Lip Enhancement Options: From the Bullhorn to the Mona Lisa

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As many know, my plastic surgery practice is very diversified and unique as my interests are deep and wide; I am always up to challenges and to learn new techniques. I enjoy thinking outside the box. Consequently, among Toronto plastic surgeons, I have become something of a lip enhancement expert.

I have worked on lips for 15 years now, which is unique as a plastic surgeon serving Yorkville and other Toronto-area communities. Like any plastic surgeon interested in continuously evolving his craft, I’ve tried and used all available fillers on the market, including the patient’s own fat with microfat grafting. I’ve also worked with permanent fillers, most being no longer on the Canadian market due to their complications but still available in various less-regulated and less-scrupulous countries; consequently, I have accumulated a vast experience in treating so-called “botched” or complicated permanent lip augmentation; lip revisions are common requests sent to me from other plastic surgeons, dermatologists, ENTs, and cosmetic family doctors.

I am also one of a very small select group of North American plastic surgeons performing lip lift procedures, another boon for Toronto residents. I describe my techniques of various lip lifts in details, notably the Italian, the Bullhorn, the Corner, and the Gullwing lip lift on my website. Those are all techniques of lip lifting, with the primary goals being to shorten the height of the white upper lip (between the red lip and the nose), to create an eversion of the red lip for more lip show, and to increase the teeth showing (with and without smiling).

Lip reduction is also commonly requested in my practice from patients who consider their lips to be too large in proportion to their face. Patients from mixed cultural heritage, patients from the Caribbean, those from the Pacific islands, and the occasional Caucasian patients are often individuals requesting lip reduction surgery.

When discussing lip augmentation, it is crucial to follow the GOLDEN RULE, aka the DIVINE PROPORTIONS.  This is a ration that is found all over nature (leaf, shell, sunflower, Romanesco cauliflower, an egg, etc) and which the great artists such as the Greeks and with their Pantheon, Michelangelo, DaVinci, LeCorbusier, Dali, etc. have emulated in their respective art.  The ratio is called PHI and it is 1,81603398… so let’s use 1,6 for our purposes; the upper lip should 1 for lower lip of 1,6 if one wants to follow the NATURE’s rule of beauty.  This applies to many parts of the face too.

The so-called Cougar Lip refers to deep creases in the outer upper lip corresponding to a structural weakness of the upper outer lip in a woman as she reaches the mid-40s and early 50s (hence “cougar”). The term does have somewhat a pejorative connotation – I apologize for the choice of vocabulary – but this lip weakness is real and fixable with Restylane® and JUVÉDERM VOLBELLA® and VOLIFT® when using the fern technique. The deep outer crease on the left and right of the white upper lip have the effect of narrowing the width of the upper lip, something no woman is willing to have. Filling up those deep creases and providing them with structure will effectively widen the upper lip and the smile, analogous to filling up deep temples and its effect in lengthening the eyebrows. The cougar lip does not refer the the many smaller sunrays-like lines around the lips called “barcode” by the French. The “barcode lip” is secondary to the ongoing activity of the circular muscle around the mouth, used in kissing, pursing, whistling, and smoking, hence their more Toronto name: the smoker’s lines. Those are best addressed with fillers, PRP (platelet-rich plasma) and deep laser resurfacing.

The Mona Lisa lip is a term I have coined over 10 to 12 years ago to describe my way of framing the lips. When I teach doctors and nurses across Canada, I commonly show them the Mona Lisa with a fancy frame and the Mona Lisa without a frame. Any painting with a frame will direct the observer towards the painting and will make the painting be the only object of desire. Hence framing the lip. A tiny amount of filler in the white roll of the vermillion, i.e. where ladies commonly apply their lip liner, will create this normal anatomic frame and will make any beautiful lips stand out even more. But caution: Too much of it can create the infamous “ducky lip,” something not desired by my Toronto ladies. Softly filling up the white rolls (framing) will also help to soften the Bar Code lines… i.e., rejuvenating the Barcode lip.

A heart-shaped lip is a relatively common request amongst the young ladies, and it refers to a central upper lip augmentation (where the Parisian technique can be used, see below) and a single central lower lip augmentation, as opposed to a more standard full-length augmentation of both upper and lower lips, as one can appreciate on Julia Roberts, for example.

Finally, the Parisian lip refers to a specific technique of lip augmentation I learned when I studied in Paris, France, where the injector will create vertical pillars, usually in 3 directions, in the meaty parts of the lip, everything efficiently the peak of the philtrum column (the cupid’s peaks). This was first developed and described when we were using collagen for the lip and I have since been using this wonderful French technique for my patients in Toronto and Richmond Hill.

Cost for any of the above varies depending on the technique and filler being used.

Recovery will also vary, the longest recovery being for the surgical micro fat grafting and perhaps laser resurfacing. Most others are short recovery, if any, and the tenderness of most procedure is very well managed with topical anesthetic cream and the use of cannula. I must say, my use of the cannula technique has converted most lip augmentation procedures into a “no downtime procedure”.

I perform all the injections in my clinics, The No-One-Lip-Fits-All principle is respected and embraced at the Visage Clinics. You will be happy to know that I do not have any cookie-cutter way of doing lips; only a personalized and artistic approach for every individual, males and females, and all custom-made. A sculpture. Seek an artistic injector, someone with both the eye and the hand to create the perfect lip for you – a Bespoke lip.

Dr. Marc DuPéré, aesthetic plastic surgeon

4 Responses to Lip Enhancement Options: From the Bullhorn to the Mona Lisa

  1. jackie lauren says:

    Hello Doctor,
    interesting, i could do this lip enhancement, you think is best but would you send me some cheek enhancement/s i prefer non-invasive surgery for both lips and cheek implants? or fillers.. you have my face on file,I’m Jackie Laurin from Ottawa.

    Kindest regards,
    Jackie

    • Dr. Marc DuPéré says:

      Hi Jackie, thank you for your question. I will email you details about lip and cheek non-surgical enhancements. We have newest longer-lasting fillers you might be very interested in! Kind regards, Dr. D.

  2. Alena says:

    Hello dr Dupere, do you have any experience with reconstructive lower lip surgeries? I had 0.5 cm pyogenic granuloma removed from my lower lip almost 5 month ago and I have small piece of tissue left at the border. I am looking for facial plastic surgeon who can help me to correct it

    • Dr. Marc DuPéré says:

      Hi Alena, VISAGE means face so I have a large expertise in facial surgery. I have also just replied to your email with informations and answers to your other questions. We look forward to meeting you, Kind regards, Dr. DuPéré

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