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 cosmetic physician’s offices.

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.

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:

Aesthetic lips:

• An appropriate upper to lower lip size ratio
• A distinct cupid’s 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: 

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.