Lip lines

LIP LINES - UNDERSTANDING THE BEAUTY OF NORMAL LIPS

There are four major types of lip lines that bother us when they appear! Before we look at these lines, it is important to bear in mind the normal (and beautiful!) shape of ideal lips and the mouth! A careful study of youthful lips allows the particular plastic surgeon to know the surface anatomy that is so vital to recreating lip structure after trauma, tumours or for aesthetic purposes. I have analysed the lips below in detail not found in standard plastic surgery text books.

“I have fillers done to my lips because they give me confidence and I think they are my best feature. Dr. Patel always talks me out of over-filling them and I am glad he does as I work in medicine and would not like patients to think I look funny. Although I like fuller lips, he shapes them beautifully and no-one realizes I get fillers to make my beautiful lips look even better. I know it is shallow of me because I look after cancer patients but many of my patients pass comments on my “beautiful lips” and I enjoy talking to them about things other than cancer” L. Restori 29 Yrs Old with Gorgeous Lips in London- London, England

LIP LINES - APPLYING KNOWLEDGE OF SURFACE & THREE-DIMENSIONAL ANATOMY TO RECONSTRUCTION AFTER TRAUMA AND CANCER

Understanding the surface anatomy described above, the relationships between the wet and dry zones of the lips, the vermillion border, the gradual but defined decrease in fullness of the normal lip as one gets to the lateral edges and the importance of preserving and recreating the lip mound (I call it “the earthworm that sits on the lip’s edge” giving it the prominence and beauty of a normal lip) allows the cosmetic and reconstructive surgeon to use his cosmetic understanding and respect for proportions to be applied to reconstructive cases.

“My husband actually asked me the other day when I was going to see Dr. Patel as he loves my lips after I have filler done by Dr. Patel. It is always invisible to everyone and I don’t know how but he makes those two vertical lines for me and what he calls the cupid’s bow to give me a hollow between the lines which makes my lips look much younger. I have fine lines on my lips which look much better after the filler and I like having my lips fuller again. I would like them fuller still but he tells me to be conservative “don’t spoil a perfectly good result” is what he told me and so I am sticking with just one vial of restylane filler for my lips!” Mary S 49 Yrs Old with Lips in Park City, Utah

UNDERSTANDING THE FOUR TYPES OF "LINES" THAT AFFLICT LIPS OVER TIME

1. VERTICAL LIP LINES

Vertical lip lines are variously called “smoker’s lines”, “straw lines”, “marionette lines” (which is an incorrect use of the descriptor “marionette”), “whistle lines” and just plain “old lady lines”.

Interestingly these occur much less impressively in chaps: whether hormones have anything to do with them is unknown. Those men that do get them are generally smokers. Genetics has an important role, as is lifestyle (smoking, sun damage, etc). Although over decades these lines become deeper, the first lines are often seen in the third decade in non-smokers (and white Caucasians) and in even in the second decade in smokers.

The lines are much less common in people with darker skin: melanin protection has some part to play.

2. DOWNWARD TURNING LINES AT THE CORNERS OF LIPS

The downward turn of the corners of lips leads to a “sad” look. Hence these are called “sadness lines”, “Marionette lines” – which points to the continuation of the downward turn of the corners of the mouth into the mento-labial folds, “Cruella lines”, and more recently, “handmaiden lines”.

As one develops laxity of the lower face, and, in particular jowls, these corners of the lips turn further downwards. The depressor angularis oris muscle also, over time, seems to dynamically pull the corners of the lips downwards.

Downturning corners of lips seem to affect all races, but the depth of the lines are less deep in races with more pigment.

3. HORIZONTAL MENTAL CREASE

This is less common as a cosmetic concern than the first two types of lines described. As can be sen in the photos below, there is generally a gentle depression between the lower lip and the chin. In youth, it is rarely deep, but does deepen with time. At what level it becomes cosmetically objectionable is undefined. In my experience, some people are bothered by it more than others. A number of tissue release and augmentation with fillers or fat may be used to improve the deep crease, as seen in some of the results shown further below.

4. SUBNASAL CREASE

This is the least common of the lines around the lips that is seen and needing attention. However, when it is present, it becomes accentuated when one smiles and gives a rather pronounced look to the perioral region. Those people who have it, know about it and do not like it!!

BEFORE-AND-AFTER PHOTOGRAPHS OF THE FOUR TYPES OF LIP LINES

As is understandably obvious, lines generally do not occur in isolation: one often sees the vertical lines together with one or more of the other lines. Treatment is therefore focused on the particular anatomical and physiological changes to achieve the best results.

Some lip lines may be treated in isolation with lasers with or without fillers. More often, a combination of tissue manipulation, augmentation, laser use, tissue repositioning and repair of surrounding tissues (jowls, folds, grooves, volume deficiency, volume excess, etc) is used to give the best possible results.

Improvement in the mental crease gives a better looking lower lip and chin. Also improved are the vertical upper and lower lip lines, the downward turn to the corners of the lips and the marionette lines. We generally address as many of the four different lines that occur around the mouth to give a congruous and pleasing result

Here we see improvement in the vertical lip lines, the corners of the lips, the chin changes, an improvement in the mental groove and a generalized thickening of the peri-oral tissues surrounding the lips giving a much more robust and youthful look to the mouth and lips

The sub-mental crease has been shallowed, giving the chin a more youthful look. The corners of the lips and the marionette lines have been addressed as have the vertical lines on the upper lip. Lip shaping with appropriate fillers can now be performed to give more projection without looking like “overfilled lips”.

