Background: Lip augmentation is one of the most commonly done injectable fillers treatments for women. It is both very effective and versatile and can create almost any type of lip augmentation change a patient desires. But it does have one drawback…it is not permanent. And while lip injections can be repeated many times the inconvenience, cost and discomfort of doing so can create filler fatigue.
Such filler fatigue can make patients seek a more permanent surgical solution of which there are numerous options. The most well known of the surgical lip enhancements is the subnasal lip lift which is an ‘off lip’ procedure that simultaneously improves the upper lip fulness as well as decreases the nose to skin distance. But the most versatile of the surgical lip enhancements is the vermilion advancement. Done directly at the vermilion-skin junction the visible border of the lip can be changed anywhere along its edge including the corners of the mouth.
While incredibly versatile for any lip augmentation change it is not frequently done by many surgeons because of the understandable fear of adverse scarring. While it is true the lip is a sensitive area for any form of surgical manipulation careful surgical technique with attention to detail can create effective vermilion lip enhancements in an aesthetic pleasing manner.
Case Study: This female desired to improve the pout of her upper and lower lip. She had naturally full lips but had wanted fuller central areas (pout) and had been getting injectable fillers to achieve that effect. While effective she now sought a very specific surgical enhancement of the cupid’s bow area of the upper lip and the central lower lip. A central cupid’s bow advancement of 3mms was marked out as well as a 3mm central lower lip advancement.
She was having other procedures done so these lip enhancements were done at the same time under anesthesia. (normally by themselves they would be done under local anesthesia) The marked skin zones of the upper and lower lips were excised and the vermilions advanced and closed with a fine dissolvable two layer suture closure.
Her immediate post results showed the lip enhancements but with swelling.
When seen one year later the improved upper and lower lip pout was seen permanently maintained.
While the vermilion advancement procedure can be used for total lip augmentations it can also be used for selective lip shape changes. A few millimeters of vermilion advancement can have a very visible effect because of the relocation of the lip border…which is how the lips are seen even more so than just volume enhancement alone.
Case Highlights:
1) When patients tire of injectable fillers to the lips various types of vermillion advancements can be permanent surgical options.
2) Increasing the pout of the upper and lower lips can be done by centrally based vermilion advancements.
3) The long term scar outcomes are very favorable for more limited vermilion advancements even of the upper lip cupid’s bow area.
Dr. Barry Eppley
Indianapolis, Indiana