This article discusses and presents options related to the cosmetic reduction of enlarged lips, primarily in ethnic populations. No formal study is performed. The author presents a literature review and discusses his personal 26-year experiences in lip surgery. When basic tenets are followed, cosmetic lip reduction is a predictable procedure with very little morbidity. Although lip augmentation is a popular cosmetic procedure, a certain percentage of the population desires smaller lips. Reduction cheiloplasty is a safe and predictable procedure that has been performed over a half century. This procedure is relatively simple and has a moderate learning curve. Cosmetic lip reduction is safe and effective, and has a high level of patient acceptance when certain diagnostic and treatment criteria are fulfilled.
Lip enhancement has been a popular custom, especially in females, in most societies since the dawn of recorded history. Lip enhancement is the mainstay of the minimally invasive portion of most cosmetic facial surgery practices, but not all patients seeking cosmetic lip enhancement desire bigger lips. A certain percentage of the population seeks cosmetic consultation for lip reduction, and the cosmetic facial surgeon should be versed in this treatment option as well. In the author’s personal experience, most patients presenting for lip reduction are of African American heritage but the author has performed this procedure on patients from other ethnic groups, including multiple Caucasians ( Fig. 1 ).
Diagnosis and consultation
Macrocheilia defines a larger than normal lip. Various ethnic groups share the characteristic of larger lips including African American, Asian, and other groups ( Figs. 2 and 3 ). For the remainder of this article racial lip differences with larger lip anatomy are referred to as “ethnic” lips. This term would apply to racial groups that commonly have lips that are larger than the Caucasoid lip and more frequently seek cosmetic lip reduction.
In the Caucasian patient the upper lip constitutes one-third of the total lip volume while the lower lip constitutes about two-thirds of the total lip volume, with a ratio of about 1:1.6 ( Fig. 4 ). African American lips are generally larger in all dimensions, and the upper and lower lip volumes are frequently nearly the same in many patients. Ethnic lips are also more protrusive, in part due to having more soft tissue mass. The normal chin and lip soft tissue thickness is approximately 12 mm in Caucasians and 15 mm in African Americans. Vermilion height norms vary in different ethnicities; for example, on average, African American males have 13.3-mm upper lips and 13.2-mm lower lips, and African American females have 13.6-mm upper lips and 13.8-mm lower lips. North American Caucasian vermilion height norms of upper and lower lip for males and females are 8.0 and 8.7 mm and 9.3 and 9.4 mm, respectively. In the normal situation there is a 0- to 3-mm intralabial gap between the lips in repose. Patients with larger intralabial space may not be good surgical candidates. The importance of ruling out dentofacial deformities as contributing factors to macrocheilia cannot be overstressed, and orthodontic, oral, and maxillofacial consultation and lateral cephalogram may be of assistance.
