Episode 53 - LA LA Lips with Dr. Brent Moelleken: Natural and Full Lips and How to Get Them.

Transcript

Teri Hausman: Hi. I’m Teri Struck, host of Beauty Now, a weekly podcast on keeping ourselves beautiful. Beauty Now has interviewed top docs on specialists, on lasers, on lifts, tucks, breast augs, Brazilian butt lifts, your skin, hair, inner beauty, outer beauty, and today I’m going to have our favorite doctor back, Dr. Brent Moelleken. Welcome back Dr. Moelleken.

Dr. Brent Moelleken: It’s great to be back.

Teri Hausman: You have so many great shows and if our listeners haven’t checked those out, make sure to check them out. He’s done everything from tummies and breasts and he’s one of our top specialists. So today we’re going to talk about one of the most difficult things for a patient to be pleased with, your lips. You have a new procedure, Ooh La La Lips is what you’re calling it, and everybody wants those Angelina Jolie lips. Tell us how we can get them.

Dr. Brent Moelleken: Well, I’m not sure you can get Angelina Jolie lips ‘cause only Angelina Jolie can have Angelina Jolie lips…

Teri Hausman: We hate her, okay.

Dr. Brent Moelleken: We hate her, right.

Teri Hausman: We do hate her.

Dr. Brent Moelleken: But you can augment your lips and there are a million ways to do it, and one of the things that we’ve been very happy with is taking the patients own tissue, we call, we use live cell grafts, which are little strips of the patients own tissue, they’re all alive when they go in, and we place those through little incisions inside the mouth, little nicks inside the corners of the mouth, we put the La La Lip Graft into the lips.

Teri Hausman: So how do you get the patients tissue?

Dr. Brent Moelleken: Usually we go down to the pubic area and we need about a one inch incision, and then we get the little strips of tissue from the deeper tissues, which are the best for augmenting lips. And they’re all alive when they go into, it’s a little bit different from another method your, your listeners I’m sure have heard about, namely fat injection. And when you do fat injection, which is another way of augmenting lips, you’re using liposuction, you’re taking fat cells out with a suction device, and then you put them in a syringe and then you inject them into a lip. Problem is when you do fat injection a lot of the cells just don’t make the journey, so they die. So what you’re starting off with when you do fat injection is maybe 25 percent live cells. So that’s why I came up with the La La Lip Graft, and I don’t know why I call it La La other than I’m from Los Angeles…

Teri Hausman: I like it, I like it.

Dr. Brent Moelleken: Los Angeles twice is La La.

Teri Hausman: Uh hmm, I like it.

Dr. Brent Moelleken: But when we take strips of a patients own tissue, that’s all alive when it goes in, so they’re both grafts, they’re both tissue taken strictly from the patients own body, so no plastic, no artificial material, no temporary stuff. This is actually tissue taken from the patients body, placed into the lips, and then the healing process starts, the patient develops their own blood supply into the grafts. And if you look at them on biopsies later, they’re actually little blood vessels in there. So this is very, very different from, you know, putting in temporary fillers or even fat injection biology. So it’s pretty exciting.

Teri Hausman: What if you’ve already had fillers in your lips, are you a candidate?

Dr. Brent Moelleken: Absolutely. Patients who’ve already had fillers are still candidates for, you know, a La La Lip Graft, and what we do typically is we let a little time go by to let the temporary fillers go away. Now I would say, you know, I’m always cautioning for procedures that I don’t care about, and one of those procedures is silicon, and you’re hearing a lot about silicon nowadays because for some reason it’s making a resurgence. Now we know that silicon in the lips looks great at first. And then over time this chronic inflammatory reaction develops that causes chronic swelling of the lips, and it can give this weird trout look where the upper lip kind of flops down from top, that kind of the trout lip look, and that’s really something we want to avoid and caution our, you know, listeners not to get any silicon injections to their lips. I would also say that material such as Radius or Artecoll or Artefill really should be avoided in the lips because they have some permanent component in them in addition to the collagen, and that can cause a chronic inflammatory reaction which could come back and haunt you years after the initial injection is done.

