Jolie a run for her money in the lips department? Probably not. First, it's not clear if Jolie ever had any sort of lip plumping; perhaps they just came that way. Second, you may not want lips like hers anyway.
"She's way on one end of the spectrum," Adams notes. "I'm not sure her lips are aesthetically pleasing because they're so large."
What To Do: Learn about lip augmentation from the American Society for Aesthetic Plastic Surgery or the American Academy of Facial Plastic and Reconstructive Surgeons.