Lips Obsessed

By: Beth Phillips, RPAC

A couple of years ago I wrote an article in this magazine about lip injections and how popular they had become. I have continued to see a significant rise in numbers of lip augmentation procedures performed in our office. What I find fascinating is the varied ages of patients that come in for their lips. I have performed lip enhancement procedures on patients varying from age 20 to 80, both male and female. Many patients come with friends or family (often mothers and daughters or sisters) to have the procedure performed together. People have differing ideas of what they perceive to be a beautiful lip. I must admit, I often find myself focusing on the lips of actors on television shows or movies in trying to best understand which characteristics seem to be the most appealing. I sometimes feel a little lip obsessed!!

There are many new techniques that allow for more sophisticated and directed sculpting of the lips. Techniques such as the “lip flip” , “keyhole” or “right angle ” are among the many emerging popular trends.

The basic anatomy of the lips does not change. I still believe that the best looking lip enhancements respect the natural lip anatomy and then highlight aspects that an individual finds most appealing.

When evaluating the lip, it is important to understand the anatomy and the areas that can be addressed or enhanced. The five main areas of concern are: 1-Vermillion Border, 2- Cupid’s Bow, 3- Philtral Columns, 4- the Tubercles, and 5- the Lateral Commissures. Volume, shape and structure of the lips should be assessed, as well as the balance of the lips with the total facial proportions. Your clinician should be able to discuss these areas with you to help you to achieve your desired result.

Often by enhancing the vermillion border, better definition of the lips is created. The ideal lip proportions are believed to have the upper lip measuring 1/3 of the total lip volume and the lower lip measuring 2/3 of the volume. Although on side view, the upper lip should extend slightly beyond the lower lip. Fullness noted in the lip tubercles creates a more natural appearing look than a totally uniform volume. Augmentation of the philtral columns along with the Cupid’s bow provides for a more youthful and sensual look to the mouth. And finally, the lateral oral commissures tend to turn downward with with age and loss of connective tissue. A small amount of fullness in this area will cause the edges of the mouth to be upturned and appear more pleasant and happy.

Dermal fillers are most commonly used in lip augmentation. There are several fillers, most of which are hyaluronic acid gels. These fillers are injected into the lips to provide temporary fullness that generally lasts 6-12 months. This gel is reversible if the outcome is undesirable. Dermal fillers are often suggested for first time augmentation. Filler may be injected with small needles or with a blunt cannulas.

Fat grafting is also commonly used. This is a procedure where fat is harvested from a different location in the body and reinjected into the lips. The pros to fat injection include more permanent results with the fat that survives, a more natural feel than dermal fillers, and there is no cost for the product. The cons are that this requires a fat harvest site, the amount of fat that “takes” is unpredictable. The volume can change significantly with weight fluctuations. There is a longer recovery from fat injections, and the cost of the procedure is higher.

Lip implants may consist of synthetic or biologic materials. Synthetic materials such as silicone or gore-tex among others, provide a permanent yet reversible result. These may feel more unnatural than other options and have possible side effects of scar formation or may become infected as any foreign body can. Biologic materials such as collagen or Alloderm can be absorbed to some extent and therefore are not as reliable in their long-term outcome.

Most lip augmentation procedures can be performed in your physician’s office under local anesthesia. Often topical anesthetics are used just prior to injectable fillers. Dental blocks can be performed as well with a few intra-oral injections like one would have with a dental procedure.

There are surgical options for improvement of the lip shape and position on the face. A lip lift or vermillion advancement procedures involve surgical removal of skin either directly above the lip or just below the nose. These are more invasive but provide permanent improvement.

There are risks associated with lip augmentation. The most common side effects include temporary bruising and swelling usually only lasting a few days. Uncommon side effects include injection into a blood vessel that can cause tissue damage or infection. If the procedure is performed properly, there should be minimal risk of long-term damage.

Lastly, the delicate use of neurotoxins (ie Botox) can be used to enhance the shape of the lips. Often it is used to treat a “gummy smile” where too much gum line shows when a person smiles.
It can also be injected carefully to decrease lines surrounding the lips or placed in the DAO muscle to elevate the oral commissures.

Lip enhancement trends seem to be continuing to grow with no evidence of slowing. Results do not have to leave you looking like a duck. If done with experience and care, most patients can achieve natural and pleasing results.

For more information contact CNY Cosmetic &
Reconstructive Surgery at 315-663-0112