Lip Augmentation
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Cosmetic lip augmentation consists of the enlargement and reshaping of otherwise normal lips to improve their dimensional relation with the patient’s nose, teeth, and surrounding facial structures. The appearance of the lips is determined by the spatial relation of the lip structures with the teeth in a 3-dimensional space and by their function during animation and speech.
According to a study by Popenko et al, which sought to establish the most attractive lip measurements in white women by using focus groups to evaluate facial images, the dimensions judged to have the greatest attractiveness included a lip surface area making up 9.6% of the lower third of the face and an upper/lower lip ratio of 1:2. [1]
For information on other lip procedures, see Medscape Reference articles Lip Reduction and Lip Reconstruction Procedures.
Lip augmentation has been described at least as far back as the early 20th century. Miller describes a procedure to evert the lip with multiple small incisions, giving it the appearance of increased size. [2]
Women of all ethnic and social backgrounds have applied cosmetics to their lips to define or alter their appearance since the Stone Age. Tribal ceremonies involving the introduction of various materials in the upper and lower lip to alter their shape, usually with the intent to enlarge them, have been practiced in African tribes for centuries.
Cosmetic lip augmentation is defined as the procedure designed to augment and improve the shape a lip that is not affected by trauma or congenital deformity. Typically, the upper lip is treated more frequently and to a greater degree than the lower lip.
Cosmetic deformities of the lips include both congenital and acquired etiologies. Some patients never develop adequate fullness in the lips; others develop atrophy of the soft tissue of the lips as they age.
Cosmetic indications refer to lip size and shape.
An accurate physical examination determines the specific area of deficiency or desired enhancement. Specifically, evaluate the patient’s occlusion, maxillary-mandibular relations, and aging pattern. A general evaluation of the relation between the upper lip and the incisors reveals the appropriate course of action. Dr Bahaman Guyurion summarized the following algorithm approach to physical evaluation prior to lip augmentation:
Optimal incisor show – Conservative augmentation by fat transfer or dermis fat graft
Excessive incisor show – Augmentation by fat transfer or dermis fat graft
Inadequate incisor show, long lip – Lip shortening and lift with incision at nasal base (“buffalo horn”) in young patients with acute columella-labial angle or incision at vermillion border in older patients with perioral rhytids
Inadequate incisor show, normal lip length – Maxillary lengthening with possible lip augmentation
Cosmetic indications include patients who desire a fuller or more shapely upper or lower lip and who are otherwise in good health.
Lip augmentation (see the image below) consists of the reshaping and/or enlargement of the visible portion of the lip, the vermillion. Alteration of the shape of the Cupid’s bow and of the relation between the vermillion and the skin underlying the nasal columella also fall within the category of lip augmentation.
The upper lip extends from the base of the nose superiorly to the nasolabial folds laterally and to the free edge of the vermilion border inferiorly. The lower lip extends from the superior free vermilion edge superiorly, to the commissures laterally, and to the mandible inferiorly. Around the circumferential vermilion-skin border, a fine line of pale skin accentuates the color difference between the vermilion and normal skin. For more information about the relevant anatomy, see Lips and Perioral Region Anatomy.
Also important is to consider the relationship between lip height and incisor show in the anatomic analysis. Evaluate possible maxillary hypoplasia and protrusion and consider the patient’s occlusion status.
Contraindications for cosmetic lip augmentation include facial nerve disorders, recurrent herpes simplex lesions, diabetes, severe hypertension, history of multiple allergies, and/or autoimmune disorders.
Popenko NA, Tripathi PB, Devcic Z, Karimi K, Osann K, Wong BJF. A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness. JAMA Facial Plast Surg. 2017 Jul 1. 19 (4):261-7. [Medline].
CC Miller. Operations about the mouth. Cosmetic Surgery. Philadelphia, PA: FA Davis Company; 1924. 20.
New Image. Lip Plumpers. NewImage.com. Available at http://www.lipaugmentation.com/lip_plumpers.htm#34. Accessed: 6/18/08.
Guida S, Mandel VD, Farnetani F, et al. Permanent implants for lip augmentation: Results from a retrospective study and presentation of tips and tricks. J Plast Reconstr Aesthet Surg. 2017 May. 70 (5):699-704. [Medline].
Godin MS, Majmundar MV, Chrzanowski DS, et al. Use of radiesse in combination with restylane for facial augmentation. Arch Facial Plast Surg. 2006 Mar-Apr. 8(2):92-7. [Medline].
Kanchwala SK, Holloway L, Bucky LP. Reliable soft tissue augmentation: a clinical comparison of injectable soft-tissue fillers for facial-volume augmentation. Ann Plast Surg. 2005 Jul. 55(1):30-5; discussion 35. [Medline].
