Male vermilion lip advancement is a surgical procedure used to increase visible red lip show (vermilion) by advancing the vermilion border outward. In men, the approach must be more conservative and anatomically respectful than in female patients to avoid feminization.
1. Indications in Male Patients
- Thin flat upper lip with minimal vermilion show
- Aging-related vermilion inversion
- Asymmetry or prior trauma
- Secondary revision after lip lift
- Desire for subtle enhancement without fillers
Most common request in men: restore lost lip show, not create fullness.
2. Key Aesthetic Differences: Male vs Female
When performing vermilion advancement in men:
Preserve Masculine Characteristics
- Flatter Cupid’s bow (less peaked than female)
- Less central tubercle exaggeration
- Straighter upper lip contour
- Slightly longer upper lip length acceptable
- Avoid excessive eversion
Over-advancement is the main cause of a feminized appearance.
Case Study
This middle-aged male desired to enhance his very thin upper and lower lips. He had less than 2mms vermilion show in either with a thick density beard skin around it. Lip markings were 4mms for the upper lip and 2mms for the lower lip.
The marked lip skin was removed, vermilion advanced and close with 6-0 vicryl for the dermis and 6-0 plain for the skin.
When seen four months later he had improved lip shape with minimal scarring
Discussion
Men can undergo very successful lip advancements with a lower risk of adverse scarring than in women. This is due to their beard skin which has more favorable healing characteristics than non-hair bearing skin in women. It is also to their advantage that a lip advancement eliminates the narrow non-hair bearing area between the beard skin and the vermilion of the lips, moving the beard skin right. next to the vermilion (a form of scar camouflage)
But despite the favorable characteristics of men for lip advancements meticulous surgical technique is still needed for good results.
Surgical Technique Overview
Incision Placement
- At or just inside the vermilion–cutaneous border
- Can be either upper or lower lip or both. By far the upper lip is done more frequently than the lower lip.
Tissue Handling
- Skin excised at vermilion-cutaneous junction along predetermined markings
- Vermilion advanced superiorly (upper lip) or inferiorly (lower lip)
- Precise alignment critical along the full length of the lip is needed to avoid border irregularities
Closure
- Fine, meticulous layered closure
- Scar sits at vermilion border
Since preoperative markings are needed it must be determined how much advancement in men?
Typical advancement:
- 1–2 mm (subtle)
- More aggressive is 3 to 4mm upper lip and 2 to 3mm on lower lip in males
More than this risks:
- Over-eversion
- Feminized lip contour
- Visible scarring
Conservative planning is essential.
Advantages Compared to Fillers (in Men)
- Permanent
- No risk of filler migration
- No periodic maintenance
- More controlled vermilion show
Men often prefer this because:
- They dislike the “puffy” filler look
- They want structural correction, not volume
Risks and Considerations
- Visible scar (especially in thick-skinned men)
- Hypertrophic scarring risk
- Sensory changes (temporary)
- Overcorrection difficult to reverse
- Tightness if excessive advancement
While men are theoretically more prone to thicker scar formation…this has not been seen in my experience.
Combination Procedures
In male patients, vermilion advancement is sometimes combined with:
- Subnasal lip lift (if vertical length is excessive)
- Corner lip lift (rare in men)
Ideal Male Candidate
- Thin upper lip with minimal red show
- Realistic goals
- Prefers subtle, structural improvement
- Accepts a permanent scar at the vermilion border
Dr. Barry Eppley
Plastic Surgeon