Loop Electrosurgical Excision Procedure (LEEP)

What is a loop electrosurgical excision procedure (LEEP)?

Loop electrosurgical excision procedure (LEEP) uses a wire loop heated by
electric current to remove cells and tissue in a woman’s lower genital
tract. It is used as part of the diagnosis and treatment for abnormal or
cancerous conditions.

The lower genital tract includes the cervix and vagina. The cervix is the
lower, narrow part of the uterus and the vagina connects the cervix and the
vulva.

With LEEP, an electric current passes through the fine wire loop to cut
away a thin layer of abnormal tissue. This tissue will be sent to the lab
for testing. LEEP can also remove abnormal cells to allow healthy tissue to
grow.

Why might I need a LEEP?

LEEP may be done when cervical or vaginal problems are found during a
pelvic exam, or abnormal cells are found during a Pap test. LEEP is also
done to detect cancer of the cervix or vagina.

Cells that appear to be abnormal, but are not yet cancerous, may be called
precancerous. These abnormal cells may be the first evidence of cancer that
could develop years later.

LEEP may also be used to assist in the diagnosis or treatment of the
following conditions:

• Polyps (benign growths)
• Genital warts, which may indicate infection with human papilloma virus
  (HPV), a risk factor for developing cervical cancer
• Diethylstilbestrol (DES) exposure in women whose mothers took DES
  during pregnancy, as DES exposure increases the risk for cancer of the
  reproductive system

Your healthcare provider may have other reasons to recommend LEEP.

What are the risks for a LEEP?

Some possible complications may include:

• Infection
• Bleeding
• Changes or scarring in the cervix from removal of tissue
• Trouble getting pregnant
• Potential for preterm birth or having a low birth weight baby

If you are allergic to or sensitive to medications, iodine, or latex, tell
your healthcare provider.

If you are pregnant or think you could be, tell your healthcare provider.

There may be other risks depending on your condition. Be sure to discuss
any concerns with your healthcare provider before the procedure.

Certain factors or conditions may interfere with LEEP. These factors
include:

• Menstruation
• Acute pelvic inflammatory disease
• Acute inflammation of the cervix

How do I get ready for LEEP?

• Your healthcare provider will explain the procedure and you can ask
  questions.
• You will be asked to sign a consent form that gives your permission to
  do the procedure. Read the form carefully and ask questions if
  something is not clear.
• Generally, no preparation, such as fasting or sedation, is needed.
• If you are pregnant or think you may be, tell your healthcare provider.
• Tell your healthcare provider if you are sensitive to or are allergic
  to any medicines, latex, tape, iodine, and anesthesia.
• Tell your healthcare provider of all medicines (prescribed and
  over-the-counter) and herbal supplements that you are taking.
• Tell your healthcare provider if you have a history of bleeding
  disorders or if you are taking any blood-thinning medicines
  (anticoagulants), aspirin, or other medicines that affect blood
  clotting. You may be told to stop these medicines before the procedure.
• Your healthcare provider will tell you not to use tampons, vaginal
  creams or medicine, douching, or having sex before the procedure.
• LEEP is usually done when you are not having your menstrual period.
• Your healthcare provider may recommend that you take a pain reliever 30
  minutes before the procedure.
• You may want to bring a sanitary napkin to wear home after the
  procedure.
• Follow any other instructions your provider gives you to get ready.

What happens during a LEEP?

LEEP may be done in a healthcare provider’s office, on an outpatient basis,
or as part of your stay in a hospital. Procedures may vary depending on
your condition and your healthcare provider’s practices.

Generally, LEEP follows this process:

