Lip augmentation, making the lip bigger, is most commonly and successfully done with injectable fillers. Regardless of the injectable filler used, its instantaneous result is very satisfying in most cases. The use of injectable fillers in the lip, however, is predicated on one important concept…that there is enough vermilion (pink part of the lip ) to expand. For that is what fillers so, expand the soft tissue of the lip.
There are some people, however, that do not have or show a lot of lip vermilion. Trying to expand these thin vermilions with filling agents can create a ‘duck lip’ appearance, which creates more horizontal projection rather than a vertical increase in exposed vermilion which creates a bigger lip.
For these types of thin lips, the only way to really increase the size of the lips is to physically move the vermilion. These two surgical options for lip lifting are the vermilion advancement (lip advancement ) and the subnasal lip lift. (bullhorn or gullwing lift) Both are simple operations but they differ in location on the lip where they are performed and in what they can achieve. They are very similar in that both result in scars.
The vermilion advancement is the removal of a strip of skin to allow the vermilion to move up (in the upper lip) or move down. (in the lower lip) This simple but powerful procedure directly results in more vermilion exposure by the amount of skin removed. In the upper lip, the shape and accent of the cupid’s bow can be designed as part of the cut out. While this does leave a fine line scar at the junction of the vermilion and skin, this procedure affects the entire length of the lip from corner to corner. And its result is permanent.
The subnasal lip lift removes skin under the base of the nose in a gull wing or bullhorn fashion. This places the scar in a well hidden area. But it only creates more of a central upper lip pout as the skin excision is limited to the width of the base of the nose. Therefore, thin lips that taper down to the corner of the mouth will be unchanged. Plus, there will be some loss of the central pout over time as the upper lip relaxes somewhat. For this reason, the subnasal lip lift needs to be overcorrected to some degree.
Surgical lip enhancement is a most effective procedure that offers a permanent solution to small lips. Because of their scars, I do not perform them as the initial procedure for most thin lipped patients. One should undergo an initial injectable filler to ‘prove’ that this temporary procedure will not achieve the patient’s goals. This makes the decision to accept lip scars more acceptable.
In my Indianapolis plastic surgery practice both procedures can be done under local anesthesia, if desired, in an office setting. Other than some temporary swelling, there is very little discomfort and no restrictions after in regards to eating or the wearing of lipstick.
Dr. Barry Eppley
Indianapolis, Indiana