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What is lip graft (dermofat graft) surgery?

Before providing any explanation regarding the lip graft surgery method, we first intend to familiarize you with the place of the lips in human facial beauty, as well as the different methods of lip surgery and maximizing lip volume. We examine the advantages and disadvantages of lip cosmetic surgery methods. We also review the reasons why people pay attention to plump lips that are today regarded as one of the aesthetic criteria.

Dermofat graft surgery

y studying this page, you will acquire all the required information about the available techniques for maximizing lip volume and lip surgery. If you feel the need for undergoing lip surgery in yourself and your relatives, you can choose the most appropriate surgical method and get to know the factors of choosing the best lip surgeon in Iran.

When it comes to cosmetic surgery In Iran, the picture that immediately comes to mind is rhinoplasty, and most people think that by rhinoplasty and correcting nose defects, their dream of having a beautiful and ideal face, which they have always imagined in their minds, will be realized.

But have you ever thought to what extent the beauty of other facial elements, such as eyes and lips, affect the face beauty?

It is interesting to know that a research study conducted in this area demonstrated that eyes have the greatest effect on facial beauty. Eyes are the first way through which we communicate with the surrounding world. Eyes are a window to convey human feelings and emotions. After the eyes, lips are the second main and important organ that affects the facial beauty and attractiveness. The beauty of lips has been of great importance since long ago, especially among women. The production of all types of lipsticks, lip liners, and other cosmetic products by various companies to beautify the lips, and their high sales statistics worldwide testify this issue. All women regardless of their ethnicity, race, culture, and nationality always try to make their lips more beautiful. In addition to increasing the face’s attractiveness, the beauty of lips will boost self-confidence in people. In most occasions, it has a great effect on developing sexual attraction (from the opposite sex’s point of view) and improving the people’s emotional and personal relationships.

After lips, the nose plays the third important role in facial beauty. Therefore, it is sometimes seen that persons who have beautiful eyes and lips look beautiful even with their big noses.

Lips beauty criteria

First of all, we should know what beautiful lips look like and what criteria make lips look beautiful.

It should be noticed that the beauty of lips is generally investigated from two perspectives:

  1. Lips form and shape
  2. Lips proportional volume to other facial elements

The first beauty criterion in lips is the lip symmetry both when the lips do not move (static state) and when they are moving (dynamic state) like when we are laughing and speaking.

It can be said that the higher the rate of symmetry, the more the beauty of lips. However, it should be noticed that a little asymmetry in all people is completely normal and is not required to be removed by surgery. The extreme asymmetries may be reduced to an acceptable extent via lip asymmetry surgery. However, in none of the surgical methods we can expect these asymmetries to be completely removed. The asymmetries can only be reduced by performing a surgery and creating visual error.

lip surgery

The second important criterion of lip beauty is the proportionality of the upper lip to the lower one. The upper lip and lower lip should not be significantly different from each other in terms of form and volume. For example, one lip should not be too narrow and the other one should not be too wide, or the position of lips should not be in a way that one lip comes forward and the other goes backward. The other important point is the proportionality of the lips themselves to the surrounding tissues. Sometimes, the disproportion between the lips surrounding tissues may cause the lips to not look beautiful. For example, the lips may not look beautiful in people with a small receding chin as compared with the normal state, or in people in whom a proper groove has not been formed between the lips and the chin, or those with drooping nose. For this reason, the proportionality of other facial elements will also significantly affect the lips beauty. The presence of these criteria together causes lips to help with facial beauty and depict an attractive face.

Lips beautifying methods

With the increasing advances in medical science, newer methods are introduced to beautify the lips. These methods are divided into two general categories: invasive methods and non-invasive methods:

Non-invasive lip beautifying methods

  1. The simplest and most elementary method is lip makeup.

 A lip tattoo is another method that causes the lips form to look better by creating visual error, but makes no changes to the lip’s volume.

  1. Filler or gel injection

 By increasing the volume of lips, these materials beautify the lips. The gels used in the past had higher durability, but a very low safety. These gels gave their place to the gels that are used today. The new gels minimize the risk of infection and reaction of the body due to their less durability (6 months – 1 year) but higher safety. Today, the injection of this type of gel, which contains hyaluronic acid, is very common, and the risk of infection has significantly reduced. Therefore, it is recommended that people who expect minor changes in their lips do gel injection first. If they were not satisfied with the changes and wanted to permanently change their lips, they can look for a skillful and experienced physician for lip surgery.