1. You will be asked to undress completely or from the waist down and put
   on a hospital gown.
2. You will be instructed to empty your bladder before the procedure.
3. You will lie on an exam table, with your feet and legs supported as for
   a pelvic exam.
4. Your healthcare provider will insert an instrument called a speculum
   into your vagina to spread the walls of the vagina apart to expose the
   cervix.
5. Often, the healthcare provider will use a colposcope, an instrument
   with a special lens similar to a microscope, to magnify the tissues.
   The colposcope will be placed at the opening of your vagina but does
   not enter your vagina.
6. Your healthcare provider will look through the colposcope to locate any
   areas for treatment on the cervix or in the vagina. Photographs with
   the colposcope or sketches of the areas on your cervix may be made for
   your healthcare record.
7. Your cervix may be cleaned and soaked with a vinegar solution, also
   called acetic acid solution. This helps make the abnormal tissues turn
   white and become more visible. You may feel a mild burning sensation.
   An iodine solution is sometimes used to coat the cervix, called the
   Schiller test.
8. The healthcare provider will numb the area using a small needle to
   inject medicine.
9. A type of forceps, called a tenaculum, may be used to hold the cervix
   steady for the procedure. You may feel some cramping when the tenaculum
   is applied.
10. You will hear humming and/or blowing sounds from the equipment.
11. The LEEP wire will be inserted through the speculum and passed through
    the abnormal tissues. One or more passes may be needed. You may feel
    pressure or a slight cramping.
12. Some women feel faint during the procedure. Tell your healthcare
    provider or the nurse if you have this feeling.
13. It is very important that you lie still during the procedure.
14. The amount and location of tissue removed depends on the whether LEEP
    is being used as a diagnostic tool, or to remove abnormal tissue. LEEP
    wires come in different sizes and shapes.
15. The electrical current will seal the blood vessels, so usually there is
    very little bleeding. Any bleeding from the LEEP site may be treated
    with a paste-like topical medicine.
16. The tissue will be sent to a lab for further testing.

What happens after a LEEP?

After LEEP, you may rest for a few minutes after the procedure before going
home.

You may want to wear a sanitary pad for bleeding. It is normal to have some
mild cramping, spotting, and dark or black-colored discharge for several
days. The dark discharge is from the medicine applied to your cervix to
control bleeding.

You may be instructed not to douche, use tampons, or have sex for 4 weeks
after LEEP, or for a period of time recommended by your healthcare
provider.

You may also have other limits on your activity, including no strenuous
activity or heavy lifting.

Take a pain reliever for cramping or soreness as directed by your
healthcare provider. Aspirin or certain other pain medicines may increase
the chance of bleeding. Be sure to take only recommended medicines.

Your healthcare provider will tell you when to return for further treatment
or care. Generally, women who have had LEEP will need more frequent Pap
tests.

Tell your healthcare provider if you have any of the following:

• Bleeding with clots
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe abdominal pain

Your healthcare provider may give you other instructions after the
procedure, depending on your particular situation.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person’s qualifications
  are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or
  problems
• How much will you have to pay for the test or procedure

What Is It, Side Effects and Recovery

This page was reviewed under our medical and editorial policy by

Ruchi Garg, MD, Chair, Gynecologic Oncology, City of Hope Atlanta, Chicago and Phoenix.

This page was reviewed on January 12, 2022.

A loop electrosurgical excision procedure, or LEEP, helps with the diagnosis and treatment of abnormal cells or cancer found in the cervix.

What is a LEEP (loop electrosurgical excision procedure)?

LEEP is a procedure in which the care team uses a thin wire loop that’s heated by an electric current to remove abnormal tissue. The wire loop comes in different sizes and acts as a surgical knife, cutting away at the abnormal tissue. The tissue is then sent to a laboratory for further analysis.

Why do I need a LEEP?

There are a few reasons the doctor may recommend a LEEP:

• To diagnose precancerous changes in the cervix and cervical cancer (precancer refers to abnormal cells that could become cancer)
• To figure out the cause of an abnormal Pap test result
• To treat precancerous conditions and early-stage cancer in the cervix

How to prepare for a LEEP

There are a few things women can do ahead of a LEEP appointment:

• Make sure to schedule the LEEP when menstruation isn’t likely to happen.
• The patient should tell the cancer care team about all of her current medications, as well as any herbal supplements. Patients who use blood-thinning medicines, aspirin or other drugs that affect blood clotting may be asked to stop them temporarily before the procedure.
• Patients should let the care team know if they are or might be pregnant.
• Don’t use douches, tampons or vaginal creams before the procedure. The care team will indicate how far in advance to stop these.
• Don’t have vaginal sex before the procedure.
• Ask whether it’s a good idea to take pain-relieving medication beforehand. Follow any instructions on which type of medication to use.
• Consider taking a sanitary napkin to wear home when the LEEP is done. Women may experience some bleeding or discharge.