Teri Hausman: And Radius, that is the big lumpy lip where even some doctors that are really, you know, board certified don’t know not to use that in the lip.

Dr. Brent Moelleken: Exactly. Now the Radius company, which I think has now gone broke officially…

Teri Hausman: Right.

Dr. Brent Moelleken: But, you know, they did caution even before they went broke not to use it in the lips. It wasn’t indicated for that area because the lips are so sensitive, we want to be really delicate with our lips and not just put this mone material or plastic beads or anything like that in the lips. Just stick with natural stuff like holyronic acids; Juvederm is great, Restylane is great, different hyaluronic acids like Prevel, Prevel Silk, those are great. But I would really avoid anything like Artefill, Artecoll, you know, any of the semi permanent fillers, and absolutely definitely avoid the silicon products. Now there’s some silicon products coming from Europe also. And there’re many of those that we haven’t even heard the names here, nor hopefully will we ever hear them in the United States, but those materials are in my opinion just as bad as silicon, and we’ve, we do have a number of patients from Europe that we’re having to operate on and take out the lumps from their lips from these injected materials, so I really caution people, you know… Restylane is fine, Juvederm is fine, no one gets hurt, if you don’t like the way it looks it goes away, but really try to avoid any of those permanent or semi permanent fillers.

Teri Hausman: Nothing looks worse than having your lips botched, and I don’t think we have to say this to the listeners, but lets just say it anyways, I mean, I did see somebody here that got their lips injected in a nail salon because supposedly it was a Vietnamese doctor and a good price. Don’t skimp on your face, don’t skimp on injectables like that. You need to go to a really qualified doctor to do that. So, okay, so the next question would be you’re going to have to let the fillers kind of go away before you can have this procedure done?

Dr. Brent Moelleken: Yeah. Usually fillers like Juvederm or Restylane, which are the two most common, they last about six months and they’re gone. So when we do a lip graft like the La La Lip Graft, typically we’ll wait two months after the last filler injection and that gives us a really good idea of how the lips are going to look eventually, ‘cause a lot of the filler will be gone.

Teri Hausman: What if you have scar tissue? What if you have scar tissue built up from, you know, repeated injections over the years? Is that going to affect it?

Dr. Brent Moelleken: Well one of the things we do when we put in the La La Lip Graft is we take a little micro scissors and we actually break up the scar tissue to give it a totally new plane. Now some of the older techniques that were used, they’re not really done that much anymore, like cadaver material placed into the lips, like Alloderm. That caused an inflammatory reaction and a tightening of the mouth, so some people got, literally they could not open their mouths because of the Alloderm causing a scarring reaction. So what we do in those patients is we take out as much of the Alloderm as possible and we break up the scar tissue, so when scar tissue is present and we’re putting in a La La Lip Graft, our first step is break up as much of the scar tissue as possible. Now of course it’s better not to have that scar tissue in the first place, so don’t put crazy stuff in your lips.

Teri Hausman: Like, what about, what do you think about this new Surgacil lip implant that just came out?

Dr. Brent Moelleken: Well, I’m not…

Teri Hausman: I don’t know if it just came out, but I, I don’t know if it just came out but I just saw a thing on The Doctor’s on it.

Dr. Brent Moelleken: Yeah. I don’t care for lip implants that are actually implanted. I’d much rather use the patients own tissue to achieve more volume, because you have a synthetic implant in the lip that you can totally feel, you can actually feel it, and it’s weird if you’re kissing somebody and they go, “What is that piece of plastic in your lip?” That’s just horrible. So you never want to have that experience in my opinion.

Teri Hausman: No, and the more natural your lip could look, the better you look.

Dr. Brent Moelleken: Absolutely. So that’s why when patients come in and we, you kind of made a joke about Angelina Jolie, but people do come into our offices and they say, “Can I look like Angelina Jolie?” And the answer is, you know, usually not. What we do is we take the lips that the patient has and we enhance them. That’s our goal. Not to make totally different lips on somebody, because the lips just aren’t ready for it. They just will not take that volume.

