Rejuvenation of the upper lip is a commonly requested and performed procedure. There are numerous strategies for treating an aged upper lip and one of the basic approaches is to add volume. Usually through injectable fillers, volume is added to create a more protruding and pouty lip. This is based on the fundamental belief that volume loss is a significant part of lip aging.
 The plastic surgery literature is replete with literature that describes aging changes of the upper lip and subsequent treatments for it. A consistent theme is that the upper lip gets longer, the visible vermilion becomes less, and the lip gets thinner. To verify that such changes do occur as espoused, an anatomic studies on the aging lip in the August 2009 issue of Plastic and Reconstructive Surgery was published.
Using cadaver specimens, the upper lips of younger (< 40) and older (> 80) females were histologically evaluated. By comparing the two groups, a histomorphometric analysis was done. Their results revealed that the skin significantly thins with loss of elastic and collagen fibers. The underlying orbicularus muscle also undergoes atrophy as well. But the overall lip volume does not change due to an increase in subcutaneous tissue. The lip does indeed thin but that is due to a volume redistribution, changing from width to length. Thus, the longer lip appearance.
These histologic changes are not earth-shattering but they do provide support for many of the lip treatments that we currently do. The use of laser resurfacing helps smooth out upper lip wrinkles but it does not make it thicker, which is one reason why upper lip wrinkles return over time. While the lip may not lose overall volume, it does become thinner in cross-sectional width. Thus adding volume, regardless of the method, is useful for returning thickness.
What is interesting about this anatomic study is that it shows that the upper lip does lengthen. This indicates that surgical methods that shorten the upper lip, such as vermilion advancements, are effective at treating one important problem of upper lip aging. If it were not for the fine line scar that results, lip advancements would be much more commonly done as they do have a powerful rejuvenating effect. Shortening the long upper lip and exposing more vermilion addresses two of the three upper lip aging problems.
Because there are three fundamental age-related changes in the upper lip, no one treatment approach is completely satisfying. Combinations of lip treatments are always needed for good results. This can include various combinations of volume addition, skin resurfacing, and lip shortening techniques. (vermilion advancements or subnasal lip lifts) Which combination of two of them is decided based on how inherently thin one’s lip was to start with. In my Indianapolis plastic surgery practice, I most commonly perform volume addition and skin resurfacing for the younger patients with early signs of lip aging and lip advancements and skin resurfacing for the more advanced aged lip. All of these can be performed under local anesthesia in the office. Complete recovery is one week or less.
Dr. Barry Eppley
Indianapolis, Indiana