What to expect from a LEEP (loop electrosurgical excision procedure)

The LEEP is usually performed in the doctor’s office, though at times, some providers may choose or prefer to perform it in the operating room. The procedure lasts a few minutes.

Before the procedure, the patient will remove all clothes from the waist down and empty her bladder. She will then lie down with her legs in stirrups, similar to what occurs during a pelvic examination. The doctor places a speculum in the vagina to open the vaginal canal.

• The doctor typically administers local anesthesia intravenously. This type of anesthesia is used to numb just the cervical area.
• Many doctors use a colposcope, which is an instrument with a special lens, to better visualize the tissues. This device is placed at the vaginal opening, but it doesn’t go inside the patient’s vagina. The doctor may take photos using the colposcope for the patient’s health records.
• The doctor may place a special vinegar solution on the cervix to make any abnormal tissues easier to see. Then, the loop is inserted through the vagina and to the cervix. The loop can remove abnormal tissue and take a tissue sample for analysis.
• Once finished, the patient may have a paste-like medicine, called Monsel’s paste, applied to her cervix to help control bleeding.

During the LEEP, the patient may feel some dull cramping. It’s also possible that she may feel as if she’s going to faint. If this happens, alert the doctor.

LEEP procedure recovery

Most women can resume their normal activities after one to three days. However, the doctor may advise the patient to not have sex, take baths, douche or use tampons for about two to four weeks after the LEEP. The patient may also need to avoid strenuous activities and heavy lifting for a period of time.

Most women find that the timing of their menstrual period isn’t interrupted following the LEEP procedure.

Side effects of LEEP

The benefit of the LEEP is that it can help remove precancer or early-stage cancers from the patient’s cervix or vagina.

There are some LEEP-related side effects, including:

• Cramping similar to that during menstruation
• Dark brown discharge in the first week. This is from the solution that may be used on the cervix
• Small amounts of blood from the vagina in the following three weeks

The LEEP also may cause more serious side effects, though these aren’t as common. They include:

• Fever, intensifying pain and discharge from the vagina that has a bad smell (these may indicate a possible infection)
• Heavy bleeding
• Pain that doesn’t subside with medicine

Let the doctor know right away if any of these more serious side effects occur.

Long-term side effects of LEEP

A small number of women may have trouble getting pregnant after undergoing the LEEP. Rarely, though, it is also possible to experience changes to menses, like having more painful periods.

In addition, women who underwent a LEEP procedure in the past may deliver a baby earlier if they get pregnant. This is particularly true of women who have a large amount of tissue removed or who undergo more than one LEEP procedure, since these factors can weaken the cervix.

Reviewing the results of a LEEP

The doctor sends any tissue samples to a pathologist, who can study them under a microscope. The pathologist writes a report stating whether the tissue samples are normal or indicate precancer or cancer. Discuss any questions with the care team.

Depending on the results, the patient may need to have additional tests or treatments to make sure all abnormal tissue was removed or doesn’t recur. The doctor may ask the patient to return for more frequent Pap tests after having a LEEP.

What is the LEEP procedure? Efficacy, recovery and complications

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Checked on 03/09/2020

• What is it?
  • What is LEP?
• LEEP procedure
  • How is LEEP done?
• Effectiveness
  • How effective is LEP?
• Complications
  • What are the complications of LEEP?

What is LEP?

This LEEP procedure is most commonly used to treat moderate dysplasia (abnormal changes in the cells lining the cervix or precancerous growths) found on colposcopy and/or cervical biopsy.

Loop Electrosurgical Excision Procedure (LEEP) uses low voltage electrical current to remove abnormal cervical tissue. Thus, it has an advantage over destructive methods (CO2 laser and cryocautherization) in that an intact tissue sample can be obtained for analysis. LEEP is also popular because it is inexpensive, simple, and usually has few risks or side effects. LEEP is also known as large loop excision of the transformation zone (LLETZ).

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This procedure is most commonly used to treat moderate dysplasia (abnormal changes in the cells lining the cervix or precancerous growths) that have been identified by colposcopy and/or cervical biopsy. In certain situations, severe dysplasia and non-invasive cancer that are localized and can be removed can also be treated with LEEP.

