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Of all of the lip augmentation strategies, lip advancements are the most effective for very thin lips but the least commonly performed. Also known as vermilion advancements, as that is what they literally do, they physically move the vermilion outward. As a result they create much more exposed vermilion from one mouth corner to the other. They are truly a total lip augmentation procedure as the vermilion height is changed throughout the whole lip.

While the fine line scar along the vermilion-cutaneous junction is always a concern, in the properly selected patient who has failed other management strategies it offers a chance at dramatic lip shape improvement. Some patients only require an upper lip advancement to match its size to that of the lower lip. Other patients require both upper and lower lip advancements because they have naturally thinner lips and not just lip size disproportion.

When both upper and lower lip advancements are performed, it is important to pay attention to the corners of the mouth. While normally the vermilion advancements is carried to the very end of the lip right into the edge of the mouth corner, this needs to be tempered when both lips are being done at the same time. Connecting the scar lines runs the risk of creating a scar band across the mouth corner, which needs to be flexible for mouth opening. If the scars connect this can be like tightening the waistband on a pair of sweat pants. Leaving just a few millimeters on untouched and mucosa will act like a natural scar break.

Combined upper and lower lip advancements can produce a significant change in the size of the lips, even if just a few millimeters is advanced on each lip. Not connecting the scar lines at the corners of the mouth will prevent excessive and problematic tightening  when the natural scar contracture process occurs in teh first few months after surgery.

Dr. Barry Eppley

Indianapolis, Indiana

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