Sclafani AP. Soft tissue fillers for management of the aging perioral complex. Facial Plast Surg. 2005 Feb. 21(1):74-8. [Medline].
Bagal A, Dahiya R, Tsai V, et al. Clinical experience with polymethylmethacrylate microspheres (Artecoll) for soft-tissue augmentation: a retrospective review. Arch Facial Plast Surg. 2007 Jul-Aug. 9(4):275-80. [Medline].
Ersek RA, Beisang AA 3rd. Bioplastique: a new biphasic polymer for minimally invasive injection implantation. Aesthetic Plast Surg. 1992 Winter. 16(1):59-65. [Medline].
Chopra R, Graivier M, Fabi S, Nestor M, Meuse P, Mashburn J. A Multi-Center, Open-Label, Prospective Study of Cannula Injection of Small-Particle Hyaluronic Acid Plus Lidocaine (SPHAL) for Lip Augmentation. J Drugs Dermatol. 2018 Jan 1. 17 (1):10-16. [Medline].
Dickinson BP, Roy I, Lesavoy MA. Temporalis fascia for lip augmentation. Ann Plast Surg. 2011 Feb. 66(2):114-7. [Medline].
Tansatit T, Apinuntrum P, Phetudom T. A typical pattern of the labial arteries with implication for lip augmentation with injectable fillers. Aesthetic Plast Surg. 2014 Dec. 38 (6):1083-9. [Medline].
Gryskiewicz JM. Alloderm lip augmentation. Plast Reconstr Surg. 2000 Sep. 106(4):953-4. [Medline].
Seymour PE, Leventhal DD, Pribitkin EA. Lip augmentation with porcine small intestinal submucosa. Arch Facial Plast Surg. 2008 Jan-Feb. 10(1):30-3. [Medline].
Trussler AP, Kawamoto HK, Wasson KL, et al. Upper lip augmentation: palmaris longus tendon as an autologous filler. Plast Reconstr Surg. 2008 Mar. 121(3):1024-32. [Medline].
de Benito J, Fernandez-Sanza I. Galea and subgalea graft for lip augmentation revision. Aesthetic Plast Surg. 1996 May-Jun. 20(3):243-8. [Medline].
Tabrizi R, Shafiei E, Danesteh H. Dimensional Changes of the Upper Lip Using Dermis Fat Graft for Lip Augmentation. J Oral Maxillofac Surg. 2015 Oct. 73 (10):2030-7. [Medline].
Niechajev I. Lip enhancement: surgical alternatives and histologic aspects. Plast Reconstr Surg. 2000 Mar. 105(3):1173-83; discussion 1184-7. [Medline].
Mutaf M. V-Y in V-Y procedure: new technique for augmentation and protrusion of the upper lip. Ann Plast Surg. 2006 Jun. 56(6):605-8. [Medline].
Wilkinson TS. Lip enhancement. Practical Procedures in Aesthetic Plastic Surgery: Tips and Traps. 1994. 117-44.
Guerrissi JO. Surgical treatment of the senile upper lip. Plast Reconstr Surg. 2000 Sep. 106(4):938-40. [Medline].
Richardson MA, Rousso DE, Replogle WH. Long-term Analysis of Lip Augmentation With Superficial Musculoaponeurotic System (SMAS) Tissue Transfer Following Biplanar Extended SMAS Rhytidectomy. JAMA Facial Plast Surg. 2017 Jan 1. 19 (1):34-9. [Medline].
Jacinto SS. Ten-year experience using injectable silicone oil for soft tissue augmentation in the Philippines. Dermatol Surg. 2005 Nov. 31(11 Pt 2):1550-4; discussion 1554. [Medline].
Barnett JG, Barnett CR. Silicone augmentation of the lip. Facial Plast Surg Clin North Am. 2007 Nov. 15(4):501-12, vii-viii. [Medline].
Jorge I de la Torre, MD, FACS Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics
Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, American Society for Reconstructive Microsurgery, Association for Academic Surgery, Medical Association of the State of Alabama
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Deepak Narayan, MD, FRCS Associate Professor of Surgery (Plastic), Yale University School of Medicine; Chief of Plastic Surgery, West Haven Veterans Affairs Medical Center
Deepak Narayan, MD, FRCS is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Plastic Surgery Research Council, Royal College of Surgeons of England, Royal College of Surgeons of Edinburgh, Indian Medical Association
Disclosure: Nothing to disclose.
Mario Diana, MD Consulting Staff, Department of Plastic Surgery, Clinica Diana
Disclosure: Nothing to disclose.
Lawrence Ketch, MD, FAAP, FACS Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children’s Hospital of Denver
Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, andPlastic Surgery Research Council
Disclosure: Nothing to disclose.
Lip Augmentation
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