How is LEEP done?

The patient lies on the examination table with the feet elevated in the stirrups (the position used to obtain a Pap smear). A speculum (used for a Pap smear) is inserted to open the walls of the vagina. Sometimes a special solution, either vinegar (acetic acid) or iodine, is applied to the cervix before the procedure, making the abnormal tissue more visible).

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The area is anesthetized with a local anesthetic (cervical block). Oral or intravenous medications may also be prescribed to relieve pain. A low voltage electrical current is applied through a thin wire that is passed through the tissues to remove abnormal areas of the cervix. After that, a chemical agent is applied to prevent bleeding.

Mild pain and cramping, which can be relieved by oral medication, may occur during the first few hours after the procedure. Vaginal discharge and spotting usually occur after this procedure for a few weeks. For better healing, sexual intercourse and the use of tampons should be avoided for several weeks. Douching should also be avoided.

How effective is LEP?

LEEP has been shown to be comparable to cryotherapy, cold knife conization (surgical removal of the abnormal area), laser ablation (destruction of abnormal tissue), and laser conization to remove abnormal or precancerous cervical tissue. Studies have shown that most of these methods lead to a cure (removal of all diseased tissue).

No further treatment is usually required if the entire pathological area has been removed, although the precancerous lesions may recur (recur) at a later time. After LEEP, regular follow-up Pap smears are needed to evaluate for possible recurrence of cellular abnormalities.

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What are the complications of LEEP?

Approximately a small percentage of women who have LEEP experience complications, including narrowing (stenosis) of the opening of the cervix, bleeding more than expected, or infection of the cervix or uterus.

References Physical examination: Wayne Blocker, MD; Board Certified OB/GYN

REFERENCE:

Wright, Jason D., MD Patient Information: Managing Cervical Biopsy with Precancerous Cells (Beyond the Basics). update.com. Updated January 18, 2016

what you need to know about the procedure

Bruising after procedure

Bruising is a common side effect after lip augmentation. As a rule, they occur at the injection site of the filler. Such a reaction is also considered normal, since the skin on the lips is particularly sensitive and delicate.

At the moment of penetration of the needle into soft tissues, damage to blood vessels and capillaries occurs. Because of this, the space between the cells is filled with blood, resulting in a change in shade in the damaged area.

Bruising can be affected by the use of an anesthetic during the procedure, as well as recent intake of fish oil, vitamin E, and pain medications.

You should be alert if the bruise after the procedure does not go away within 5-7 days. In this case, it is better to seek the advice of a cosmetologist.

If during lip augmentation a large vessel is affected and an infection is introduced, then the bruise will only increase. Such a reaction can be dangerous, so you should never postpone a visit to the doctor.

Asymmetry after shape enlargement

In some patients, after the passage of lip edema, an asymmetry of the shape is detected. It occurs due to the uneven distribution of the filler in the tissues. There are a lot of reasons for this – most often the problem is associated with a violation of restrictions after the procedure.

For example, asymmetry can be the result of drinking alcohol, which promotes vasodilation and causes tissue swelling, self-massage of the lips, or tissue injury. Also, do not forget about the individual reaction to drugs.

What to do in this case? You will need an examination by a cosmetologist. Almost always, the asymmetry of the lips can be easily corrected: it is enough to “prick” the filler into problem areas to make the shape beautiful and symmetrical.

How to do massage during rehabilitation?

Before lip augmentation, massage is not worth doing, but after it is even necessary. However, there are a number of rules and restrictions regarding this procedure.

Massage can be started on the fourth day after the injections (provided that the swelling has subsided). Ideally, a cosmetologist should carry out the manipulation, as he knows how to properly distribute the filler under the skin and avoid the appearance of asymmetry.

It should be understood that not all patients will need this, and it is best if a doctor performs such a procedure.

It is better to massage lips in the presence of the following factors:

• Use of anesthetics during injections.
• The formation of tubercles and balls.
• The introduction of a large volume of filler.

