Full, curved lips have always been associated with youth and female attractiveness.
It should come as no surprise then that lip enhancement is one of the most frequently requested procedures in a cosmetic practice.
One of our essential aims should be to achieve natural results with lip augmentation. We are all aware of patients who have had augmentation and look terrible.
Ultimately every face is different and you should have an assessment, followed by guidance from your doctor.
The basic structure of the lip includes the white cutaneous lip, the area below the nose. There is the red mucosal lip, also called the vermillion, and the junction is the vermillion border. Perfect lips should be curved, well-defined and have a well-defined ‘cupid’s bow’. Very importantly, the lower lip should be 1.6 times thicker than the upper lip (about a third thicker than the upper lip). It’s very common for this rule to be ignored, with poor results.
The lower lip should also be longer than the upper lip, so a line from the corners of the mouth along the lower lip should be longer than one taken from the corners along the upper lip. The mouth corners should be at least straight and ideally slightly elevated- remember the emotions we suggest when they are a bit elevated. Essential to perfection is the distance between the nose and upper lip. The desired distance is between 18 and 20 millimetres, while the distance from the lower lip or vermillion border to the chin should be twice as large, about 36 to 40 millimetres.
Projection of the lips is important and is examined in profile. The ‘Steiner S-line’ is a line drawn from the chin to a point half way along the underside of the nose. The lips just barely touch this line and offers a good guide for natural correction.
The upper lip is naturally concave with a slight elevation at the vermillion border of the upper lip. This point is called the ‘Glogau-Klein’ point and looks like a ski-jump. This must be maintained during treatment.
As we age our lips become thin and they lose their curves. The upper lip becomes flat and elongated and actually obscures the teeth, which is very important for the smile. We get radial lip wrinkles called ‘barcode lines’ and the lips become less defined. The lower lip will become shorter than the upper lip, and the lower lip and chin area lose height. The lips go downwards and the mouth descends, exposing the lower teeth.
Your doctor should discuss and aim for facial harmony. Lips should never be considered in isolation and treatment should be considered in the ‘perioral’, ‘nasolabial’, ‘marionette’ and ‘midface’ regions.
Dermal fillers are used to provide definition, volume replacement or addition, and treatment of perioral or ‘barcode lines’.
Botulinum toxin will commonly be recommended due to additive treatment benefits and the fact it helps make the filler last longer.
The commonest products used will be hyaluronic acid (HA) fillers like Belotero, Restylane or Juverderm. They are safe products which can give a natural feel and a lovely effect. They have the added advantage that the products can be partly dissolved if requested and, in very rare circumstances, can be fully dissolved if there is a medical need to do so.
So a good question to ask of your practitioner is “do you keep hyalase in your clinic?”
If the answer to this question is anything other than yes, I would suggest running away!
It is common to treat with 1 syringe, live with the result for a few months and then decide whether to add further volume. Because of the amount of movement going on around the mouth, dermal fillers may not last as long, possibly less than 6 months. With repeated treatments, patents tend to find they need to visit less often. It is worth noting that as we get older the face also gets slightly smaller and we actually need less volume for a natural effect.
Things to be aware of are:-
- Discomfort. Your doctor will discuss this and various techniques to minimise any discomfort caused. Anaesthetic creams are commonly used, nerve blocking injections considered (like going to the dentist), and dermal fillers commonly come mixed with local anaesthetic.
- Bruising. There is always a possibility of some bruising. Your doctor will use their knowledge to minimise this but it can still happen. applying pressure and ice can minimise this and arnica helps too.
- Lumps. Filler often sits quite close to the surface. Your doctor will massage the product after putting it in but due to movements of the mouth, lumps can form again. Your doctor will guide you regarding this and it usually just needs further massage.
There are various other problems that can arise which are rare in properly trained hands.
So find someone you can trust, is available, and provides you with after-care.