Teri Hausman: Yeah, see I wasn’t joking about Angelina, I really do want her lips…

Dr. Brent Moelleken: I know, exactly right.

Teri Hausman: I really do, okay.

Dr. Brent Moelleken: And we get as close as we can, we get as close as we can. If I could have a picture of anybody on the wall that I hear most requested looks for their lips it would be Angelina Jolie for sure.

Teri Hausman: I know, because they look so natural, they’re not like the kind of lips that you see where you say, you know, where we know another famous actress which I won’t name, but you’re like, “Oh my god, who did those lips? That looks terrible.”

Dr. Brent Moelleken: Exactly.

Teri Hausman: ‘Cause what happens when it bends down on the top, you know what I mean, like that, it almost folds over, what is that?

Dr. Brent Moelleken: Well there’s a lot of things that can go wrong with lip injections, and those can be with temporary lip injections or with permanent lip injections, and usually it happens when someone wants too much volume into their lips, so the skin and the mucosa is very delicate and it’s built for a certain amount of volume. And you can enhance that volume, but you can’t totally exceed the volume ‘cause what happens then is the beautiful white line on the top of the lip and the vermillion border, that starts to get blunted and weird, it looks like a sausage when you put too much volume in, so we don’t want to exceed the natural volume that the lip is capable of supporting. Also when we augment lips, we want to look at the face as a whole. This is an artistic endeavor. We don’t just want to inflate lips and send people on their way looking like Daffy Duck. That’s doing absolutely nothing for our patients, so we want to look at them as a whole. What’s going to make the patient more beautiful? Sometimes, you know, in ladies who are 50 plus, if we just augment their lips and we don’t augment some of the other areas that have lost volume, that’s when we get this disharmony, and I’m afraid to say it but in Beverly Hills you see a lot of it, where the lips are big and the patient has had the normal loss of volume that occurs over the years, and the two of them just don’t mix. We want to look at the patient as a whole, make them beautiful as a whole, not just give an older lady big fat lips. We don’t want that look.

Teri Hausman: No we don’t want that look. And we’re going to be right back with Dr. Brent Moelleken and your lips, injections and more. Thank you so much. We’re going to be right back.

Teri Hausman: We’re back with Dr. Brent Moelleken. Everything you need to know about lips this doctors going to tell you, and he’s a pro. Welcome back.

Dr. Brent Moelleken: Well it’s great to be back again.

Teri Hausman: Well we were just talking about your procedure to make La La Lips, which I love, and I really want these La La Lips, so I’m onto this. You were just talking about fillers and also the procedure to put live tissue into your lips….

Dr. Brent Moelleken: Right.

Teri Hausman: How long does this procedure last?

Dr. Brent Moelleken: Well we think it lasts for good, and the reason that is is that when you do the La La Lip Graft, what you’re doing is you’re taking tissue from the lower abdomen, you know, making an inch long incision going down to the pubic area, usually we shave the hair so the incisions not apparent, and then we go down to the really good tissues for harvesting which are the fascia and a little bit of the deeper fat. And those, we take strips from that and we actually, we close that area up, very hard to see the incision, and we take the material, we actually transplant it to the lips, so we make very teeny incisions inside the corners of the lips, I need one on each side, and that’s enough to get a nice graft on the upper lip and a nice graft on the lower lip.

Teri Hausman: Hate to ask this, but is, do people grow hair there? I mean you would have hair follicles, has that been a problem?

Dr. Brent Moelleken: No, there’s been no chance of hair follicle formation because we take the tissue a little bit deeper than where the hair follicles are, so there are no hair follicles in the tissue that we harvest.

Teri Hausman: Does it look natural?

Dr. Brent Moelleken: The La La Lip Graft looks very natural because it’s the patients own tissue, and we don’t exceed what the natural lips are capable of supporting. So we can enhance greatly the volume of the lips, but we don’t try to make someone with super, super thin Nicole Kidman type lips into Angelina Jolie. Otherwise they would just look like sausages. And if you don’t believe me just look at Australia. Oh, I didn’t say that.

