By Dr Leow Aik Ming
Beauty ideals and aesthetic standards vary across social perceptions and cultural preferences. In modern culture, plump and well-defined lips tend to be preferred. In general, ideal lips should have fullness and volume, a correct balance between the upper and lower lips and a well-defined vermilion border. Lips should also be harmonious with other facial features of the individual. Enlarged, full lips in a very small face will not be aesthetically pleasing as this would be out of proportion with the rest of face. Sexual dimorphism should also be kept in mind when treating lips, as men have a larger mouth width, philtrum width, total lip height, and lip volume compared to women. Despite general differences in men’s lips and women’s lips, it is possible to transform masculine lips to more feminine lips and vice-versa. There are various treatment modalities available to improve the appearance of the lips:
1. Upper and lower lip reduction surgery
Lip reduction surgery is a procedure for patients who have naturally large and prominent lips. The lip reduction procedure is performed under local anesthesia on out-patients basis or may be performed under general anesthesia if they are undergoing multiple procedures. A horizontal incision is made on the inner side of the lip mucosa. Excess mucosa, fat and muscle from the lips are removed. The wound is closed in layers. Lip reduction procedure can be performed on the upper and lower lips to improve the patient’s appearance and balance. These wounds usually heal well without any visible scars.
2. Upper lip lifting surgery (Upper lip shortening)
The upper lip lifting surgery is for patients who present with excessively elongated upper lip. Normally, the ideal length of the upper lip to the columella of the nose is between 12-15 mm. If the length is significantly longer than the average, patients can take the advantage of the upper lip lifting or lip shortening procedure. There are two types of upper lip lifting surgery:
Subnasal or “Bull-horn” Lift: An incision is made along the lower edge of the nose which is the junction between the nose and the upper lip. The excess amount of skin and a thin strip of lip muscle are removed. The upper lip is lifted by suturing the cut edges together. As a result, the upper lip is pulled upward. It is really important to close the incision in layers to prevent unsightly scars.
Vermillion Advancement: In this technique, an incision is made along the vermillion border of upper lip. The segment of skin is removed from just above the vermilion border. The wound is meticulously closed in layers to minimize scarring. In that manner, the upper lip is effectively pulled upward and shortened.
3. Lip augmentation
Lip augmentation is performed by injecting a natural or synthetic biocompatible material. Proper placement of the material is important to create fuller-looking lip while reducing wrinkles that form around the outer edges of the lip. There are three common techniques used in lip augmentation:
Filler injection such as hyaluronic acid fillers (eg: JUVÉDERM® and Restylane®) or smooth calcium hydroxyapatite (CaHA) microspheres (eg: Radiesse®) are few of the commonly used fillers for lip augmentation. The results of this procedure usually last approximately 9-12 months.
Lip implant such as AlloDerm® consists of acellular human cadaveric dermis. It is placed through two small incisions to create fuller lips. Since all the cells from the donor tissue are removed, there is no rejection associated with the use of AlloDerm®. The results can be permanent.
Fat transfer is performed by carefully harvesting fat from your abdomen or hips. The fat is then delicately processed to isolate fat cells. These fat cells are then injected into the proper plane of the lips to create a fuller appearance. Sometimes overcorrection is necessary as not all of the fat will survive. Occasionally repeated injections are required for a permanent effect.