As a plastic surgeon in Toronto, you might say I’m something of a gatekeeper for the latest beauty trends, as my patient base shifts to embrace what’s new and exciting.
The biggest trend for lips over the last 10 to 15 years has been “bigger, bigger and bigger.” And, sometimes, too big. When a patient wants fuller lips, there are a couple of prevailing approaches.
Dermal Fillers or Fat Grafting
There is no doubt that we have now great fillers, with high-quality options such as Restylane® and the JUVÉDERM® family. We even have the newest and longer-lasting JUVÉDERM products with VYCROSS® technology, such as VOLBELLA®, VOLIFT®, and VOLUMA®, with results that can last as long as 18 months.
Fat grafting is also becoming increasingly popular, since we know more about stem cells now. Fillers and fat transfer are also great to correct the marionette lines when a patient wants to look and feel rejuvenated without undergoing a facelift procedure.
BOTOX® or Dysport®, in a small dose, is often added to help softening the fine wrinkles around the mouth, to weaken the overactive chin muscles (peau d’orange or pitting skin) and to correct the downturn corners of the lower lip.
When I perform lip fillers, I aim for a natural-looking result. Upper lips are normally slightly smaller than the lower lips — except in the Latin, African, and Polynesian populations, where both the upper and lower lips can be equal. No culture has a larger upper lip than the lower lip.
And yes, men do get lip rejuvenation as well, and it will look sexy, plump and masculine if the injector and artist respects the masculine features of a man’s lip.
Lip Rejuvenation or Lip Augmentation?
I always discuss two concepts with my patients: one is to replenish the lost volume that we see with aging, i.e. a true rejuvenation procedure. The other concept is true augmentation of the lip, something bigger than the patient ever had before.
A good analogy to my philosophy about lips — rejuvenation versus augmentation — is what I do with breast augmentation: Some patients want only to replace the lost volume post-pregnancy, whereas others want larger than they ever had.
Now over time, we not only lose volume in the lips, but we also get thinning and elongation of the white lip (i.e., the area between the red lip and the nose, or the area where a moustache grows in men). This elongation of the white lip leads to a subsequent loss of teeth showing with smiling. We all know that some showing of teeth is considered attractive when smiling. Over time, there is also infolding of the upper lip corners, with loss of red lip and an apparent narrowing of the mouth, again, aging the face.
This is when a lip lift is indicated, a variation for Toronto patients who see facial plastic surgery as an option.
Lip Lift Techniques
1. The most common one is the bullhorn lip lift. This technique will lift the central two-thirds of the upper lip using a “bullhorn” type of skin excision under the nose/nostrils (where the nose meets the white lip), which will turn up the red lip and show more of the red mucosa, creating an augmentation-like result and more teeth showing when smiling.
2. The second most common technique is the corner lip lift. This technique will lift the corners of the upper lip, and the scar is barely visible along the upper right and left lip line. It is great to provide a youthful widening of the mouth by showing more red mucosa in the corners.
3. Another technique is the gullwing lip lift, which is an excision of white skin over the white upper lip at the “lip liner” area. This positions the scar in a normal anatomical line. It is a combination of corner lip lift and central skin excision.
4. The Italian lip lift is a modest lift of the two para-central areas of the upper lip, with excision of a small ellipse of skin under each nostril. Its overall effect is limited, but the scar is very minimal.
5. A V-Y mucosal advancement technique can also be used to evert the lip up and to make the upper lip appear fuller but will not efficiently reduce the distance between the nose and the upper red lip.
Lastly, suspension of the upper lip muscle is important when trying to achieve more teeth showing with smiling. One can suspend the lip muscle with the bullhorn technique via its incision under the nose and nostrils, using sutures to anchor it to the nasal septal cartilage.
In summary, there are many great and newer options for the aging lips, and it is important to consider them all when trying to achieve a true rejuvenation.
Dr. Marc DuPéré
