The key is subtlety, not overkill! A beautiful, sensual pair of lips is a very attractive facial feature and this can be enhanced by using injectable gels like Restylane, Perlane and others, or using fat fills, the former being quick office procedures and the latter requiring a minor operating room at least. Few procedures have received as much bad press as lip enhancement, principally because it is regarded as easy to perform and is very often overdone, making the patient look decidedly odd, rather than anything approaching attractive.
The upper lip comprises a central fullness called the tubercle, and a lateral lip element of either side of it, often with a small junctional groove. There are 2 philtral columns that extent from the cupid’s bow apices up to the nostril sills. The upper lip volume is usually no more than 2/3 of the lower lip volume.
The lower lip has 2 halves, each with slight fullness, and often with a small central groove. The white roll is a light reflex which outlines both upper and lower lip, and is more or less obvious in most people.
The ageing lip and peri-oral region tends to lose volume, hydration and pout and develop fine lines around the mouth area in general. The mouth corners also deflate somewhat, giving a down turned appearance. The upper lip also appears to lengthen over time, obscuring the upper teeth when smiling.
Each patient is assessed individually to see where the lip might be best enhanced – there is no standard way to do this. I generally use only stabilised HA gel (either Restylane, Perlane or others within this range), which are packaged in either a 1/2cc or 1cc syringe and contain a local anaesthetic. I often make use of a blunt “cannula” for injection (rather than a needle), as this limits bruising and is often more comfortable for the patient.
Areas that may be enhanced include the white roll, the philtral columns, the lip corners and the vermillion (red part). To turn the vermillion out to increase pouting, the gel is injected in small amounts on the inside of the lip, not along the free order of the lip, as is often done. I rarely use more than 1cc to enhance both top and bottom lip – in this case, less is really more!! The lips should appear moist and well hydrated, slightly fuller / plump and ideally the proportion between top and bottom lip should be respected, not distorted!
UPPER LIP LIFT / SHORTENING
This is an under-utilised, simple surgery done under local anaesthetic, usually as an outpatient. It can be done in isolation or in concert with other facial rejuvenation procedures, e.g. facelift.
A “bullhorn” of skin is removed at the upper lip-nostril junction and the wound closed with deep tissue and skin sutures, the latter being removed at 5-7 days post op. Isolated lip lifts are done within my office procedure room and take around an hour start to finish. Light oral sedation makes the lip lift more comfortable, and this is coupled with local anaesthetic injections to numb the area.
The procedure takes about 45 minutes, and results in a marked rejuvenation of the long, ageing, upper lip by not only shortening the lip thereby increasing dental “show”, but also results in a degree of improved pout of the vermillion. The scar is placed in the shadow of the nose, and generally heals very well to become barely perceptible after a few months.