Massage of the lips after the increase is correctly done with light movements with the fingertips. Circular movements are best suited to help dissolve bruising and swelling. After the procedure, it is worth applying a moisturizer or gel to the lips, you can also use peach seed oil. It moisturizes the skin well and prevents puffiness.

What should I do if my lips hurt after augmentation?

Pain after injections is completely normal. As a rule, unpleasant symptoms persist for 2-4 days, much depends on the individual characteristics and pain threshold of the patient.

You can apply cold compresses to relieve soreness. It is also acceptable to use painkillers and creams.

Should alert if:

• The pain is sharp, bursting.
• After taking an anesthetic, unpleasant symptoms persist.
• After 4-5 days after the procedure, the pain did not disappear.
• There are general inflammations.

In these cases, it is better to seek the help of a cosmetologist. The specialist will help to understand the cause of your symptoms and, if necessary, prescribe the right treatment.

Can I drink alcohol before and after the session?

Alcohol before lip augmentation is one of the main contraindications. In addition to the fact that it negatively affects the body, it can provoke swelling. There is another reason to give up alcohol before the procedure: when interacting with hyaluronic acid from fillers, its detrimental effect on the body increases significantly. The following occurs:

• Hyaluronic acid begins to break down, turning into an intercellular fluid and being absorbed into the tissues.
• Drinking alcohol increases blood pressure. This contributes to the expansion of blood vessels, which will provoke swelling and bruising after injections.
• Alcohol provokes dryness and dehydration of the skin, so crusts form at the injection sites. They can crack, which can lead to infection.
• Preparations based on hyaluronic acid are safe for the body, but this does not exclude the occurrence of allergies or side effects after their administration. And alcohol is an extra burden on the body, which can aggravate the situation.

It is better not to drink alcohol 2 days before the procedure, including the restriction applies to low-alcohol drinks. Take this recommendation seriously so as not to harm your own health.

Many are interested in why you can’t drink alcohol after lip augmentation, because the procedure has already been completed, what can happen? Alcohol retains fluid in the tissues, and this provokes unnecessary swelling. Complete tissue healing after injections will take approximately 5-7 days, and drinking alcohol during this period will increase the risk of side effects, injections and swelling. So, if you do not want to face unpleasant consequences, then exclude the intake of any alcoholic beverages.

How to smear lips after contouring?

If you want to speed up rehabilitation after the procedure, then you can use special healing ointments and creams. Most often, doctors recommend products like Bepanten, Traumeel or Solcoseryl. If there are hematomas on the lips, then Troxevasin and similar agents can be applied.

It is best if you follow the doctor’s recommendations and use the ointments that you have been advised. It is not worth choosing your own drugs.

When can you use lipstick?

Many patients are interested in when it is possible to paint lips after an increase. As a rule, it is recommended to wait 1-2 days. However, if you have severe swelling or soreness, as well as bruises and visible injection marks, then we advise you to wait with makeup. In this case, it is worth applying healing ointments and special creams. And you can use lipstick in about 5-7 days, when the side effects disappear.

Why can’t you drink coffee before lip augmentation?

The fact is that coffee increases blood pressure, and also increases blood circulation in the tissues. As a result, severe bleeding may occur during injections.

To avoid such troubles, we advise you to follow all the recommendations before the procedure and not to drink coffee, alcohol, energy drinks and various hot drinks.

Can you drink energy drinks?

We have already dealt with the issue of power engineers before the procedure. But is it possible to drink an energy drink after lip augmentation? The answer is also negative.

It is better to wait with any drinks, foods and drugs that can affect blood circulation and pressure. This can be dangerous, as it will provoke severe swelling of already damaged tissues.

The minimum period required to limit energy drinks, hot drinks and food after the procedure is 4-8 hours.

Are painkillers allowed?

After lip augmentation (lip augmentation), you can drink painkillers, moreover, such drugs will help eliminate discomfort and discomfort. However, it is worth remembering that not all means are suitable. For example, you should not drink Ibuprofen or Aspirin, which affect blood clotting and can provoke the appearance of new bruises. If you are taking a course of these medications, then we advise you to postpone contouring or take a break from taking medications.

Can I smoke after lip augmentation?

You should also stop smoking after the procedure. And the point here is not at all that tobacco can come into contact with the skin of the lips, but that nicotine constricts blood vessels and thereby affects the blood circulation process.

