Background: The size and shape of the lips is controlled by many factors. But one of the most important is the pink part of the lip known as the vermilion. The size of the lips is largely controlled by the vermilion height of the vermilion. (lip line out to the skin edge or vermilion-cutaneous junction) How vertically long or short the vermilion is determines how one perceives the size of the lips.
Like size, the symmetry of the lips is similarly controlled by the vermilion. Any differences in the height of the vermilion along the lip line will create an obvious lip asymmetry. When it occurs closer to the corner of the mouth, as it most commonly does, it will make the lip look like it is curled inward. This is exaggerated when one smiles as the vermilion is naturally pulled thinner, sometimes making the asymmetry even more noticeable.
Case Study: This 19 year-old male was bothered by a lower lip asymmetry. His right lower lip near the corner was shorter or less full than the rest of the lip. This asymmetry became more obvious as he smiled as the lip pulled up and outward which naturally stretches the vermilion thinner. He was happy with the fullness of the rest of his lip.
The new lower level of the desired vermilion location was marked out to be even with the vermilion-cutaneous junction of the rest of the lip.
Under local anesthesia, the skin was removed between the pen mark and the natural edge of the vermilion border. The vermilion edge was advanced out and closed to its new skin location with a two layer closure. (dissolveable sutures for the skin) It is usually advised to advance the vermilion out 1mm ore than desired to account for any amount of scar contraction.
Case Highlights:
1) Lip asymmetries caused by differences in vermilion show can be corrected by lip advancement or reduction of the vermilion-cutaneous junction.
2) Subtotal vermilion adjustments can be done under local anesthesia as an office procedure.
3) With animation (smiling) the adjusted lip asymmetry may or may not reappear. Subtotal lip vermilion adjustment are static-based procedures.
Dr. Barry Eppley
Indianapolis, Indiana