Your Questions

Q: Dr. Eppley, I would love to discuss getting breast implants, keloid removal, and possibly upper lip injections. My questions are: 1. Would all three of those procedures be able to be done during the same surgery andin the same anesthetic if I so chose to do all three? 2. The keloids are on my right ear are from botched piercings/healing. This a substantial keoid on my earlobe, a more minor one on the upper ear cartilage. 3. In your experience, what products are the most natural looking, safest, and have the most longevity in the human body for breasts and same question for lips. Again, I appreciate all insight and hope to soon be one of your patients.

A: In answer to your breast augmentation, ear keloid removal and lip augmentation questions, I can provide the following answers. It would most efficient and prudent to combine all three procedures during the same surgery. Ear keloids are common and their removal often involves the concurrent use of steroid injections to prevent their known high rate of recurrence. For earlobe keloid removal the use of a postoperative compression earlobe device is recommended. The most assured and effective method of breast augmentation is the use of breast implants. Silicone breast implants offer the most natural feel and longevity over saline breast implants. For lip augmentation one should take advantage of the operative location and anesthetic to do fat injections for the lip augmentation. While no method of lip injections is assured, the use of fat at least offers the potential, is natural and is best done in an operating room location.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hello Doctor, I just had juverderm ultra injected into my lips several weeks ago. But I am not happy with the amount of lip size that I got from it. I am interested in having more filler put in and want to change to Aquamid.  Is it safe to use Aquamid a few weeks after having a Juvederm treatment ? What are the potential problems that could happen?

A: There are no studies that provide comfort that the mixing of different injectable fillers is safe. In fact, a recent report that looked at multiple different injectable fillers used in the same patient indicates that complications do arise from doing so. It may be one thing to mix and match different hyaluronic-acid based fillers (such as Juvaderm and Restylane, for example), but putting two completely different chemical compounds into the same facial site is unknown in terms of their compatibility and asks for problems. No facial area is more sensitive to  inflammation and granulomatous reactions from injectable materials than the lips.

I would highly recommend that you want at least 6 months before considering injecting another filler into your lips because of these concerns.

I would also not recommend the use of any semi-permanent or particulated injectable filler be placed into the lips. Fillers, such as Radiesse, Artefill and Aquamid, are comprised of a mixture of polymer beads suspended in some form of a more liquid carrier vehicle. In the lips, these particles have been shown to have a higher incidence of foreign-body reactions, lumps, and even infection. The injectable fillers with the best track record of safety in the lips are of hyaluronic-acid derivation. Do not risk long-lasting results at the price of soft tissue problems. This is a particularly poor trade-off in the lips. 

Dr. Barry Eppley

Indianapolis, Indiana