Background: The mouth is an important aesthetic facial feature of a woman. The main feature of a pleasing mouth area is adequate lip size. Lips that are full and plump are associated with youth and increased sexuality. Some women are born with naturally full lips that last their entire lifetime. Others are born with moderately sized lips that decrease slightly with age. And then there are those women that have always had thin lips than become even more atrophic with age.
The size of the lips is essentially a function of how much vertical vermilion or pink tissue exposure there is. Due to the constant action of the mouth and its muscles, the lips and the surrounding skin are exposed to repetitive motions. This can cause the lips to lose volume from collagen loss. This results in lip deflation and a rolling inward of the vermilion. This creates a smaller or thinner lip, often with the development of vertical wrinkle lines.
When this aging process affects naturally thin lips, the amount of visible vermilion can be quite small with little visible upper lip shape. As the face ages around the mouth and falls forward to it, the corners of the mouth can be pushed downward. This creates a sad or frowning appearance which, when combined with thinning lips, creates an old-looking or aged mouth appearance.
Case Study: This 62 year-old female presented with an unhappiness about the appearance of her lips. She had always had thin lips but they were getting even more so as she got older. When combined with the downturning of the corners of the mouth and the vertical lip wrinkles, she really began to dislike her mouth appearance. She tried Juvederm injectable fillers but did not want the recurring expense and the discomfort of the needle injections.
She opted for a surgical solution that would be permanent for her thin lips, lip advancements. As an office procedure, the design of the lip advancements was marked out like lip liner using a mirror for her approval. The amount of lip advancement was 4mms at the cupid’s bow of the upper lip and along the lower lip. The lower lip tapered down towards the corners of the mouth. The upper lip design did not taper at the commissures so a corner lifting effect could be created. Under local anesthesia, the skin within the marks was removed and the vermilion of the lips advanced outward. A more visible shape of the cupid’s bow of the upper lip was created by the design.
Her fine lip sutures were removed one week later. She had no restrictions afterwards in regards to eating and oral hygiene. While she did have some slight swelling, there was no bruising. She wore lipstick the next day after having her sutures removed. The change in lip size and shape was immediately apparent and will not change over time. The trade-off for lip advancements is the permanent fine line scar around the lip margins. It is important to not have the advancements go around the mouth corners so that there is not a completely circumferential mouth scar. The other aesthetic trade-off is that lip advancements will cause a flattening in the natural upturning of the white roll. (junction of the skin and the vermilion)
Case Highlights:
1) Lip advancements can provide a dramatic change in the shape of the aging thin lips. If designed properly, it can also provide a lifting effect of the downturned corners of the mouth.
2) The effects of a lip advancement are based on the concept of creating more visible vermilion tissue.
3) Lip advancements have two minor adverse aesthetic effects, a fine line scar and loss of the pout of the white roll.
Dr. Barry Eppley
Indianapolis, Indiana