Background: The size and shape of the lips has taken on great aesthetic significance over the past two decades. Many makeup, injectable and surgical methods have been devised and are available to enhance one’s lips. The usual goals are to make the lips look bigger with increased vermilion show and projection as well as a more defined upper lip cupid’s bow shape.
Cosmetic tattooing of the lips (also known as micropigmentation) is a well established technique to enhance their color and shape. Colored metallic pigments are implanted into the dermis of the skin or mucosa with an extremely fine needle or cluster of needles. Because it is not surgery or temporary fillers, it is extremely popular as it eliminates the daily use of pencils to outline, fill-in, or reshape lip borders. The permanent color that it provides also decreases the need to reapply lipstick or lip gloss.
One technique of lip tattooing is that of a blended lip liner. This is done by placing a liner on the lip border which is then shaded inward so it appears as if the person’s lipstick has faded. Some women find this lip tattooing method more appealing than a plain line lip liner which can appear unnatural and very distinct.
Despite its many benefits, lip micropigmentation places pigments that are permanent. Should one later want to remove the lip liner, this can prove difficult to do. The use of a q-switched laser can be used to remove unwanted lip liner. It requires multiple treatments and is not always completely successful.
Case Study: This 24 year-old female had permanent lip liner placed that she ultimately decided she did not like. She did not prefer its color nor the way in which it was placed. (plain line) She wanted the lip liner surgically removed but also wanted her lips bigger at the same time.
Presurgical markings were made for lip advancements that would incorporate the inner border of the lip lines as well as an outer rim of skin for removal. Given that the lip advancements included some vermilion for the lip liner removal, the amount of skin marked to be removed was less than normal.
Under local anesthesia the undesired vermilion lip liner and marked skin were removed. The remaining vermilion was advanced to the outer edge of the excised skin on the upper and lower lips and closed with 6-0 plain sutures.
Lip advancements are a well known surgical method of lip enhancement. It is a powerful technique because it relocates the vermilion-cutaneous border which makes the lips look bigger and more shapely. It does so with the trade-off of a fine line scar at the vermilion-cutaneous border. But in the properly selected patient that aesthetic trade-off may be worthwhile. Removal of permanent lip liner can be one of those patient groups where it has the advantage of an immediate and assured removal of lip pigment as well as that of larger lips.
Highlights:
1) Lip liner is permanent and can not always be completely removed except by surgical excision.
2) A lip advancement can be done to both simultaneously excise the undesired lip liner and increase the size of the lips.
3) The amount of skin that can be removed for a lip advancement when lip liner is being excised will be less than normally done.
Dr. Barry Eppley
Indianapolis, Indiana