  1. Fat injection

Fat injection is among less invasive methods, but the fat in this region has less durability than gel due to the mobility of lip tissue.

  1. Lip prosthesis

Using lip prosthesis is among the methods that can increase the volume of lips. It was used more in the past. The prostheses are commonly used to augment different parts of the body and in most cases they yield satisfactory results. However, this does not hold true regarding lips, and the applicants are not satisfied with it! Experience has shown that people who use lip prostheses to increase the volume of their lips tend to remove the prosthesis after some time when they are not satisfied with the result of the surgery.

Although the lip prosthesis is permanent, different problems may arise after inserting the prosthesis into the lips. For example:

  • Lip prosthesis may shift or move. Considering the lip tissue and the delicacy and sensitivity of the skin of this area, even a small displacement of the prosthesis is clearly visible.
  • The lips are mobile organs whose tissue is constantly contracting and expanding in different situations such as laughing and speaking. On the other hand, prosthesis is a foreign object. Despite the many advances that we have witnessed in prostheses fabrication, experts have not yet succeeded in manufacturing the prostheses capable of contracting and expanding like the natural tissue of the lip.

Therefore, the presence of prosthesis in lips causes them to look artificial. This situation is unpleasant for people, and causes them to prefer gel injection over this method to increase the lip volume. Although the gel is regarded a foreign object, it is not a full piece unlike a prosthesis and is changeable. Moreover, its soft texture is similar to lips tissue. That is why it is more welcome today.

Invasive lip beautifying methods

Different lip beautifying surgeries

Direct lip lift

In this surgery, the form and/or volume of the lips or both can be simultaneously changed by incisions made in the lips.

There are various methods to change the form or volume of the lips:

  • lip surgery from inside the lip

In this method, the surgical incisions are made inside the mouth. These incisions are W-shaped and cause a change in the shape and form of the lips by changing the internal tissues of the lips and directing these tissues outwards.

As it is impossible to predict post-surgery changes in this method, the demand for lip surgery in this way has decreased over time.

  • lip surgery from outside the lip

The lips form and/or shape or both of them can be simultaneously changed by undergoing this surgery.

Fascia Graft

Fascia graft is one of the tissues used by cosmetic surgeons over recent years for lip augmentation. Fascia refers to a thin but firm tissue that is placed on a muscle like the tissue that exists on the ear.  This fascia is made into a roll and used to augment the lips due to its thinness.

Dr. Bohlouli et al. (2013) (please find the article through the URL below) used the temporal fascia for lips augmentation and its six-month results were investigated. Some of the results are presented as follows.

Fascia Graft


As can be seen in the above pictures, the use of fascia causes positive changes to the lips.

Due to the low volume of the obtained fascia, the changes made cannot be significantly justified. In the above mentioned article, the 30*30mm2 fascia was used only for the central part of the upper lip. Certainly, this amount of fascia is not enough to augment the lateral parts and if we add the lower lip to it, we see that there is a severe shortage of fascia.

dermofat lip

Most lip augmentation applicants expect to see changes more than 2.5mm. As can be seen in the pictures, although the amount of change in lip augmentation is positive after six months, it is not too much (the average lip change of 1.15-1.32). Therefore, to meet the expectations of the surgery applicants it is necessary to use a more appropriate and better tissue for lips augmentation.

Direct lip surgery without tissue grafting

In this method, the incision site is at the vermillion border (red lip border) and the lip is incised all around and the lip mucosa is stretched out, this increases the lip mucosa. This stretch and its form vary depending on the form of the lip designed prior to surgery.

The important point in designing the lip form and shape before surgery is that the designed lip should be proportional to and in harmony with the whole facial elements. The suture marks may remain in this surgery. The surgeon uses some techniques to make the suture marks less visible. Therefore, it is recommended that, before deciding to undergo this surgery, you use the experiences of those who have undergone this surgery in your surgeon of choice’s surgical center.

