Background: The most common method of lip augmentation is injectable fillers. While this lip augmentation method may not be permanent it is effective for many patents if they have an adequate amount of vermilion show to expand. But when a small lip exists with limited vermilion show fillers do not usually create a good aesthetic result as they push the vermilion mainly outward rather than upward creating a ‘duck lip’ effect.
Thus in the very thin lip a more effective approach is to physically move the location of the vermilion-cutaneous junction. This is known as an upper lip advancement (gull wing procedure) as the vermilion border is advanced after a measured amount of skin is removed above it. This differs from the more commonly performed surgical lip procedure of a lip lift (bullhorn procedure) where skin is removed from under the nose and the upper lip is lifted.
The lip advancement is more effective than the lip lift because it enlarges the entire upper lip from one mouths corner to the other. It is a powerful lip changing procedure but does so at the aesthetic tradeoff of a fine line scar at the vermilion-skin border. How well the lip advancement scar appears depends on numerous factors from the technical execution of the procedure to the type of skin on which it was performed. While females by far out number men who undergo a lip advancement procedure they often do better with the resultant lip scar.
Case Study: This male had thin upper and lower lips but the upper was even thinner than the lower. The lower lip had 6mms of vermilion height but the upper lip had only 2mms of vermilion height. It was equally thin from one mouth corner to the other with a flat cupid’s bow shape.
A 4mm upper lip advancement was marked out with a tapering of the markings as they approached the mouth corners.
Under local anesthesia the upper lip advancement was performed by excising the skin between the markings and moving the vermilion border upward. Fine rapidly dissolving sutures were used for closure.
Surgical lip enlargement is often preferred by men as they often have less tolerance for repeated injectable filler treatments. But in very thin lips with little vermilion show a surgical procedure is the only approach that will work. In this male patient with a scant 2mms of vermilion height the lip advancement procedure provides an easy doubling in lip size which is consistent throughout the whole lip.
Scars from lip advancements are always a concern and the question is always how well does the scar appear later. Men have a unique advantage in lip advancements because of their beard skin. The contribution of the hair follicles is a potential increased re-epithelization of the scar which translates to a good scar appearance. The removal of the skin segment puts the vermilion edge right into the areas where the beard hair begins. This location is another reason the lip advancement scars do very well in men.
Case Highlights:
1) For the male with a very thin upper lip only a surgical lip advancement can create increased vermilion show from one mouth corner to the other.
2) With a thin upper lip the goal of most males is to get it to the same amount of vermilion show as that of the lower lip.
3) The scar from an upper lip advancement in men with beard skin heals very well due to the epithelial contributions from the hair follicles.
Dr. Barry Eppley
Indianapolis, Indiana