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Case Study: Treating Lips in Skin of Colour Patients Aesthetic nurse Lucy Williams discusses her method for treating skin of colour lips The golden ratio is considered an important concept for treating the face in medical aesthetics, and in terms of lip treatments it refers to where the lower lip should be 1.6 times thicker than the upper lip.1 While this is true for the Caucasian face, it does not apply to all ethnic groups.1 Certain skin colours, in particular black skin patients, genetically have greater lip volume as they age. This is due to increased melanin in darker skinned patients, which helps protect the skin against ultraviolet radiation and cause the skin to be protected throughout the patient’s lifetime, shielding the skin against damage to the DNA2 and ultimately resulting in patients of racial origin having a greater lip fullness.3 Skin of colour is also less prone to solar elastosis, a degenerative condition of elastic tissue in the dermis due to prolonged sun exposure, which causes the skin to become thicker (also known as photoageing).3 It is normally found in patients with fair complexions, negatively affecting the production of collagen and elastin.2 Due to this, skin of colour patients rarely develop radial rhytids (fine lines and minor creases) in their lips and vermilion border, resulting in more volume within the lip regardless of ageing.4 Therefore, in the case of black or mixed-race patients, the ratio of their lips should typically be 1:1 rather than 1:1.6.1 As such, when treating skin of colour patients, practitioners should ensure that they are able to assess and treat the face differently. In terms of lip filler treatments for ageing skin of colour patients, they may seek to restore the youthful fullness of their lips. In this case it is more common that the injectable product is placed only in the upper lip, as the lower lip usually maintains its volume.5 It is also found that decreased lip volume and perioral lip lines are also more pronounced in Caucasian skin, likely due to a combination of muscle action and the deleterious effects of UV exposure on lighter skin.6 So, it may be more likely that perioral lines are less likely to be a concern for patients with darker skin.
Case study Consultation and assessment A 30-year-old skin of colour (mixed race white and black Caribbean) female patient presented to my clinic with concerns of a general lack of definition to the lips and a lack of volume in the
top lip, which she felt had worsened with age. A thorough understanding and assessment process will result in a better understanding of the aesthetics of the lips and consequently a more successful treatment plan and outcome. As such, I spent around 45 minutes undertaking a full consultation which included a full facial approach and gave the patient all the information about the treatment, so that fully informed consent could be given. It is also important to fully understand the patient, who they are, and their motivations for treatment to help manage patient expectations and give them a good treatment outcome. The patient had no relevant medical history and had never had any aesthetic treatments before. To add to this assessment, mental health, social and economic factors were also undertaken. My assessment determined that my patient was a previous smoker, exercised regularly, ate healthy and had no sun damage concerns. Undertaking a full medical consultation enables us to give an understanding of the patient’s reason for treatment and for us to develop a safe treatment plan. Lips are three dimensional and it’s important to assess the profile as well as the front view. There are three basic types of facial profile. A straight profile, also known as the straightjawed or orthognathic, is where the nose, lips and chin are almost inline; a convex profile, also known as the retrognathic profile, has a retruding chin, long nose and prominent mouth; and a concave profile, also known as the prognathic profile, is characterised by a bold lower jaw and chin.7 The angle of convexity of 8-16° indicates a straight profile, while an increased or decreased angle is an indication for convex or concave profile.8 As such, I identified that my patient had a
As the patient wanted natural looking lips with volume and definition, the correct product selection was key
Reproduced from Aesthetics | Volume 8/Issue 11 - October 2021
