The lips, like the eyes and the nose, are central facial features that are also quite visible in facial expressions. Their size and shape determine their degree of attractiveness and contemporary pleasing lips are known to be full and have a well defined cupid’s bow. As the lips age numerous changes can take place including thinning of the vermilion, flattening of the cupid’s bow and vertical wrinkles of the upper lip. Naturally thin lips have no wrinkles but also lack vermilion height and have a flatter cupid’s bow.
Lip lift surgery has been around for decades but never achieved widespread clinical use due to scar concerns. With the introduction and widespread use of injectable fillers, lip lifts have almost been forgotten and seem like an ancient and out-of-date lip enhancing technique. While even though it is a method that will never replace injectable fillers, lip lifting techniques still have a very useful role in the properly selected patient. I would even argue that because of injectable fillers, lip lifts have been revived and are indicated that they ever were before. This is for the simple reason that injectable fillers can not solve all aesthetic lip problems.
Lift lift surgery involves two distinctly different techniques, the subnasal lip lift and the vermilion lip advancement. Both procedures lift the lips but change the upper lip differently and are thus used for different reasons.
The subnasal lip lift involves a wavy form excision of skin under the nose. Because of the shape of the skin excision it is often called the bullhorn lip lift. It’s primary use is to reduce the vertical height of the skin between the nose and the lip and I consider it a ‘white show’ reduction procedure. It will create more of an upper central lip pout and may even result in slightly more upper tooth show. But the sides of the lip beyond the philtral edges will not change. It is best used in those patients interested in a lip lift and want to keep the scar well concealed or even invisible. It is also the only lip lift that most men will find acceptable.
Complications from subnasal lip lifts can occur from too much skin excision (never greater than one-third of the philtral length), cutting into or suturing the orbicularis muscle, or violation of the natural nose-lip base shape with the line of the scar.
The vermilion advancement involves an excision of skin just above the upper lip vermilion. The pattern of the skin excision because of the height of the cupid’s bow creates a pattern that has earned it the name of a gullwing lip lift. It’s primary use is to move the whole horizontal length of the lip upward, increasing the vertical vermilion height, which makes the entire lip look bigger. In the older patient, any wrinkles that are in the excisional pattern are removed. The shape of the cupid’s bow can also be accentuated. The vermilion advancement is the most powerful lip enhancement procedure known because of these predictable and very controllable changes. It is ideal in older women with very thin lips in which injectable fillers perform poorly. It is also useful in younger women who either do not get good results from fillers or want a more permanent solution.
Complications from vermilion advancements can occur from improper skin excisional patterns where the height of the cupid’s bow is too accentuated or exacting detail is not done in its execution, resulting in visible vermilion irregularities.
Dr. Barry Eppley
Indianapolis, Indiana