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Assessing and Augmenting Lips Dr Ayad Harb and Dr Yalda Jamali present five principles to lip assessment and treatment for successful results The lips are a universal symbol of beauty and youth and throughout history have evolved as one of the key sensual landmarks in the face. Lip adornments, colours and cosmetics that draw attention to the lips, date back to fourth century BC, when lipstick was first used by Sumerians.1 Furthermore, lips are the focus for facial symmetry and the triangle of beauty.2 Added to this, lips play an important role in phonation, communication, feeding and intimacy. With the rise in demand for lip treatments, lips have become one of the most popular areas that aesthetic providers learn to treat. Enhancement of the lips usually involves enlarging, defining, and reshaping. Undoubtedly, there are significant individual differences in lip appearances, however, through an in-depth knowledge of anatomy, comprehensive structural assessment and using an appropriate technique, a practitioner can achieve natural, safe, and repeatable results. Within Dr Ayad’s clinic, we have devised a methodical technique for lip assessment and treatment, based on five key principles, which helps us restore and maintain a natural appearance.
Lip development and ageing The development of the lips in the foetus is an intricate process that occurs between four to six weeks’ gestation.3 The upper lip and palate are formed by the fusion of the maxillary processes bilaterally with the medial and lateral nasal prominences. These fusion lines remain visible as anatomical and aesthetic landmarks in the fully developed upper lip. The lower lip and mandible are formed by the meeting of two mandibular processes which fuse in the midline.4 The anatomical layers of the lips are composed of skin, muscle, and oral mucosa. The distribution of the superior and inferior labial arteries can vary, but they are predominantly submucosal (78.1%). Some variations exist whereby the vasculature is intramuscular (17.5%) or subcutaneous (2.1%).5 The lips follow a familiar pattern of decline and ageing, similar to the rest of the face, with the formation of wrinkles, loss of definition and decline in volume within the lip, as well as structural changes related to the underlying bone and muscle. The oral commissures drop,
giving a downward turning of the lips and the intercommissural width reduces. Maxillary retrusion results in a reduction in maxillary angle and height, which leads to a more posterior position of the lip. Tooth loss and tooth wear can lead to a decreased projection of the lips. Lips can appear inverted and thinner.6 The skin in and around the lip shows typical signs of ageing, resulting from the decline in collagen and elastin within the dermis. The results are visible static and dynamic rhytids, which typically appear as vertical barcode lines. Loss of vermillion border definition, as well as flattening of the cupid’s bow are particular to the lips. Furthermore, as the epidermis thins and the dermal-epidermal junction flattens, this creates a suboptimal skin barrier that leads to water loss and dry lips.6 A decline in the orbicularis oris muscle tone leads to a widening of the lip, as well as a reduction in lip height. A combination of muscle and skin laxity results in elongation of the cutaneous lip. An increased tone of the lip depressors, particularly the depressor anguli oris, contributes to the down-slanting appearance of the oral commissures, so is a characteristic of the ageing lips.6
Five principles of lip assessment For our lip assessment approach, it is considered in five components: lip volume, lip height, vermillion border and landmarks, oral commissures, and perioral skin condition. Each component is assessed separately, and a decision is made regarding the most appropriate treatment, if any.
Maxillary retrusion results in a reduction in maxillary angle and height, which leads to a more posterior position of the lip
Reproduced from Aesthetics | Volume 8/Issue 9 - August 2021