Teri Hausman: Okay, well then I will. Okay, no I didn’t say that either. So you’re thinking that this lasts forever. Do you, do people get fillers on top of this implant?

Dr. Brent Moelleken: People can get fillers for little nooks and crannies around the lips, and you’re never really free of the need for filler because fillers are wonderful for fixing little teeny nooks and crannies on the surface. Live fill or the La La Lip Graft is a lot better for restoring three-dimensional volume. So that’s the difference between fillers and, you know, the La La Lip Graft. So you can also get fillers in little nooks and crannies that develop over the years in the face.

Teri Hausman: So you’re not going to really have the need to use fillers right away, but you might want to fill in the little lines that, like the smokers lines, right?

Dr. Brent Moelleken: Well the La La Lip Graft helps a great deal for smokers lines. Now smokers lines have a lot of causes, and one of them is, you know, loss of volume of the lips. Over the years the lips just get smaller and smaller and smaller, so women who are in their 40’s look back at their 20’s, pictures taken in their 20’s and they say, “I wish I had those lips again”, ‘cause the lip volume actually diminishes. And what happens when the lip volume diminishes, the skin is exactly the same as it used to be, so it’s going to look deflated and sometimes those lip lines start to form. Now sun also causes those lip lines to form. Too much sun will cause damage in the elastic fibers of the lips, and they will literally be unable to shrink back, you know, as the volume recedes over time. Then the third thing that causes those lip lines is of course smoking. And then there’s a fourth thing that people don’t know about, and that’s kind of mannerisms, like British people a lot of times, they’ll sort of purse their lips, they’re very elegant in the way they speak, but they can get very, very deep lip lines because they kind of purse their lips. And for those patients who have that sort of habit of pursing their lips and causing lip lines to form, we can actually put micro amounts of Botox into the lip, into the areas just to kind of mellow out the lip muscles that are hyperactive, that are too active, that are forming these lip lines. So…

Teri Hausman: I want to ask you about that, so, ‘cause I have heard of that, putting some drops of Botox there, so… There’s no worry of, you know drooling or… ‘Cause doesn’t that make your muscles relax, so, so if you put a couple drops there, you’re saying that’ll just make it relax enough that you’re not going to have slurred speech or anything like that?

Dr. Brent Moelleken: Well we need to be very, very careful when we use Botox anywhere on the face ‘cause what Botox will do, it’ll do just what you tell it to. And if you put it in the lip muscles in extremely, extremely small quantities, it can mellow out hyperactive lip muscles, but if you put in too much then absolutely you’ll be drooling like a fool because the Botox will do what you tell it to, it’ll totally relax the lip muscles and then boom, you have a problem that will take three months to go away and it’ll just be horrible to sit there drooling in your soup but looking beautiful.

Teri Hausman: Exactly, so again, go to a professional. Really check out your doctor.

Dr. Brent Moelleken: Absolutely.

Teri Hausman: I personally wouldn’t go to a nurse for that. I wouldn’t. I mean, just because doctors go to school for a long time for a reason, even though I think there’s a lot of great nurse out there that can inject, I really do, but I would ask for the doctor if I was going to be having it put above my lip.

Dr. Brent Moelleken: Right. You know, and the laws of California state that a nurse can perform injections, you know, as long as they’re under the supervision of a doctor. But what you see often is that many nurses actually have their own private practices, which is against California law, I mean, we’re here in California now. It’s against California law, but, you know, it seems to be done a lot and there’s sort of a doctor supervising, but really that’s not kosher. It really should be…

Teri Hausman: No, and I was actually at a  plastic surgery convention and I was out by the pool and this nurse started talking about how she works in a medi spa and I said, “Oh, do you have the doctor there?”, and then she said, “Oh no, we don’t have the doctor there”, and she was saying all this stuff that she did. So that was scary.

