The lips are one of the first thing that draws the eye. They are a sign of youth and beauty, which is why so much time and effort is spent with cosmetics trying to make them appear more attractive. For some, they naturally have a full lip. For others, they lack the volume or shape they desire. As you age the upper lip (between the nose and mouth) beings to elongate. This creates the appearance of a long upper lip, drooping nose, and thin lip. The philtrum (the two columns connecting the lip to the nose) also smooths out. The lack of these two columns leads to the appearance of an aged lip. Finally, the red part of the lip turns inward as a result of shrinking of the upper bones of the mouth making the lip appear thinner.
The ideal lip naturally has certain characteristics. First, it should have a well defined Cupid's bow. This is the area in the center of the upper lip that has two peaks (at each philtral column) and then comes down in the middle to form a little bow. A telltale sign that someone has been over treated with filler is when this bow disappears and becomes more of a rainbow. Furthermore, the central part of the lip should be more full to settle into a slight depression in the lower lip. On the outsides of the upper lip near the corners, the lip naturally disappears. It should not extend all the way to the edge. The lower lip lacks the bow but as mentioned earlier, has a slight depression centrally with two slight peaks to fill in the areas of the upper lip above. If you read the textbooks, the upper lip should make up 1/3 of what is seen from the front and the lower lip 2/3. In reality, most patients prefer more of a 50:50 ratio. From the side view, the upper lip should stick out just slightly more than the lower lip.
Depending on the degree of change there are various options for correction. These include both non surgical (fillers) and surgical options including using your own collagen or fat. When it comes to fillers there are three different fillers Dr. Guy prefers at this time. These include Juvederm Ultra XC, Restylane Silk, and Volbella. Juvederm tends to add the most volume and is ideal for patients looking for a more full lip. Silk and Volbella do a nice job defining the margins of the lip without adding much volume. In any scenario, Dr. Guy takes a conservative approach to lip augmentation. It is easy to add more volume. As a rule of thumb, you should never focus on a set volume but rather a well defined goal.
Surgery can provide a more lasting result but it is not for everyone. Dr. Guy is not a fan of permanent lip implants given the long term risks and complications as well as the unnatural feel. The use of your own collagen, fat, or lifting procedures can be considered in the appropriate candidates. Surgical options include making an incision directly around the mouth. There naturally is a white line around the mouth which blends this incision. However, it may still need to be masked with a lip liner. Another option is making an incision directly below the nose (known as a bull horn incision). This moves the incision away from the mouth but runs the risk of being visible below the nose. Other options to add more volume involve incisions made within the mouth itself. These are nice in that there are no external incisions, but the degree of lift is limited. With the various options, Dr. Guy creates a very natural, youthful look, and not an artificial or "Hollywood" lip. The treatment possibilities can be discussed with Dr. Guy in consultation.