After passing the recovery period and healing the wounds, other sub-methods, such as make-up, tattoo, dermabrasion, laser, or restorative ointments can be used to improve the suture marks. If people are not willing to use these methods following surgery, they are recommended to refrain from undergoing this type of lip cosmetic surgery.

Direct lip surgery through tissue grafting (dermofat graft)  

Lip graft surgery also known as dermofat graft or graft is among the most popular lip surgery methods used for permanent lip augmentation. Sometimes, it is observed that people are dissatisfied with both their lip form and lip volume. If for any reason you are not willing to use gel injection or fat injection for your lip augmentation, you can choose a proper body tissue to augment your lips. This method is called tissue grafting or graft. Graft refers to a tissue removed from one’s body and placed within the lips. Therefore, in addition to making an incision at the vermillion border, another incision is also made where the graft was removed from.

The tissue can be removed from different sites in different people. In people with a history of previous surgery, such as cesarean section or appendicitis, the surgery site can be used for tissue removal. In most cases attempts are made to remove the tissue from sites that are less visible, such as behind the ear, and the groove under the buttocks. The tissue removal site varies depending on your opinion and the discretion of the doctor.

Therefore, like any other surgery, the suture marks will naturally remain in the incision site. The rate of repair and improvement of the suture marks in this site depends greatly on the skin type, as well as the post-operative care performed by the person. As aforementioned, the surgical team’s effort is to ensure that the graft removal site is in the least visible place. By performing this surgery, you can expect lips with an appropriate and augmented shape.

before after dermofat graft

Advantages of dermofat graft method

  1. This method has all the advantages of lip prosthesis (permanent lip augmentation).
  2. It does not have the disadvantages of lip gel injection and lip prosthesis (laughing or speaking is normal) due to its flexibility and complete adaptation to the body.
  3. It has a durable effect and is the most reliable permanent method to increase the volume of the lips.
  4. As the incisions are internal and are not seen, no trace of surgery remains on the skin.
  5. It is an outpatient surgery and is performed under local anesthesia (like dentistry works).
  6. This method can be performed independently without any need for other lip forming methods (it is specially suggested for those who are not satisfied with their lips’ form and only want to increase the volume of their lips).
  7. It can be used in those who experienced side effects associated with gel injection and cannot use any other method.
  8. In people who were not satisfied with gel injection or did not feel good after lip prosthesis placement, this method can be used to increase the volume of lips at the same time with gel discharge or prosthesis removal.
  9. Unlike fascia graft, dermofat graft has no volume limitation and can be used to augment lips to the extent that is required.
  10. The required dermofat graft can be removed from the previously operated areas, thus no new incision is made.
  11. Dermofat graft is very suitable for those who tend to make their lips more prominent after lip augmentation, and it is possible to repeat the surgery.
  12. Dermofat graft causes o limitation for other cosmetic surgeries like face lift.

Lip projection or augmentation is a factor that makes the lips beautiful, especially in the profile view, but it does not mean extreme protrusion of lips because as the proper volume and protrusion of lips have made them beautiful, excessive protrusion of lips reminds duck tip, causing ugliness in lips.

In most cases, gel injection increases lip protrusion by increasing the volume of lips indirectly. Sometimes, it is observed that the lip projection is genetically high in some people, or the excessive injection of gel or fat has caused this protrusion to occur. Direct gel injection at the vermillion border or superficial or front parts of the lips increases the lips projection. Therefore, if you are going to use non-surgical methods to beautify your lips, you must take this point into account and examine the protrusion (projection) of your lips.

People whose lip protrusion is genetically excessive had better use direct lip lift surgery to reduce this protrusion (it is necessary to know that the central lip lift does not change the lip protrusion or it increases the rate of protrusion if it causes any change).

By undergoing lip surgery through tissue grafting, a beautiful form and volume can be simultaneously created in lips.

Sometimes, a combination of different methods can be used for lips beautifying. It may be necessary to first use a method to attenuate the lip projection, and then increase the volume of the lips via another method. For example, in people who undergo direct lip lift, a more augmented lip with proper projection is created using tissue grafting.

