Non-Injectable (Surgical) Lip Enhancements
By far, the most popular form of lip enhancement or rejuvenation is by injecting any of the commercially-available forms of hyaluronic acid gels (e.g., Restylane or JuvaDerm) By injecting into the body of the lip or along the white roll, good results can be consistently obtained in the vast majority of patients. However, there are some patients with very thin lips in which injecion treatments do not produce a good result. And by good result, I am referring to a natural lip that is both bigger and aesthetically pleasing. When the amount of vermilion (pink) show is small, injections may make the lip bigger primarily by making it stick out. This is not very aesthetically pleasing and usually makes the patient standout as ‘someone who has had their lips injected’. A look that not a one of my patients would ever want.
In these atypical cases, it is usually an older woman who has lost much of her upper lip with age (because she had a small one to begin with) or, rarely, a younger patient who simply has very little upper lip and a poorly-defined (flat) cupid’s bow. The surgical procedures of vermilion advancement or subnsasal lip lift are better for these thin lip patients. With the vermilion advancement, a strip of skin along the white roll is removed and the vermilion ‘advanced’ upward and sutured into place. This is a powerful procedure that can make an upper lip fuller….forever. But at the price of a fine line scar along the border of the vermilion and the upper lip skin. The cupid’s bow can be highlighted and better defined with this procedure as well.
For those patients who cannot accept an upper lip scar and, only want the cupid’s bow area enhanced, then the subnasal lip lift is an option. Skin is cutout along the base of the nose and the entire middle-third of the upper lip is lifted as it is sewn into place. It is important to remember that the subnasal lip lift will do nothing for the sides of the upper lip which lie beyond the nostrils which is the tail of the cutout. This results in a more lip scar in a better location but the effect is not as great as the vermilion advancement procedure.
In either case, It is extremely important to use these procedures as a ‘last measure’ for a thin lip problem. I always have the patient go through a trial of lip injections first, even if I think it will not work well. They may very well make the patient happy….and that is the ultimate goal. If not, then they have qualified themselves to be willing to make the trade-off of a lip scar for a significant change in their lip appearance.
Lastly, remember the vermilion advancement procedure can be used on the lower lip as well. When both lips are done together, the effect can be quite dramatic.
Dr Barry Eppley
Indianapolis, Indiana