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The most common and effective form of lip augmentation over the past two decades is with the use of injectable fillers. Such synthetic fillers work by expanding the existing size of the vermilion tissues of the lip. (visible pink area) While such volumetric expansion is three dimensional given the suspension of the lip tissues in front of the teeth much of the expansion is in the forward and inferior direction where the lip has no tissue restrictions. The height of the lip vermilion can increase but it is more limited by the skin of the upper lip above it.

As a result the success of lip fillers is highly influenced by the amount of natural vermilion show. (vertical vermilion height) The less vermilion show that exists the less effective putting volume into it has. There has to be a certain amount of vermilion show to be effective although there has never been any study to evaluate what that is. Since fillers are easy to do and are reversible there is never any harm in trying them.

The importance of vermilion show in lip size and shape can be easily appreciated when lip vermilion show disproportion exists. This is where part of the lip has adequate vermilion exposure and a part of it does not. This is commonly seen in the upper lip where the central cupid’s bow region has good vermilion height but as it heads out to the mouth corners the vermilion essentially disappears.

While injectable fillers can be done for vermilion show disproportion they frequently ‘fail’ as there is not enough vermilion show to be able to be adequately volumetrically expanded. This is where the vermilion advancement procedure can be extremely effective and offers a permanent solution. By creating a new vermilion-skin edge the intervening skin is removed and the vermilion show is immediately increased and the whole lip has a more harmonious shape.

While vermilion advancements do create a fine scar line at the skin edge this usually heals well in a near imperceptible fashion. This is especially particularly true in men due to the presence of hair-bearing skin.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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