Dr. Brent Moelleken: Yeah. Well these issues are complex, and when you’re messing with your face, you know, it’s inconvenient if you have a problem for three months to walk around with lips that don’t function too well, but if you’re a newscaster or someone on the air or if you make your living with your voice or you’re in contact with people a lot, that can be pretty, pretty damaging.

Teri Hausman: Well for anybody really. I’m sure nobody wants to look like a drooling freak either, but…

Dr. Brent Moelleken: Absolutely.

Teri Hausman: so that’s the thing, and lips are very hard I think to get right. I mean I do think that it’s fair that if you have to go back for a little touch up on one side of your lips, I think it’s fair to the doctor.

Dr. Brent Moelleken: I think that’s a great philosophy. If your doctor is conservative, if they do a good amount but, “Hey, I need a little bit more”, wonderful, no one gets hurt. But if you’re too aggressive the first time, you can’t go back and, and say, “Wow, we went too far, you know, how can we go backwards?” That’s, the backwards step is a very hard step to take. The forward step….

Teri Hausman: That’s a good philosophy.

Dr. Brent Moelleken: Exactly.

Teri Hausman: Because also you’re skin on your eyes and your face, like we talked before, that you can always go back and take out more, but you can’t put more skin back in.

Dr. Brent Moelleken: That’s absolutely right. So a conservative attitude, if you look at the really, really top doctors, by far most of them tend to be a little bit conservative.

Teri Hausman: Right. That’s really, really good advice. So tell us more about your procedure; how long until you’re looking beautiful? When you leave and you’re, I’m assuming you’re very, very swollen.

Dr. Brent Moelleken: You know, the swelling that you get from the La La Lip Graft is much, much less than you get from fat injections, and the reason for that is we don’t have to exaggerate how much we put in when we do the La La Lip Graft. When you do a fat injection technique you’re, you’re counting on a lot of the cells not surviving, so you have to over exaggerate the amount of fat you put in. And we’ve actually done some studies looking at the, you know, which cells are alive and which cells are dead with fat injection, and you can’t really tell. Some parts of the specimen, the cells are maybe half alive, and some parts of the specimen they’re almost all dead, all depending on where the fat was suctioned and was writ in relation to, you know, the negative effects of, of the vacuum and all sorts of technical things. So you really can’t tell which of the cells are alive and which are dead, so when you’re exaggerating the amount of fat you put in how can you be sure that the amount that you’re exaggerating will survive evenly, and that’s been one of the bugaboos about fat injection, is when all the swelling goes down, and there’s a lot of swelling, you tend to see areas of lumpiness, so areas that more fat survive and areas where less fat survive. So the La La Lip Graft has been much more predictable in our hands because the tissue is more alive when it goes in, and we’ve done some studies looking at CT scans, and we’ve looked at the volume that survives of the initial graft, and it’s very, very high. So we’re seeing…

Teri Hausman: Compared to the fat then…

Dr. Brent Moelleken: Exactly.

Teri Hausman: What if you’ve already had fat injected, can they still get the La La Lift?

Dr. Brent Moelleken: We still can do the La La Lip Graft in patients who have had fat injections because usually the patients who have had fat injection will say, “I loved it at first after the swelling went down, I loved it, but then the fat tended to go away”, and this is not a surprise because most of the fat you’re injecting is dead and the body’s not going to be happy about that, it’s going to take its little white blood cells and get them over to the lips and start chewing up the fat injection, so that’s why we like the La La Lip Graft where the live cell material that’s used is alive. It’s, you know, in our studies we showed about 88 percent of that material is alive when you put it in as opposed to about 25 percent from the fat injection. So that’s why we prefer, you know, our practice the La La Lip Graft.

Teri Hausman: Well I’m off subject really quick. I’m reading about fat injections into the breasts, so what do you think about that, just your opinion?

Dr. Brent Moelleken: Well my opinion on fat injection of the breasts is don’t do it…

Teri Hausman: Right.

