Lip enhancement is one of the most commonly performed non-surgical procedures and is usually done with injectable fillers. Adding volume to the lips can be highly effective and can meet most patient’s lip augmentation objectives. But filler can not achieve very specific types of lip reshaping changes. This is particularly true in the cupid’s bow of the upper lip. Fillers and a subnasal lip lift can make the existing shape of the cupid’s bow fuller or more visible but they can’t change its actual shape.
The cupid’s bow is created by the intersection of the vermilion-skin junction of the main lip body with the raised philtral skin columns of the skin-bearing upper lip. This creates two distinct raised areas of the central upper lip, known as the cupid’s bow, that can have a wide variety of shapes. Some cupid’s bows are barely discernible in very thin lips while they can have a much stronger appearance in larger lips. There is a definite correlation between lip size and the prominence of the cupid’s bow.
Beyond its prominence the cupid’s bow can also have different shapes to its two peaks. Some are rounded, others are more triangular and some people even have asymmetric shapes between the two peaks. When one wants to change the shape of the cupid’s bow only a direct approach to it will be effective. You can not use voluminization or subnasal lifting techniques to change the specific shape of the cupid’s bow.
A direct cupid’s bow lift or cupid’s bowplasty is a limited vermilion advancement. Through skin excision the shape of the two cupid’s bow peaks can be changed. A triangular-shared peak can be changed to a rounder one and vice versa. This is controlled by the shape of the skin excision. Once the skin cut out is done the vermilion of the existing bow is advanced to the upper edge of the skin excision and closed. This will not only change the shape of the peaks but will also make the central upper lip a bit bigger. (more vermilion exposure)
The direct cupid’s bowplasty does create a fine line scar at the vermilion-skin junction. But the movements are not usually excessive (as it is only changing the central upper lip shape) and, as a result, there is not much tension on the closure. This leads to the least visible scarring as possible.
Dr. Barry Eppley
Indianapolis, Indiana