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The visible lip is composed of a special tissue known as vermilion. It is the pink or red part of the lip. Its vertical height determines the size of the lip that is seen. Vermilion is uniquely different than the surrounding skin being thinner, much more pliable and capable of substantial stretch. This is a valuable property when it comes to opening one’s mouth and allowing food to pass through. Its elasticity is also why injectable fillers work so well to make the lip bigger, they push the flexible vermilion up and outward creating a fuller lip. But there is a limit as to how much the vermilion can stretch and without adequate vermilion height the push of an injectable filler can only make the vermilion come forward rather than up. This is why women with very thin lips that receive injectable fillers can have the ‘duck lip’ look, too much vermilion movement forward and not enough upward. With thin lips more natural vermilion show may be achieved by actually moving its location. This is known as a vermilion or lip advancement procedure that changes the location of the vermilion-cutaneous border by removing skin and advancing the vermilion border outward. This is a powerful procedure that creates a dramatic change in lip size and is permanent.

Dr. Barry Eppley

Indianapolis, Indiana

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