Ok, so I saw Dr. Mehta yesterday for the lip plumping. His words....
"I know you wanted the lips to be fuller so that you can get closure. i know exactly what you are saying. The lips were fuller before from the swelling induced by the operation.
Dont worry - we can get them fuller again. That will be our goal.
There are 2 ways to do it:
1) Restylane injection here in the office - can be a little painful even though we give you numbing medicine. not too bad.
Downsides of it: lasts for a few months - not long lasting. Also, very expensive although we have approval to do it today.
When it wears off, you can have it again if you liked it. Or go to second option:
2) minor surgery to augment lips using Alloderm - a material that we have in the O.R. It's artificial skin - works very well - lot of people use it for cosmetic purposes. Gives you nicer, fuller lips and will help you close better.
It's done under local anesthesia with maybe a little sedation. No fat is used, it's ready made material in a package. The procedure is easy to go through, takes less than an hour. Lips are a little swollen/bruised for a week. We just did this technique 2 days ago for a lady with facial paralysis. She likes it. She also had restylane before (twice) but it wasn't lasting long enough, nor making her lips full enough.
So it's up to you which option you want to do first."
(here i opted to try the restylane first. From start to finish it took about 20 minutes. Then we went back to discussion)
"I was hoping that a little restylane would do it, but that was wishful thinking. It looks better. The upper lip is not as thin. but your closure problem will just need a lot of volume which the other technique does well.
We used 1 full cc of restylane. Now, your lips are so thin that its going to require a lot of volume to get it to where we want. Even if were to use one more cc , it is not going to be enough. You may notice a little benefit - certainly they look better already but to get that closure you need, we will need a larger volume technique like the other option we talked about.
That's what I think will work best for you. Otherwise we will be injecting a ton of restylane into your lips for not a very long lasting effect. Your insurance also will not allow us to inject that high volume. You can see that the lips get fuller with restylane but you just need a lot more to get closure. From facial paralysis, the muscle in the lip gets so weak and thin. You already had thin lips and the facial paralysis has made it worse. Make sense?"
(Here I decided to go for the other procedure He will submit the request to the insurance today. Once it's approved, we will go ahead and just do it.)
(I asked him, how will you gauge how much to put in?)
"It is sort of an art where you have to estimate. We can always do it again if we need to. the good thing about it is that is much more long lasting - likely permanent."