Because of this, the lymph flow can slow down, which will cause severe swelling and even soreness. Tissue regeneration will slow down, and the injected fillers will be processed faster by the cells of the body. As a result, the effect after the procedure will last much less. It is best not to smoke for 1-2 days after the procedure.

Is it possible to play sports after shape correction?

Serious physical activity after the introduction of fillers is prohibited. This applies to strength and cardio training, swimming in the pool, dancing and any other loads. It is especially important to observe this rule in the first 2-3 days. And it’s better to limit sports for 5-7 days.

Why is it so important. The fact is that strength training after lip augmentation will accelerate blood circulation, which can provoke the migration of fillers and other unpleasant side effects.

It is best to ask your beautician when you can start training. The doctor will take into account your individual characteristics and help you choose the best time to return to your previous lifestyle.

How to stretch your lips?

You need to knead with your fingertips, in gentle circular motions. It is better to avoid strong pressure, especially if tissue soreness is present.

You can also perform a light massage with a toothbrush. To do this, just turn the brush over and apply to your lips. Gently knead the tissue in a circular motion, without applying much force. It is better to massage from the center to the corner and in the opposite direction.

Also, along with a massage, you can perform light gymnastics. For example, pronounce vowels, strongly stretching the lips.

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Feelings after lip augmentation

In the first days after the introduction of the filler, the lips may ache a little, and many patients also experience tightness and numbness of the skin. The next day, maximum swelling appears, which persists for 3–7 days. During this period, there may be discomfort while eating or communicating.

Important! After the session, carefully follow all the recommendations of the doctor, this will shorten the rehabilitation period and achieve an even distribution of fillers in the tissues.

Signs that the lips are completely healed are:

• The tissues become soft, the fillers are evenly distributed.
• Puffiness completely disappears.
• Lumps and balls disappear.
• Lips become natural to the touch, the drug is absolutely not felt.

As a rule, after a week almost all unpleasant symptoms disappear, and the drug is completely “fit” within a month.

When do lips decrease after correction?

Edema can last up to 7 days, depending on the individual reaction of the body. As a rule, already on the 2-3rd day, a decrease in puffiness and the almost complete disappearance of side effects are noticeable.

The final result of contouring can be assessed after 7-14 days. The effect will last on average up to 1 year – the duration of the result depends on the type and amount of gel injected, individual characteristics and the shape of the lips.

Is it possible to kiss after lip augmentation?

It is possible, but not earlier than in 3-4 days. Due to the presence of edema, bruising and slight inflammation during kissing, soreness may occur. In addition, there is a risk of displacement of fillers, tissue infection and long-term rehabilitation. Therefore, we advise you to wait for the restoration of the lip area.

Is it possible to go to the solarium?

It is better to limit visits to the solarium for 10-14 days, since exposure to ultraviolet radiation will not benefit during the healing period.

In addition, UV rays have a negative effect on hyaluronic acid in fillers. Under their influence, it is destroyed faster, which is why the results of the correction are saved for a shorter period than you expected.

Is it possible to sunbathe in the sun?

Visiting the beaches and any sunbathing will also have to be abandoned. It’s all about the effect of ultraviolet rays on the sensitive skin of the lips.

If sun exposure is unavoidable, apply sunscreen. It will help to avoid unpleasant consequences.

Is it possible to prick lips during pregnancy?

Pregnancy is one of the contraindications for contouring, so for the period of bearing a child, you will have to abandon such manipulation.

Fillers do not penetrate into the blood, so they cannot affect the functioning of internal organs. However, during pregnancy, serious hormonal changes occur in the body, which makes it impossible to predict what the reaction to the increase will be. Any cosmetologist will say that you need to wait until the end of pregnancy and the end of lactation.

Is it necessary to make a correction?

Additional correction may be required 2-4 weeks after the introduction of fillers. This is necessary in cases where it was not possible to remove strong asymmetry in 1 session or the resulting lip volume turned out to be insufficient. If the result of the first procedure completely suits you, then correction is not needed.

We hope that now you know almost everything about the procedure for lip augmentation with fillers. Do you have other questions? Ask them to the specialists of our Cosmos clinic.

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