Lip
Augmentation

The upper lip comprises a central fullness called the tubercle, and a lateral lip element of either side of it, often with a small junctional groove. There are 2 philtral columns that extent from the cupid's bow apices up to the nostril sills. The upper lip volume is usually no more than 2/3 of the lower lip volume.

The lower lip has 2 halves, each with slight fullness, and often with a small central groove. The white roll is a light reflex which outlines both upper and lower lip, and is more or less obvious in most people.

The ageing lip and peri-oral region tends to lose volume, hydration and pout and develop fine lines around the mouth area in general. The mouth corners also deflate somewhat, giving a down turned appearance. The upper lip also appears to lengthen over time, obscuring the upper teeth when smiling.

Each patient is assessed individually to see where the lip might be best enhanced – there is no standard way to do this. I most often use Juvederm Ultra Smile, which is packaged as 2 x 0.55cc syringes and contains a local anaesthetic. Areas that may be enhanced include the white roll, the philtral columns, the lip corners and the vermillion (red part). To turn the vermillion out to increase pouting, the gel is injected in small amounts on the inside of the lip, not along the free order of the lip, as is often done. I rarely use more than 1cc to enhance both top and bottom lip – in this case, less is really more!! The lips should appear moist and well hydrated, slightly fuller / plump and ideally the proportion between top and bottom lip should be respected, not distorted!

Fat grafts are another useful option for lip enhancement, but then require the patient to be in the operating room – this is often done as part of another procedure, e.g. facelift or eyelid surgery.