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The lips serve critical life functions of eating and speaking. They serve an important social purpose and convey emotions and affection. The function and the aesthetic of the lips are closely interrelated and cannot be separated. The lips consist of the red (vermillion) portion, and the skin (cutaneous) portion.
An aesthetic lip region consists of special proportions between the relative heights of the red and skin portion of the upper and lower lips. The upper lip also forms a gentle bow with two peaks. Beautiful lips are covered by smooth and blemish-free skin and are free of wrinkles at rest and at animation. The lips are central to the image of youth, attractiveness and sensuality in women and increasingly in men as well.
Individuals with upper lip aging present with loss of the bow-like shape of the upper lip. The upper lip transforms from a three-dimensional youthful protuberance to an elongated, flattened and two-dimensional structure. There is loss of the vertical height of the upper lip vermillion and an imbalance of the height proportion between the upper and lower lips. The upper lip skin lengthens and this causes inversion of the lip vermillion and further loss of height of the latter. These changes contribute to a loss of the youthful aesthetic appearance.
Elongation and thinning of the upper lip skin is due to age-related reduction of skin production of elastin and collagen fibers. The loss of upper lip fat contributes further to the skin excess resulting in lip inversion. The lip vermillion loses muscle volume and this contributes to the loss of height.
Upper lip thinning is reliably treated with filler injection or structural fat grafting. Both are simple and effective ambulatory treatments that attain a high degree of satisfaction.
Filler injection is often used for restoring soft tissue volume in areas where age-related volume loss has occurred and is a popular ambulatory procedure. The lip requires the use of softer fillers to create beautiful outcomes at rest and at animation.
Filler injection increases lip volume and height and everts (rotate outwards) the upper lip vermillion. This restores the height ratio seen in youthful, beautiful lips.
Individuals with shallow, dynamic wrinkles with minimal skin laxity are suitable for botulinum toxin injection. Botulinum toxin injection does not reverse forehead skin laxity.
We frequently see or hear of people who look unnatural following aesthetic treatments. This is often due to practitioners who attempt to reverse all the signs of aging by using revolumization techniques alone, resulting in over-filled lips, popularly known as a “trout pout”. Filler injection does not reverse upper lip elongation. Choice of the incorrect filler type will also result in irregularities that become more prominent when a person eats or speaks. A beautiful, elegant result is frequently possible and requires a combination of appropriate product choice, precise technical execution and an experienced practitioner.
The lip contains a complex network of blood vessels that should be avoided when delivering filler injection. Injection of the lip is a delicate art that strikes a balance between injecting sufficient filler and in the correct location to produce optimal improvement whilst avoiding causing of unnatural irregularities. The injection technique is individualized to the deformity present in each person and each lip.
The effects of filler injection may be observed almost immediately following the procedure. Most of the filler will be resorbed in 4 – 6 months and repeat treatment is required to maintain the result.
Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 2 hours following filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.
Individuals are advised to avoid vigorous massage or rubbing of the treatment area for 2 hours following filler injection to minimize the potential for bruising. Individuals may resume their usual activities immediately following the procedure.
Structural fat grafting involves harvesting fat from areas of excess, purifying it, then grafting it in volume-deficient areas. A high proportional survival of fat cells may be attained with the use of specialized fat grafting cannulas available at Picasso Plastic Surgery. Structural fat grafting delivers elegant and long-lasting results. Structural fat grafting is a minimally-invasive ambulatory surgical procedure performed under local anesthesia, with optional intravenous sedation if requested.
Individuals with any degree of upper lip thinning and seeking long-term improvement are good candidates. Individuals with other areas of hollowing and volume loss may undergo concurrent structural fat grafting to the face, neck, or hands and achieve simultaneous benefit in multiple sites. Those with severe hollowing will benefit from significant cost saving in the long term as compared with recurrent treatment using large volume filler injection.
Common sites for fat harvest include the inner thighs, hips, flanks and lower abdomen. Small incisions are made near the areas of intended liposuction, and local anesthetic is infused for optimal intra- and post- operative pain relief. The fat is broken up and aspirated under negative pressure. It is purified before being grafted into the upper lip using purpose-made fat grafting cannulas for optimal survival. Grafting is performed through 1-mm incisions that are well-concealed.
Many individuals are able to return to work on the day after the surgery. Depending on the extent of fat harvesting performed, most of the swelling and bruising will resolve by the 7th postoperative day. Stitch removal is usually performed on the 5th postoperative day.
Individuals are advised to avoid pressure on the grafted areas to optimize graft survival. Face washing is possible on the 2nd postoperative day. Postoperative swelling is reduced by remaining upright during the daytime and by elevating the head of the bed with extra pillows when asleep at night. Bruising may be minimized by avoidance of strenuous activity for the first 2 weeks.
After structural fat grafting is performed, blood vessels grow into the fat grafted area (neovascularization). The degree of neovascularization determines the proportion of fat graft survival. In general, 50 to 70% of the grafted fat will survive and the appearance at 2 months postoperatively is normally representative of the long-term result. The body absorbs the non-surviving fat during the first two months. The fat grafts that survive persist for many years.