The desire for larger lips is commonplace in today’s society. Larger fuller lips (like a strong chin or jaw line in a man) casts an image of desirous femininity. While some ethnic groups have naturally fuller lips, many Caucasian women of northern European and English descent are not so blessed. The upper lip is usually smaller than the lower one which, while not in of itself abnormal, is not the most aesthetically pleasing. Injectable fillers provide an immediate and usually very satisfying result in those so ‘afflicted’, albeit a temporary one.
There is a plastic surgery procedure of the lip that can provide a permanent alternative for lip enhancement. The vermilion advancement procedure is well known and dates back to an era long before any form of injectable fillers ever existed. It is actually more effective than injectable fillers because it directly causes more vermilion lip exposure which is what makes a lip look bigger. However, this procedure has been and should continue to be used very cautiously as it does leave a scar at the junction of the vermilion of the lip where it meets skin. While the scar may be quite fine, it is a scar nonetheless on a visible location. In addition, the white roll of the lip is lost which causes a little bit of flattening of the lip line.
But in the properly selected patient, a lip advancement can be a good procedure despite its drawbacks. In my Indianapolis plastic surgery practice, I have one particular type of lip problem that will consistently yield a very happy patient.
In the very thin upper lip that is so flat, it doesn’t even have much of a defined cupid’s bow, there are no other good alternatives. While injectable fillers should still be done first as a trial, they are not likely to achieve enough of a difference and may even make the lip look unnatural with so little vermilion to expand. In the older thin lip with vertical wrinkles, a lip advancement achieves several desirable goals… make the lip bigger, accentuate the shape of the cupid’s bow, and getting rid of some of the wrinkles by cutting them out.
Lip advancements are also good for lip asymmetries such as in cleft lip revisions and in cases of lower lip facial paralysis. In these lip surgeries, the vermilion advancement is usually done on just one side for balancing and symmetry purposes.
Lip advancements can be done in the office under local anesthesia very comfortably. In local patients, I place very tiny sutures that are moved in a week. For out of town patients, I use small dissolveable sutures which are covered with a tissue glue. Swelling and bruising is largely gone in about a week after surgery.
While some thinner lip patients may be tired of ongoing injectable filler treatments, even though they are successful, I would still hesitate to do a lip advancement. There are other non-scarring lip enhancement options such as fat injections, allogeneic dermal grafts, and even synthetic (Advanta) implants which should be the next step on the treatment algorithm. Lip advancements in these patients should be a last resort when the patient may be more accepting of the fine line lip scars.
Dr. Barry Eppley
Indianapolis, Indiana