Lip Enhancement: Lifting and Augmentation

15 Lip Enhancement: Lifting and Augmentation

In the 21st century people from many ethnic backgrounds are becoming interested in having fuller, more youthful-looking lips. Injectable materials may provide temporary enhancement (see Chapter 25); however, I prefer methods that provide longer-term improvement. And although surgical correction might not be recommended for every patient, a surgical lip lift or an autologous augmentation graft using a patient’s own fat and/or collagen can offer more permanent improvement to patients concerned about thin or aging lips (Fig. 15.1).

The lip lift is performed by excising a strip of skin above the top lip and below the bottom lip, then advancing the mucosal portion of the lips into the defect. I do not recommend this procedure in men, in whom a non-hair-bearing area just outside the vermilion border exists. The standard lip lift excises this non-hair-bearing area and causes the beard to crowd the vermilion, thereby creating a nonanatomical condition.

The key to lip line advancement lies in where and how the incisions are made and closed. Incisions beveled away from the midline of the vermilion line are recommended. Fine, delicate sutures, placed while using magnification, allow the facial surgeon to accurately approximate and evert the wound edges. Vertical mattress sutures placed at the Cupid’s bow region are crucial to wound closure for thread-thin postsurgical scars. A running subcuticular, monofilament suture is preferred in other areas of the upper and lower lip.

For patients over 40, surgical lip enhancement is often combined with skin resurfacing (laser, chemical peel, or dermabrasion), certainly when rhytids are present. Because—more often than not—injecting “fillers” underneath the skin above the vermilion borders results in “duck lips,” I do not recommend filling these regions.

In younger patients, lips may be enlarged by fat/fascia transplantation alone. In these cases, fascia can be harvested from the postauricular sulcus and overlying fascia of the postauricular musculature. Patients who have undergone previous facelift surgery have a sheet of favorable scar just beneath the subcutaneous tissue behind the ear. Mature scar is the ideal graft for lips, melolabial grooves, and deep glabellar creases.