After the upper third of the face, particularly the eyelids and brows, the lower third is considered the next most important cosmetic unit of the face. And the lips are the showpieces of the region. Any improvements made to them enhance the entire area, even if no other changes are made to the chin, the nose, or the skin immediately above and below them. As it does with the eyes, rejuvenation in this location contributes significantly to an overall look of health, well-being, and youthfulness of the entire face.
The lips, like other areas of the face and neck, change with age, typically shrinking slowly over time and losing the sharp definition of their borders along with much of their bulk. Even the philtrum, the so-called Cupid’s bow, located centrally above the upper lip and below the nose, becomes more flattened and less defined. When full and plump, the lips convey youthful softness and sensuality. By contrast, when thin and asymmetric, they may contribute to an appearance of sternness, meanness, or even untrustworthiness. The literary expression "pursed lips" speaks to a close association between our mouths, our emotions, and how we may be perceived by others.
To conform to the “ideals” of beauty in Western culture, your lips must be of a certain size, shape and proportion to one another. Lips like those of Angelina Jolie may not be quite your thing, but in general, when it comes to them, size does matter. The width of the mouth should be no wider than the distance between the inner colored portions of your eyes. And the upper lip must be no more than three-quarters the fullness of the lower lips in order to assure that a protruding pout is maintained, regardless of just how plump or full each of the lips is individual.
Finally, in profile, there should be a gentle S-shaped curve between the bottom of the lower lip and the chin with an approximately one-fifth of an inch rounded depression between the base of the lower lip and the chin. If these measurements are not respected, the mouth may not only look out of proportion but downright odd-looking.
The loss of lip mass with age may also give rise to several other aesthetic problems. Thinning lips can create the illusion that the upper lip (or actually the space between the upper lip and the base of the nose) is elongated. In addition, the volume loss can accentuate the vertical, so-called “lipstick bleeding” lines above and below the mouth. These wrinkles are sometimes referred to as “smoker’s lines, although they are quite common in non-smokers. Taken together, the changes can impart an aged, withered, and stern appearance to the lower face.
A number of surgical methods for lip augmentation have been devised to address these problems. In general, they rely upon the insertion of synthetic implants, such as Gore-Tex or Softorm. These products are non-dissolving, non-organic substances that are manufactured from the same material from which some forms of permanent surgical sutures are currently made.
Alternatively, implantable tissue for the lips may be harvested from elsewhere in the person’s own body. This is known as an autologous graft and may be obtained from tissue removed when the individual undergoes another surgical procedure, such as a tummy tuck or breast reduction. If this is not available, a small piece of the patient’s dermis (skin stripped of the epidermis) or fascia (the tissue layer covering muscles, usually the temple muscle) can be surgically retrieved for grafting. Dermis derived from donor tissue (Alloderm) has also been implanted. But whatever the material is chosen, it must be shaped and then surgically threaded through the lip from one side to the other. To reach the desired plumpness, several strips of material often must be inserted into each lip.
Non-surgical lip enhancement addresses the problems of aging lips without the need for any cutting. Lip enhancement is not restricted to replenishing volume loss within the red portions of the lips, what doctors call the vermilion. It can also be used to restore the integrity of the lip boundaries, the vermilion border, which is the white, hair-free line that outlines the margins of the lips and separates them from the skin immediately above and below.
A variety of volumizing injectables have been tried for the lips, including collagen. However, the hyaluronic acid fillers have proven to impart a smooth effect with little chance of any lumpiness. Restylane is my personal favorite for the vermilion and vermilion border.
The procedure is quick and simple. The lips, being especially sensitive, are first sprayed with a topical numbing agent, such as Cetacaine, that dentists use before injecting gums. Afterward, they are anesthetized locally with lidocaine. Following this, the borders of the lips are filled along most of their length. Doing this simultaneously softens the appearance of any vertical lip lines, reducing the need to outline the borders of the lips with lip lining pencils. Next, the body of the lips themselves is plumped to the desired shape and configuration, keeping the proportions mentioned above in mind. If desired, the lines of the Cupid’s bow can also be accentuated with filler, creating the so-called “Paris Lip” that was all the rave about a decade ago.
If the vertical lipstick lines are especially long and numerous, each may be filled with a tiny amount of Restylane or another hyaluronic acid filler, such as Juvederm Ultra, and then two microdroplets of Botox Cosmetic can be instilled on each side of the upper and lower lips to complement and prolong the effects of the filler.
The entire procedure generally takes no more than about ten minutes. Slight swelling and bruising are common afterward, but these usually disappear within a few days. Lipstick can be applied immediately afterward. Results usually last about four to six months. When all of the above is performed, the cost may range from $750 to $1500, depending upon the kinds and amounts of materials used.
The accompanying images demonstrate the lips before and after treatment with Restylane alone. In this person, only the vermilion lip border and the body of the lip were treated. Note how much more vibrant, healthy, and youthful the lips are following treatment. So, what’s stopping you? Pucker up.