Here, the marionette lines, the downward turning lips, the lateral lip grooves, the few lip lines and the proportions of the lips have been addressed. With age, one loses the normal proportions of lips: paying attention to recreating these proportions pays dividends!

COMBINATION MANAGEMENT OF LIPS

In this patient, three of the four types of lines were addressed. However, to make lips and the perioral region look more attractive, attention must be paid to the tissues surrounding lips and the mouth, viz. the jowls, the jawline, the nasolabial folds and also any lower facial deformities.

In this case, a lower cervico-facial rhytidectomy (facelift) allowed us to improve the jowls, achieve elevation of the descended cheek fat pads, augmentation of the jawline and the lips with fat and the use of lasers to the perioral pores and rhytids. This rejuvenates the whole region. it is a mistake to try to improve just one single change that may affect the lips: results are then incongruous.

Lip augmentation can be undertaken after the cosmetic reconstructive surgery is complete, giving a nice chape and age-appropriate fullness to the lips.

ISOLATED VERTICAL LIP LINES

If you are an active smoker, treatment of the lips with lasers can be undertaken, but your healing will be slower, there is a greater risk of infection and the risk of scarring is also increased. These are just facts that you ned to know. If you have completely stopped smoking, these risks reduce over time!

In many cases, these lines are seen in non-smokers. Certainly, in the modern world, second-hand smoke does have a part to play in the development of some of these changes. Genetics, sun exposure and lifestyle also have a bearing on the speed with which these appear and progress.

In the absence of other surrounding changes (jowls, labio-mental lines, neck laxity, etc), isolated treatment of the lips can give very gratifying results as seen here.

Vertical lip lines, even in non-smokers, can appear in the third decade. Whilst there is no way of preventing them, treatment with a combination of appropriate lasers, fillers and/or fat grafts gives very nice results.

HORIZONTAL LINE SUB-NASAL/SUPR-LABIAL!

With great care and attention to surrounding surface anatomical contours and changes

EXAMPLES OF LIPS, LIPS, LIPS.....

“I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm.” D. Gull Highly recommended for eye lift surgery – Salt Lake City, UT

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FAQs

WHAT KIND OF ANESTHESIA WILL BE USED?

Treatments for lips may be undertaken during surgery or in the clinic using local anesthesia with or without sedation

WHERE ARE THE LIP PROCEDURES PEFORMED?

Surgical lip lift to shorten the vertical height of the lip is performed with or without sedation in a sterile surgical center setting. Other treatments like lasers and fillers can be performed with topical and injection anesthetic in the sterile minor operating theatre in the clinic

WHAT KIND OF SUTURES ARE USED?

A combination of dissolving sutures and more permanent sutures (which are removed after a few days) are used for surgical procedures around the mouth and involving the lips

DO YOU USE LASERS?

Lasers will be used to treat peri-oral lines, “sleep lines” on the cheeks and other skin irregularities. The advantage of using all the skills and modalities available to us gives us the best results

HOW LONG DOES IT TAKE TO PERFORM PROCEDURES TO THE MOUTH AND LIPS?

If any surgical procedures are being performed in addition to other procedure like a facelift, necklift or a Hammock Lift, the procedure is performed in the same surgical setting. If individual treatments are performed, they generally take 20 – 40 minutes

WHAT ARE THE MOST COMMON RISKS OF TREATMENTS ADMINISTERED TO LIP LINES?

Although we can rejuvenate the mouth area and the lips consierably, every single lip line cannot be wiped away! Patients may need further laser treatments as well, depending upon your history of previous smoking, habits, ethnic background and other factors

HOW MUCH BRUISING AND SWELLING WILL I HAVE?

The lips and the mouth area do bruise for a few days with surgical procedures performed

DOES INSURANCE COVER TREATMENT OF LIP LINES?

Cosmetic procedures are not covered by insurance

HOW PAINFUL IS A LASER TREATMENT FOR LIP LINES?

Because we use local anesthetic nerve blocks, the procedures is then painless. After the procedures, simple moisterizing of the skin is required. Most patients do not even need simple tylenol for discomfort

ARE THERE ANY RESTRICTIONS AND WHEN MAY I RETURN TO WORK?

The pinkness after laser treatments to the mouth region and the lips can last a number of days and even two to three weeks later, some pinkness will be there. You can use makeup as early as day 7 after treatment. The pinkness is a sign of tissue change and is an excellent indicator of the improvements you will see

WILL WEIGHT LOSS OR WEIGHT GAIN AFFECT LIP LINES OR WHEN I HAVE THEM TREATED?

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Contact Info

Dr. BCK Patel MD, FRCS
1025E 3300S
Salt Lake City, Utah 84106, USA

(801) 413-3599 (phone/text)
E-Mail: bckpatelmd@gmail.com
bckpatel.info

Dr. BCK Patel MD, FRCS
617 E Riverside Dr Suite 101
Saint George, UT 84790, USA
(435) 215-0014
E: drbckpatel@gmail.com