Male Vermilion Lip Advancemen Case Example

Vermilion lip advancement is a surgical technique designed to increase the visible height of the pink portion of the lip (vermilion). It is most commonly performed on the upper lip but can also be done on the lower lip.

This is a direct excisional procedure performed at the vermilion–cutaneous junction (the white roll).

Indications

• Thin upper lip with a long cutaneous lip
• Age-related vermilion thinning (involution)
• Poor response to or dissatisfaction with fillers
• Desire for permanent lip enhancement
• Vermilion height asymmetry
• Secondary revision after cleft lip repair (selected cases)

Surgical Concept

The procedure increases vermilion show by removing a strip of skin immediately above the white roll. The vermilion edge is then advanced outward to the outer margin of the skin excision, thereby increasing its vertical height.

This technique:

• Increases vertical vermilion height
• Improves lip show at rest
• Enhances Cupid’s bow definition
• Can slightly shorten the apparent cutaneous lip

Case Example

This male patient was bothered by the shape of his lips. While the upper lip had a reasonably defined Cupid’s bow, the lateral portions became progressively thin toward the corners. There was also vermilion asymmetry, with the left side demonstrating less vertical height than the right.

Although the lower lip was proportionally better than the upper lip, the patient desired modest enlargement of both lips.

Marking

• Excisional design along the vermilion–cutaneous junction
• Typically 3–4 mm advancement on the upper lip
• Typically 2–3 mm advancement on the lower lip
• Markings carefully designed for symmetry
• Preservation of Cupid’s bow shape is essential

Excision and Closure

• Elliptical skin excision
• Full-thickness skin removal while avoiding violation of the orbicularis oris muscle
• Deep dermal sutures to reduce tension
• Fine skin closure to recreate the white roll
• Precise alignment is critical for optimal aesthetic outcome

Result

The procedure produced significantly improved lip shape and symmetry, with barely visible scarring along the vermilion border.

Discussion

Vermilion advancement lip augmentation can be performed in several variations:

• Upper lip only (most common)
• Lower lip advancement
• Commissure (corner) extension
• Central-only advancement for selective Cupid’s bow enhancement
• Combined with a subnasal lip lift

Advantages

• Permanent result
• Predictable increase in vermilion height
• No foreign material
• Ideal for patients who metabolize fillers quickly

Disadvantages

• Visible scar at the vermilion–cutaneous border
• Not ideal for patients prone to hypertrophic scarring
• Over-advancement can appear unnatural
• Does not significantly increase lip projection (unlike fillers)

Comparison to Other Procedures

Ideal Candidates

• Patients with a thin upper lip and good skin quality
• Individuals seeking a permanent solution
• Patients comfortable with a fine-line scar at the white roll

Dr. Barry Eppley
Plastic Surgeon