Lip lift

There are surgical and non-surgical techniques for effecting lip lift and lip augmentation to the lips. The surgical techniques include incisions below the nose and in the periphery of the lips area of the face, the perioral area; other techniques effect the surgical incisions from inside the mouth.

The aesthetic ideal of a mouth with youthful lips—shaped like a lozenge—features an upper lip with a pronounced Cupid's bow, and much fullness to each lip; however, such an ideal physiognomy declines with age, and the lips shrink and lose anatomic definition, as the lips sag, which affects the aesthetics of the smile, by revealing less of the teeth during a relaxed smile.[1][2] The American Society of Plastic Surgeons reported 3.2 million cosmetic surgery procedures performed to mature patients, aged 55 years and older, in 2008. The patient demand for facial rejuvenation indicates that most requests do not include the mouth, which results in a surgical outcome that is aesthetically deficient.[1][3][4][5][6] In the 1980s, when collagen, originally the principal filler for the lips, proved limited in effecting permanent correction, plastic surgeons then developed surgical techniques for lifting and augmenting the lips, and correcting aesthetic defects and deformities.[7]

The "gull-wing lift" is an effective surgical technique for increasing the prominence (display) of the vermilion coloring of the lips, by removing skin (and other tissues) as required, either directly from or from above the white line of skin that borders onto, and sets off, the vermilion of the lips (the white roll). The incisions remove tissue and significantly alter the shape of the lips by moving up the vermilion from both peaks of the Cupid's bow outwards to the commissures, the corners of the mouth. Incisions are also made below the lower lip to increase the projection of the vermilion of the lower lip. This gull-wing lip lift usually requires an OR time of approximately 20 minutes; post-operatively, the swelling of the lips subsides at 1–2 weeks and the tightness subsides at 2–4 months. Asymmetry, under-correction, and hypertrophic scarring are possible complications.[1]

A technical variant of the gull-wing lip lift is the sub-nasal lip lift (bull-horn lip lift), which involves the removal of either an ellipse or a curved-edge ellipse of tissue from under the nose. The skin then is raised, and sutured to lift the lip and expose more of the upper-lip vermilion.[2][9] Depending upon the indications of the patient, this technique can increase the drooping the corners of the mouth (commissures); thus, the sub-nasal lip lift often includes a corner-lift surgical step.[6] In the corner lift procedure (external angle oral commissuroplasty), triangles of tissue are resected from above the commissures, thereby elevating the corners of the mouth.[3] A descending wedge of tissue can also be removed to add contour to the Cupid's bow or to reduce bulky lips.[2]

Another variation is the thread lift, in which a square stitch is placed from one nostril to the other and down to the peaks of the Cupid's bow. This variation has fallen out of favor because the results are short-lived.

Another variation is the double duck lip lift, in which the columella of the nose is not incised.

Another variation of the procedure consists of a lenticular excision of the white skin surrounding the upper oral commissure in order to lift this part of the lips. This technique has also been dubbed the "Smile Lift".

Another variation of the procedure is for a surgeon to make an incision inside the mouth to loosen the mucosa and vermilion, which are then advanced and secured, leaving a portion of scar tissue inside the mouth which may take 2–4 months to heal.[3] Yet another technique uses a "W" incision inside the mouth to create several "V" flaps, which are then used in a V-to-Y plasty technique to advance the vermilion of either or both lips.[3] This procedure leaves no exposed areas inside the mouth, but can be painful and has a lengthy recovery period.[5]