Like other surgeries, this method does not correct asymmetries, especially when laughing, but the good news is that the asymmetries are less visible as the lips are more augmented. The asymmetries may be seen less with surgery. These methods can to some extent improve the form of lips in people whose lips have been damaged for any reason or in those who have cleft lip, or parts of their lip tissue have been lost due to the presence of a tumor in the lip. It is good to note that if you have drooping lip corners, neither direct lip lift surgery nor central lip lift will correct these droops, and another type of surgery is required to correct this problem.

Best appropriate method for lip augmentation

Which one is better among lip augmentation methods, fascia graft or dermofat graft?

In order to answer this question, we had better investigate the role of fascia and then assess the removal site of these tissues in terms of different complications. Fascia is actually a sheath or cover surrounding the muscle. Usually the available muscles are used to remove fascia. The most comfortable available fascia is the temporal fascia.

Fascia is removed through the incision made within the hair. This way the surgery site is not seen. Of course, we can also use the fasciae that exist in other parts of the body, but they are not commonly used due to difficulty with getting access to those parts of the body and remaining the trace of surgery. The temporal fascia is a very valuable tissue with various applications; some of these applications are as follows.

What are the uses of the temporal fascia?

This fascia can be used in many nose reconstruction surgeries, and even in eardrum reconstruction surgery (tympanoplasty). However, it plays a more important role in cosmetic surgeries. The presence of this strong layer in the temple area is a support for facial tissues lift.

In common surgeries, such as temple and forehead lift, the surgeon connects the lifted tissues to this fascia using the Endotine device. The desirable results of lift surgery are affected if this fascia is removed for any reason or its strength is lost. Therefore, the temporal fascia is very valuable and has no alternative.

Although the use of temporal fascia for lips augmentation is a completely scientific and effective method, comparison of the results of this method with those of dermofat graft shows that fascia graft has not yielded significantly acceptable results regarding lips augmentation and we will see that there is a better and more effective method for lips augmentation. Therefore, as an experienced surgeon with regard to face lift, I suggest the temporal fascia not be used as a graft in vain. There are better methods and tissues to be used in lip augmentation.

Certainly, each lip augmentation surgery’s applicant experiences the descent of eyebrows and facial tissues with aging and will be most likely a candidate for full face lift in the not too distant future. As aforementioned, lifting these facial areas requires a healthy temporal fascia. Accordingly, removal of temporal fascia can reduce your chances of success in upper face lift surgeries in the following years.

Comparison of lip augmentation through fascia graft and dermofat graft methods:

Fascia graft Dermofat graft
Removal site Temples Different areas of body
Durability Permanent Permanent
Rate of augmentation Low to moderate High
Adverse effects on face lift results Has negative effect Has no negative effect

Important thing to know before undergoing lip surgery

As the last recommendation, those who are willing to undergo lip surgery need to know the following things:

  1. Before undergoing lip surgery, you had better use temporary or non-invasive methods to make changes. You can then undergo lip surgery if you want the results to be permanent.
  2. People who don’t wear make-up for any reason and don’t want to use methods like tattoos had better refrain from doing this surgery because these methods together with surgery will yield the best result.
  3. Like any other surgery, you should be patient to obtain the best result. The real result of the surgery can usually be seen about six month after surgery.
  4. Graft texture and consistency is to a great extent similar to the natural texture of the body. This creates a natural sense in lips. This good sense may not be felt by those who use gel injection.
  5. Experience has shown that lip surgery is a safe operation with very few complications, and in most cases it is possible to implement the patients’ wishes by applying their taste.

What is the objective of lip surgery?

Using lip surgery, the surgeon can change the form and shape of lips and make them wider or thinner. The volume of lips can also be increased using techniques, such as tissue grafting.

How many days does it take to heal from swelling following a lip surgery?

Lips usually swell for 3 days after surgery. Swelling of the lips recovers within 7 -10 days post operation.

Where is the incision site in lip surgery?

With the aim to change the form and shape of the lip, the lip is incised all around.

Do the suture marks remain in lip surgery?

The suture marks usually fade away over time. Depending on the skin type, the suture marks may remain as a faded white line that can be removed using methods, such as dermabrasion.

Is it possible to inject gel or fat after lip surgery?

Yes, it is. Six months after surgery, gel or fat injection can be done.

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