Dr. Brent Moelleken: For one, you don’t get that big of an augmentation anyway, and number two, you’re taking this material, this fat injection material where remember which is mostly dead and you’re injecting it into the breasts. Now the body deals with dead cells differently. Sometimes it’ll just gobble them up and they’ll go away, no harm done. But sometimes the body will wall off the dead cells, it’ll literally make a little wall around the cells, and in these walls tend to form calcium, and we all know what calcium is. That’s what you look at when you’re looking for mammograms. You look for the odd calcium to detect cancers early. Now what happens if you do the injection of fat into the breasts and the little, little spots of calcium form? How do you know if it’s cancer or not? So what if all these women who are getting fat injected into their breasts develop calcium down the line, what are we going to do about it? Are they going to be needing a bunch of needless biopsies? Because, you know, the radiologist is scratching his head saying, “Wow, I see all this calcium. You know, I don’t know if it’s cancer, I don’t know if it’s not cancer. You better biopsy it.” And…

Teri Hausman: Good advice.

Dr. Brent Moelleken: And then someone who got, you know, fat injected into their breasts may be saying, “Gosh, I wish I hadn’t done that because, you know…” So fat injection into the breast is still considered very experimental. There’s some very good doctors who are experimenting on it, but if my wife or my sister came to me and said, “You know, I’m considering a breast augmentation, what do you think about fat injections?”, I would say absolutely not. Lets wait until the studies are done, wait until they prove it’s safe long-term, then we can consider it.

Teri Hausman: Good advice. Especially since, it’s the same with your lips then, right?

Dr. Brent Moelleken: Yeah, you don’t want to be experimenting on anything, you know, in your lips, especially with, you know, temporary fillers or with silicon. Those are the things that can cause, you know, problems that can never be fixed. Silicon in the lips causes a chronic inflammatory reaction, it changes over time, it can never be fixed completely.

Teri Hausman: Well I can’t let you go without asking this important question: how much does it cost?

Dr. Brent Moelleken: You know, usually most people have the La La Lip Graft done under local anesthesia, sometimes they’ll have a little bit of sedation, and it’s around $5,000 dollars.

Teri Hausman: And it lasts forever you think?

Dr. Brent Moelleken: We, in our studies it has lasted forever, yes. It is a graft from the patient and, you know, and there’re lots of copiates with that, the patient can’t smoke or the graft my die, the patient has to take good care of themselves, and there is, you know, the element of chance for any graft that’s transplanted, there is a chance that it might not survive. However, we do have very, very high success rates with our La La Lip grafts.

Teri Hausman: It sounds amazing, and of course we always say, “Please don’t smoke. Check with your doctor.” There’s a drug called Chantrix, is that correct, Chantrix?

Dr. Brent Moelleken: Yes, Chantrix, and that’s been a big help for many, many patients.

Teri Hausman: Yeah, we don’t want you smoking, that’s not a Beauty Now philosophy.

Dr. Brent Moelleken: That’s brilliant advice.

Teri Hausman: Well I think it’s most people’s advice that I know. A lot of people are addicted, so Dr. Moelleken told me about a drug called Chantrix, and so that did help my sister. She ended up going and getting it, and so she is quitting. That’s great.

Dr. Brent Moelleken: Good.

Teri Hausman: So she can be in to see you soon.

Dr. Brent Moelleken: That’s wonderful.

Teri Hausman: So, thank you so much for being with us again today, and for telling us all about lips, and I want that procedure immediately, that sounds so good. I love to have big lips, I think they look so great, but of course I want natural ones.

Dr. Brent Moelleken: Well it’s wonderful to talk to you.

Teri Hausman: You too, and thank you. And if you would like to get Dr. Moelleken’s website or his email, please go to personallifemedia.com. If you’d like transcripts of today’s show, please go to personallifemedia.com. We’re going to link you up to Dr. Moelleken’s website, his info, you can check out his other shows on tummy tucks and face lifts, and he also does Licil on the neck too, so that’s pretty interesting. And thank you again for being with us. If you have any more questions [email protected], and I’ll hook you up with Dr. Moelleken. Thanks again for being with us.

Dr. Brent Moelleken: Well it’s my pleasure.