Surgical lip reshaping involve relocation of the vermilion border through either direct or indirect methods. The most recognized method is the well known subnasal lip lift (bullhorn lift) where the the amount of upper lip vermilion show is increased by removal of a strip of skin under the nose. This skin removal pulls the lip vermilion upward as the amount of skin between the base of the nose and upper lip is reduced.
Direct methods of increasing lip size and/or shape is the vermilion advancement. Excision of skin and replacing it by movement of the vermilion to close the defect will increase lip size (gull wing upper lift) or change its shape. The most common reason vermilion advancements are done is to make very thin lips fuller, fix lip asymmetries and improve lateral upper lip fullness when combined with subnasal lip lifts.
But another very effective use of vermilion advancements is for cupid bow enhancements. This is a more limited use of the vermilion advancement technique for the patient who has a flat cupid bow’s shape or desires more prominent peaks to an indistinct bow shape. The desired shape of the new cupid’s bow is marked in the skin above the bow in the amount of increased show or in the desired new shape.
The skin is then excised between the markings which may include a small amount of orbicularis muscle. The vermilion is three advanced to cover the defect, creating a more visible and/or prominent cupid’s bow.
While there is the tradeoff of a very thin scar line this is usually not overly visible. When fillers, fat injections or the subnasal lip lift has failed to procedure the directed effect at the Cupid’s bow area of the upper lip the direct vermilion advancement can out the finishing improvements to it.
Dr. Barry Eppley
World-Renowned Plastic Surgeon