Great Lips

lip enhancements are a simple and common procedure at cosmetic physician's offices. Lip enhancement procedures are regularly performed by David Ross Smart, MD at The University of Utah's Department of Dermatology

Great lips are great.

Having full, plump lips is often considered a sign of good health and youth. And symmetric, well-shaped, proportionate lips are generally regarded as an alluring, cross-cultural sign of beauty.  For these reasons injectable lip enhancements are common and popular procedures in the cosmetic physician’s office.

As we age, the lips can slowly lose their fullness and shape.  The distance between the bottom of the nose and the upper lip sags and slightly lengthens, giving the upper lip a longer and thinner appearance.  And adding or restoring volume and shape to the lips is an easy non-invasive way to quickly enhance overall beauty in many patients.

Lip enhancement is simple, quick, and carries immediate reward with relatively low risk.  A good lip enhancement is generally subtle, accentuating the natural shape of the lip, correcting any asymmetry, and sometimes simply adding volume.

When done well, the effect is impressive and patients are very pleased. However, they have not always been done well.   Poorly filled or over-filled lips are readily noticeable, and the picture of someone with those shapeless, overfilled, sausage lips has, over the last couple of decades, become the pop culture poster child of bad cosmetic surgery.  But the majority of good lip enhancements go almost unnoticed because they are natural and subtle.

A good candidate for lip enhancement:

A good candidate is someone who wants to accentuate the shape, improve proportion, or correct some of the volume loss that has happened over time, then they might be a good candidate.

As always with elective cosmetic interventions, motivation and expectations about outcomes are important considerations when deciding if someone is a good candidate.  Is the patient considering lip augmentation to make someone else happy or to try to fit an ideal image? If so, the patient should think twice about it.  Enhanced lips may make your lips plumper and fuller, but you will still be you when you walk out of the doctor’s office.

lips before and after a visit to the cosmetic dermatologist

Before and after photos of a standard cosmetic dermatology procedure by Dr. Smart
before and after 1cc of Juvederm

Lip augmentation is a simple procedure that can be done easily at a cosmetic dermatologist office

before and after images of a lip augmentation performed by David Ross Smart, MD at The University of Utah Department of Dermatology

It is important to remember that not everyone needs their lips filled.  I certainly don’t advocate that.

What to expect during the procedure:

Before the injections, a topical or local numbing agent may be applied to ease discomfort. Sometimes injections can be given before the treatment to completely numb the lips.  After carefully marking the areas to be injected, very fine needles are used to inject the substance into your lips.  Following injection, ice may be given to ease discomfort and control swelling.  Lipstick or other lip products are best avoided immediately after the procedure.  You should be able to notice a difference immediately.

A little more in depth:

Attaining the perfect lip proportions is possible with just a few visits at a cosmetic physician's office

Aesthetic lips:

  • An appropriate upper to lower lip size ratio
  • A distinct cupids bow
  • Fullness and a concave sloping of the upper lip in profile
  • A defined and thick vermilion border
  • A prominence or presence of philtral columns
  • Upturned oral commissures

Aging lips:

  • Flattening of philtral columns
  • Lengthening of the cutaneous upper lip
  • Thinning of the lip and volume loss
  • Convex sloping in profile
  • Downturned oral commissures
  • Loss of the natural vermiliocutaneous pout

The proportions: 

Perfect Lip proportion?
Note that while 1/3 is written, the upper lip is clearly not 1/2 of the size of the lower.

Achieving the perfect lip proportions is possible with simple cosmetic dermatology procedures offered by Dr. Smart at The University of Utah Department of Dermatology

Different sources will state slightly different things. The most commonly quoted is the golden ratio, 1.0:1.6, as demonstrated in the above diagram. However, it has been my experience that these ratios convey perception and  not reality.  Great lips do not quite fit any of these ratios. In fact, even the diagrams used to illustrate the proposed ratios are noticeably erroneous.   Regardless, the point is that the upper lip is proportionally small than the lower.  If you are only injecting the upper lip then you are setting yourself up to fail.  The tubercles of the lower lip must be addressed and evaluated to maintain the appropriate proportion.

What to focus on when evaluating and correcting:

1. Philtral columns
2. Cupids bow
3. Lateral edges of the cupids bow and the white roll of the upper lip
4. Tubercles of the lower lip
5. upturn of the corners of the mouth

Lip enhancement is not a one-size-fits-all procedure, and an aesthetic eye is applied to evaluate the needs of each situation.

Perfect lips for women models

Fraxel Dual, a laser for the brown spots

solar lentigo

Freckles, dark spots, age spots, liver spots, or sun spots. Whatever you want to call them, these brown patches, medically termed lentigo, are typically found on the face and hands and can make us look older than we feel.  Here are some pictures of what I mean:

lentigo blue eye

lentigosolarLentigo_handsolarLentigo_man cheek

There are many ways to get rid of or lighten these pesky brown spots.  While many lasers, chemical peels, and a variety of creams are used to treat these lesions, and treat them effectively, I’ve been very impressed with results from the fraxel dual laser.

The Fraxel is a very popular cosmetic treatment, and it is also used  is used to treat scarring, fine lines and wrinkles as well as lightening the brown spots and smoothening blotchy pigmentation that comes with sun damage.

The Fraxel is considered a facial resurfacing laser that works by creating a checkerboard pattern of thermal or heat energy in the skin. This energy being delivered with laser precision causes specifically placed heat injury to the skin which results in a type of peeling or exfoliation. This in turn causes skin tightening and new collagen formation.  Here are some pictures of results from the fraxel laser when used specifically to treat “lentigo”.

Fraxel lenitgo
After 2 treatments
Before, 2 days after, and 1 week after 1 treatment
Screen Shot 2014-09-23 at 11.09.02 AM
After 2 treatments

The Fraxel is not as aggressive as some other facial resurfacing methods which makes this a comparatively very safe option with little to no downtime depending on each individuals response and how comfortable you are going into work with a little redness and maybe some peeling.  Some mild swelling for a couple of days is not unusual either. And sometimes a few treaments are needed to get the desired effect, especially when using the Fraxel to treat scars and wrinkles.


A little more detail:

The Fraxel laser was initially launched as a 1550nm erbium fractionated non-ablative laser. A later model called the Fraxel dual was produced and has the classic 1550mn setting as well as a 1927nm thulium laser setting.

Terms to know from the previous paragraph:

Ablative vs. non-ablative

Ablative lasers are more aggressive as they vaporize the tissue, Non-ablative lasers cause damage to the desired target cells through heat energy, but do not vaporize the tissue.

Fractionate vs. non-fractionated:

Fractionated lasers deliver energy in a checkerboard pattern, which can be beneficial in certain treatments as it leaves zones of untreated skin that make the subsequent healing process more rapid.

.fractionated pattern

The 1550nm setting has been used for years as an effective resurfacing laser for wrinkles and to tighten the skin. The 1927nm setting was added to better target the brown discoloration.

When used to treat wrinkles the results achieved from one treatment of the Fraxel are not nearly as impressive as from one treatment of an ablative laser. The upside however, is that the Fraxel has much less social downtime, and fewer side effects. A series of Fraxel treatments (typically 3 to 6 treatments) at 2- to 4-week intervals is recommended for the best clinical outcome when trying to treat skin laxity and wrinkles. Fewer treatments are necessary when you’re goal is to treat brown spots. Repeated Fraxel treatments can achieve a similar result for acne scars when compared to traditional ablative laser skin resurfacing.   However, the improvement seen after a series of Fraxel treatments for very deep wrinkles around the mouth and eyes often falls short of the impressive results that can be achieved with ablative laser skin resurfacing.