People usually desire correction of their lips because of changes related to aging or inborn abnormalities and imperfections. The most common natural deviation from the aesthetic ideal is that the lips are too thin. This may make a person look severe or prudish, and woman with such lips may want their lips to express more femininity and sensuality.
Aging changes the lip in several ways. The distance between the nose and mouth increases, the upper lip lengthens and descends. The red part of the lip (vermilion) rotates inwards and becomes narrower. A further effect of aging is that the border between the red of the lips and surrounding skin becomes less apparent. The philtrum (a central depression leading from the nose to the upper lip) flattens and the corners of the mouth droop due to gravity and volume loss. As we age the collagen fibers wither and skin loses elasticity, therefore, the lips become less resilient and wrinkles develop. The vertical rhytides, called bar code, around the lips are especially prominent due to the constant mobility of the underlying muscle.
There are many things we can do to remedy deviations in the appearance of the lips. Lip augmentation can be done temporarily with injection of fillers or permanently with patient’s own tissue (fat injections, dermal graft) or silicone implants
Age related problems such as fine wrinkles in the skin around the lips can be addressed with chemical or laser peeling, dermabrasion or injections. With simple surgical procedures elongated lips can be reduced, corners of the mouth lifted and vermilion advanced.
To achieve balanced and youthful appearance, the region around the mouth should be addressed in facial rejuvenation. It is frequently combined with a face lift or neck lift. There are a large number of different techniques with specific advantages and drawbacks. Our surgeons have ample experience to choose and perform a procedure that will give the best result in accordance with your needs and desires.
Most patients prefer temporary lip augmentation with an injectable filler as this procedure is the least invasive and the results are easily reversible. Everybody considering permanent lip augmentation should preliminary try augmentation with filler to get an idea about the outcome. Many substances have been used to temporarily enlarge the lips. Currently the best and increasingly popular soft tissue filler is a gel made of hyaluronic acid. The advantages of the hyaluronic acid are that they occur naturally in the skin and lack foreign protein, thus the risks are minimal. The filler can be injected under the white roll (the hair free line which outlines the vermilion) to make it more pronounced and better define the outline of the lips. The bulk of the lip can be increased by injections into the muscle. Lip augmentation with injectable natural filler lasts for an average of 9 months and needs to be topped up accordingly.
We recommend cautious use of artificial injectable substances for permanent soft tissue augmentation. An artificial material is easy to inject, but may be extremely difficult to remove and in that case scarring is inevitable. There might be some long term adverse reactions to permanent fillers, such as granulomas with chronic inflammation.
Autogenous fat transfer (lipofilling) is a method for correction of thin or disproportionate lips using the patient’s own fat harvested from other parts of the body. The collected fat is purified, filtered and then injected with very fine needles. Even in the best of hands and using the cutting edge technique some fat will be reabsorbed and repeated injections may be necessary to achieve the desired result. The result three months out of surgery is usually permanent. There is a low complication rate with fat transfer. Some disadvantages may include swelling in the first two weeks and an unevenness and lumpiness during the healing phase which usually disappears. As some of the transferred fat will reabsorb regardless, slight initial overcorrection is usually accepted.
Specifically designed implants for lip enhancement have been developed recently. They are made of soft silicone giving the feel of the natural lip. The right size to match the lip perfectly must be chosen. Lip implants are inserted thorough tiny incision at the corner of the mouth and can be removed if necessary. Moderate swelling is expected for two weeks after the procedure. Bleeding and infection are rare complications.
Dermal or fascial graft
Dermis (second skin layer) can be used as a graft for lip augmentation. The tissue is usually harvested as a byproduct of some other procedure. The epidermis or outer skin is removed, the dermal graft shaped and threaded through the lip. The advantage is that there are no allergies to patient’s own tissue. The graft may not take fully and there will be some thinning with age. Sometimes the graft can form a firm band that can be felt in the lip. Rare complications are infections and bleeding. An alternative graft to dermis is fascia (the covering layer of the muscle).
Lip enhancement by injections, implants or graft is limited by the amount of vermilion which can be very thin in older people.
Surgical advancement of the vermilion
When very little of the red section of the lip is visible the mucosa of the inner side of the lip can be advanced outwards to fill the lip and enlarge the vermilion. To bring more of the lip tissue to the outside of the mouth, usually two or more v-shaped incisions are made and sewn into a y shape (v-y plasty). The scars are inside the mouth and hence not visible. The procedure is often combined with fat transfer. The disadvantage of this technique is that it can sometimes lead to reduced lip sensitivity.
An elongated upper lip (increased mouth to nose distance) can be reduced surgically with the procedure named lip lift. An incision is made just below the nose, sometimes curved up into the nostrils. This procedure also rotates the lip into more youthful position. The extent of lip height reduction depends on the amount of tissue being removed. The procedure can be carried out under local anesthetic. The stitches are removed after 7 days. The wing shaped incision that follows the outline of the nose usually leaves a fine scar which is almost unnoticeable.
The corners of the mouth that have been drawn down by age can be lifted with an excision of a triangle of skin just above corners of the mouth. This results in a small (approximately 1,5 cm long) white scar at the corner of the mouth. To achieve a good final result the height of corners has to be overcorrected initially since tissues tend to stretch a bit during healing. The procedure can be carried out under local anesthetic. The stitches are removed on day 7.