WHOLE LOTTA LIP As the pouty look swells in popularity, many women turn to collagen injections

Because of incorrect information provided to The Sun, Dr. Ira Papel was misidentified in an article on lip enhancement in last Monday's Today section. Dr. Papel's correct title at Johns Hopkins Hospital is part-time assistant professor of otolaryngology and director of facial aesthetic and reconstructive surgery in the department of otolaryngology-head and neck surgery.

Pssst. Hey, lady, how'd you like to have a fat lip?


When you were a little girl, the threat would have sent you running in the opposite direction. Now, you might be more inclined to grab several hundred dollars and answer, "Yes. Please."

In fact, you might go for two fat lips -- a matched pair, uppers and lowers, like models and movie stars have. Lately, that plumped-up pout seems to be considered sexier, prettier and much more youthful than the stingy-mouthed stare of our Puritan progenitors.


If you weren't born that way, you can get there with a shot of collagen, a thick fluid composed of purified protein molecules taken from cow skin and suspended in saline solution.

The fat-lip fad seems to have started a year or two ago, boosted by reports that actress Barbara Hershey had her lips puffed for her role in the movie "Beaches," and by the sudden appearance of lippier models in magazines.

Just how popular it is remains a question, however. Dr. Linda Frank, a plastic surgeon with offices in Baltimore and Rockville, reports a rash of patients asking for the bee-stung look after "Beaches," but none since.

"Baltimore is not like California; we don't do a lot of lips," agrees Dr. Ira Papel, assistant professor of otolaryngology and director of facial plastic surgery at the Johns Hopkins Medical Institutions. He gets about six requests for it a year.

Now, however, a new look is hitting the market, the so-called "Paris Lip" introduced in October by the company that packages injectable collagen.

The differences between the lip looks are in the amount of collagen used, where it goes, and what it costs. Bee-stung is bigger on all counts: It requires several syringes of collagen, which can cost $275 to $300 each. According to one published report, it may total $1,000 to $2,000.

The Paris Lip is cheaper; a single syringeful of collagen could be injected along the outer rim of the upper lip, with a little extra at the top of the Cupid's bow, and some more in the little ridges that run down from your nostrils.

"It's a fashion thing, almost like a fashion in clothing. This year it's in to have the lips puffed up," says Dr. Charles Converse, a plastic surgeon in Severna Park who does the Paris procedure. "Michelle Pfeiffer, for instance, she has the lips you might describe as the perfect French lips. Those lips are in, and we can mimic them."


Yeah, but what happens when that kind of lip goes out of vogue? Are you going to be left with a maxi-mouth when minis come back into style?

"The reason I'm comfortable about it is that collagen is not permanent," says Dr. Frank.

Introduced in 1976 to fill in wrinkles and fill out depressions, collagen is a sometime thing. Your body will attack and dissolve it: If you don't like what it makes you look like, you just sit back and wait for it to go away. If you do like it, you just pop back into the doctor's office for a booster shot every six to nine months. And the only major drawback seems to be that it sets off a bumpy red skin response in an estimated 2 percent to 3 percent of the population.

For a 57-year-old Annapolis woman, it was the hope of erasing the creases that age had carved around her mouth, rather than a desire for a better lip, that brought her to Dr. Converse.

"You get these vertical lines around the lips after you're 50, and lipstick bleeds into them," says the woman, who didn't want her name used. "You look like someone who's been sucking lemons . . . Before they got too bad, I decided to have them done."

She's had the creases refilled several times, as the absorption of the collagen puts back the pucker three to six months after treatment. The lip-job was a one-time thing, a kind of afterthought for using up the collagen left in the syringe after a crease-fill, she says.


"It's kind of a poochy, sexy look, like the models have, but not so drastic that anyone would know. I even asked the man I was dating if it was really drastic, and he said he just noticed something a little different," she says.

Other people, she adds, just thought she had changed her lipstick color.

But it's a costly cosmetic. And even though there's anesthetic in the syringe, a very tiny needle at the tip and a lot of assurance from the doctors that it hardly hurts at all, a collagen injection is not exactly as pleasant as a facial.

Says the Annapolis woman, "I think for the first few days, or week, if you got into a real lip lock, it would feel a little painful."

But, hey, who said feminity was supposed to be easy? Although Village Voice columnist Michael Musto had a cute little pouf put into his upper a month or so ago, this business of being beautiful is primarily women's work.

"What's been going on forever is that women's bodies are never OK the way they are. Women are constantly altering, changing, remodeling, remaking, manipulating their bodies," says Rita Freedman, Ph.D., New York-based psychologist and author, most recently, of "Body Love: Learning to Like Our Looks and Ourselves."


The emphasis on lips, from lipstick to injections, can be explained in a number of ways, according to Dr. Freedman: Some experts believe the reddened, full-lipped look mimics the swollen mouths of suckling babes and contributes to the infantilization of women, while others say it's a kind of sexual signaling, and connotes genital readiness.

Or, the reversal of the thin-lipped standard of previous years might be seen as a sign of societal maturity. "When you think about the fact that ethnics have thicker lips, it was considered classier to be a thin-lipped white," Dr. Freedman says.

And then again, it could just be another manifestation of society's obsession with youth: "Lips become thinner with age," she says. "Enhancement gives you a youthful look; you are retarding the clock."

There is, of course, more than one way to fix a lip: Cut and sew surgery is also an option, as are injections of silicone. A more controversial substance, liquid silicone was known to migrate and form hard lumps in undesirable places or cause tissue damage when globs of it were injected in the early days of breast augmentation procedures.

But according to Dr. Kathleen Taylor, a Towson dermatologist who describes herself as a fan of the material, it is safe when used properly: "That means serial injections of micro-droplets," she says. "You put a droplet into an area, and you wait a month while a meshwork forms around it so it cannot migrate."

That also means it takes a long time to do a big area; but once it's done, it's done forever. Because silicone doesn't dissolve, Dr. Taylor says she is cautious about using it for lip enhancement.


"I make a judgment about whether a person can really use a lip enhancement, or just wants the Kim Basinger look," Dr. Taylor says. "I don't want to be responsible for leaving someone with the lips of 1991."