Despite all of the technological advances in plastic surgery, lip lines continue to be a difficult problem to conquer. Although not a problem in men, women suffer from lip lines as they age. Smoking, sun exposure, and genetics play a major causative role. As for treatment, lasers, peels and dermabrasion approach the problem from the outside in – fillers approach the problem from the inside out. The best results I have seen have been with the use of a phenol chemical peel, but the skin color is lost, making this technique unacceptable in my eyes. A series of silicone droplet injections into the wrinkles can give outstanding results as well, but in some patients the silicone will migrate and clump.

A recent article (Aesthetic Surgery Journal 32(5) p. 554-561) by the Belgian originators of the MACS-Lift, Drs. Tonnard and Verpaele, offers another alternative to those who suffer with lip lines. They report on fat injection to the wrinkles in a series of 250 patients treated over a 3 year period and then followed for several years afterwards. The essence of their technique is using fat to fill in the wrinkles, termed by the authors as SNIF (Sharp Needle Intradermal Fat Grafting). The wrinkle is 1st anesthetized with local anesthetic, it is then “released” by running a sharp needle under its surface to cut through any attachments to the underlying muscle, and then a small amount of fat is injected directly under the wrinkle. This fat can be taken from any area of the body where there is excess. It is important that the fat be strained of all lumps to avoid irregularities in the area of injection. Recovery usually takes 2-4 days. The procedure may be done at the same time as other facial procedures or can be done alone under local anesthesia only.

In most cases, the results last more than one year which is longer than the 3 to 6 month result that one sees with fillers such as Juvederm. Beyond one year, touch up treatments may be required since not only is the fat absorbed, but the aging process continues. The SNIF technique can also be combined with laser resurfacing, thus approaching the problem of lip lines from the outside as well as the inside.

On a final note, this SNIF technique of superficially injecting a wrinkle with fat differs from the traditional fat injection technique where deeper fat injection is used to fill in facial folds such as the nasolabial folds located on either side of the mouth and upper lip. The SNIF offers a longer-lasting alternative to filler injection and appears to have minimal complications and a relatively short recovery.

Please contact my office should you have further questions.

George Sanders, M.D.