Surgical lip lifts and non-surgical lip treatments- natural beautiful lips
2.09.26 by Dr. Jed Horowitz, Newport Beach, Ca.
Our lips and smiles are some of the features of our face that provide so much beauty and expression. Even micro-expressions of our lips allow communication, often without speaking.
We now have many options both, surgical and non-surgical, to create beautiful lips and a sexy smile. In general, we can smooth, reshape, rejuvenate and add volume. There are fillers, silicone implants, dissolving thread implants, lip lifts, lip reductions, peels, and then of course cosmetic dental care to improve the color shape and contour of your teeth and gums.
Beautification of our lips can be achieved using a variety of modalities. These methods are often dependent on the patients age and subsequent goals. Younger patients often want to enhance the fullness of their lips, which is most frequently accomplished with the use of fillers as noted below. More current treatments to enhance lip appearance include the “lip flip” a method that uses Botox to turn the lip out.
Patients who are older and may have skin changes, sun damage, lip lines, creases and folds will frequently benefit from a variety of procedures which address these individual conditions. These can include a combination of fillers, fat transfers, chemical peels, laser treatments and neurotoxins (Botox®, etc). Dermabrasion, laser or chemical peels can treat surface changes caused by the environment, habits like smoking or genetic traits. Surgical treatments can improve texture and contours in a number of ways. Dermabrasion, chemical peels, and laser peels can remove sun damaged leathery skin, fine and deep lines to smooth the surface of the skin removing years of aging. These treatments are often combined with fillers and muscle relaxers. The results are dramatic.
For those patient of all ages, who desire a more permanent solution than lip fillers, or cannot achieve their desired result with fillers of one type or another, a Lip lift, or our Total Lip LiftLift™ can often provide the beautification that our patients are looking to achieve.
Lip Lifts
Lip Liftsurgery offers more significant and longer-lasting aesthetic advantages than injectable fillers. Lip lifts are minor surgical procedures that shorten the distance between the nose and upper lip and allow more of your central upper teeth to show both at rest and when you smile. This has sometimes been called the bullhorn procedure because of the shape of the incision. The incision at the base of the nose, or sometimes just within the nostrils, tucks the muscle and shortens the skin providing a youthful upper lip in less than an hour under local anesthesia, wide awake anesthesia, or other choice depending on the combination of procedures being performed or the patient’s choice.
Another method of lip lifting is a “Gull-Wing” or direct excision at the white line or top edge of the lip. This is useful for patients with significant lip lines and lipstick bleed. It will increase the red part of the lip. Filler can be added to make the lip fuller and rounder.
A third surgical treatment uses small incisions inside the lip to advance the red part of the lips forward and out to add volume. Lastly The Corner Lip lift uses small excisions performed near the corners of the upper lip to raise these portions of the lip.
By surgically shortening the philtrum (the space between the nose and upper lip), the procedure reveals more of the “red” lip tissue and creates a more youthful, balanced facial profile. The lift also allows the front upper teeth to be more easily seen both in a relaxed pose and with a full smile. By showing more of the vermillion, or red part of the lip, any filler that is placed will have a more visible effect in creating a fuller more sensuous lip. Even lipstick is more easily applied and visibly seen. The visible show of the teeth provides a more inviting and engaging smile. The lip lift in the central portion of the lip also enhances the cupid-bow portion of the lip. The pout at the free edge of the lip can be enhanced with one of the fillers mentioned.
Total Lip Lift™is our version of a more complete lip lift. We believe this provides a more balanced lift with overall improvement of the shape and appearance of lips for many patients.
The key components include: the “Subnasal” or“Bullhorn” or more typical Lip Lift in the central part of the lip; the Corner Lip Lift; pre-operative Botox (or other neuromodulator) to stabilize the lip while it heals; and fat grafting or filler to add volume.
Fillers, Fat and Tox
Best-known fillers that we use include Juvederm and Restylane but there are newer versions that are less dense and feel softer and more natural. These are mostly HA or hyaluronic acids, the building blocks of collagen. They generally will last four to six months. Thinner patients tend to metabolize the products faster.
The G prime of filler relates to elasticity or softness; lower G prime fillers being more pliable and softer, better for lips. Higher G prime fillers like Voluma and Restylane Lift are better for structural lifting and filling in areas like the cheeks.
Another characteristic of these fillers is how the molecules of the HA link together (cross linking). Again, this structural configuration will provide different characteristics in addition to their G prime such as how much water they absorb, leading to more or less swelling after injection.
Currently we most often use Volbella and Belotero. These products have lower G prime.
Volbella absorbs less water so there is less swelling and its crosslinking seems to allow this product to last longer, up to a year for many patients. We are also able to inject this product into the fine vertical lip lines around the mouth.
Another helpful characteristic about these fillers is the ability to dissolve them in minutes if you are not happy with the shape or volume. Injectables also have the ability to fill areas of the lips where more volume is desired and do this in a more artistic manner than simply placing an implant. So, if you like Angelina Jolie’s lips, these have a fuller shape throughout, but if you like the Michelle Pfeiffer pout then you need more fillers on the sides.
Typical areas that are filled include: the fine lines or smoker’s lines of the upper lip; the cupids bow or central fullness; the columella or columns that are between the lips and nose; the lip line or white roll; the corners of the mouth or commissures; the marionette lines or folds between the corners of the lips and the chin.
Fat Grafting is natural filler that can be used to add shape and volume. It uses your own natural fat that is injected with small, specialized cannulas.
In addition, Botox, Dysport or similar muscle relaxers can be used to soften the smoker’s lines and allow the corners of the mouth to turn up from the downward “look of despair”. These products stop the harsh action of the muscles in these areas, allowing a softer younger appearance.
These muscle relaxers can also be used to elevate the corners of the mouth to reduce the “look of despair.” Injection of the DAO or Depressor Anguli Oris muscles allow the corners of the mouth to rise up.
References:
Lip Lift: Ara A. Salibian, MD ∙ Rachel Bluebond-Langner, MD
Weston MD, Byron D. G.W., Lifting Lips: 28 Years of Experience Using the Direct Excision Approach to Rejuvenating the Aging Mouth
Angela,S. Lip Lift,
Otolaryngologic Clinics of North America, Volume 55, Issue 4, 835 – 847
Impact of subnasal lip lift on lip aesthetic: a systematic review: LCA Júnior, NT da Silva Cruz… – … Maxillofacial Surgery, 2023 – Springer
The modified upper lip lift: advanced approach with deep-plane release and secure suspension: 823-patient series: B Talei – Facial Plastic Surgery Clinics, 2019 – go.digitalsmiledesign.com
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