Background: There are many options for lip enhancement today of which injectable fillers is by far the most commonly used. But for a permanent change in size, surgical options must be considered. Two basic types of lip lifts exists done either from under the nose (subnasal lip lift)or from the edge of the top of the upper lip. (lip advancement) Each of these has their own advantage sand disadvantages but the very thin (pencil thin) upper lip can only be effectively treated by a lip or vermilion advancement.
The lip advancement procedure works because it physically moves the upper border of the pink portion (vermilion) of the lip upward. (in the case of the upper lip) By so doing, the vertical length of the lip is increased permanently which creates a bigger visible lip appearance. The lip advancement also has the advantage of being able to change and enhance the shape of the cupid’s bow of the upper lip, which frequently is flat in the lip with little vertical vermilion exposure.
While women are most commonly seen as having lip enhancement procedures, men occasionally do as well. Men usually consider lip augmentation for a very thin upper lip not necessarily to make an already decent sized upper lip just a little bigger. Men also do not usually want to have repeated procedures but would prefer a one time permanent result.
Case Study: This 40 year-old male wanted to have a permanent upper lip augmentation. He wanted have an upper lip that matched the size of his lower lip with better accentuation of the cupid’s bow. Interestingly, he had a full goatee that covered much of his upper lip perhaps as a camouflage for his perception of his upper lip size concerns.
His upper lip hairs were trimmed back to expose the amount of upper lip advancement to be done. With a calipers, a 4mm skin excision was marked (1/4 of the total philtral length)mwith a cupid’s bow highlight and lack of a taper near the corners of the mouth. Under vestibular local anesthetic blocks with direct upper lip infiltration, the skin was excised and the upper lip advanced along the line of the marks. The incision was closed with 6-0 plain sutures with a few deep 6-0 monocryl sutures. Antibiotic ointment was applied as the dressing.
The final lip advancement result with mature scars was seen four months later. While he still had a goatee, the upper lip scar was virtually undetectable and the increase in the size of the upper lip was doubled.
While there is always a concern about the scar from any lip advancement surgery, that concern is magnified in men. (because they do not ever use lipstick) But my experience in men has shown that the lip advancement scar heals well and is not more of a concern than when done in women.
Case Highlights:
1) Thin upper lip concerns in men, while not as common as in women, can be treated with the same types of lip enhancement techniques.
2) An upper lip or vermilion advancement offers a permanent solution to an improved lip size and shape.
3) Upper lip advancement scars heal well in men ( and perhap better than even in women) presumably due to the hair follicles in the skin.
Dr. Barry Eppley
Indianapolis, Indiana