Q: Dr. Eppley, I found a picture below on your site, and i wanted to ask you what exactly has been done here.It looks like lip lift but it has been lifted not only in the middle, but on the sides too!I wanted to do a lip lift, but i always was aware that it lifts only the middle part, which makes lips look unnatural, but doctors who I’ve asked said that it is not true. You are the first one who confirmed my suspicions, so I kind of trust your opinion now.
A: You are correct about a lip lift, it can never do more than lift the central part of the lip. (cupid’s bow) It can look natural if it is not overdone. Some surgeons do overdo them because they believe that the more one pulls up in the center that it will somehow lift up the sides. But this, as you have surmised, is incorrect. The lady in the pictures had a lip or vermilion advancement which moves (‘lifts’) the entire vermilion or lip edge upward from mouth corner to mouth corner. This is done by removing a strip of skin at the lip edge.
The lip advancement is a close cousin to the lip lift but is much ore effective and is the only good lip enhancement option in very thin lips. The trade-off for its effectiveness is that it creates a very fine scar at the lip-skin junction. But in properly selected patients this does not turn out to be a concern.
Q: Dr. Eppley, I am interested in vermilion border advancement (lip advancement) in the sides/ corners of my upper and lower lips. I would also like to pair this with large permalip implants. I have several questions. Can these two procedures be done at the same time? What would the down time be? What is the cost? Finally, I am not looking for a “natural look”. I have had my lips quite full using injections for several years and like this look but do not enjoy the costly upkeep since they wear off in two to three months in my lips. I can pictures of my lips without injections and a photo of what I want to achieve to see if you think it is achievable using the Permalip implants and vermilion border advancement in the sides/ corners. Thanks!
A: Your description of the lip procedures you would need to achieve your goals is correct. It would be necessary to do an upper lip[ advancement but spare the central cupid’s bow area. Permalip implants could be placed at the same time as the lip advancements. As you might image there will be some considerable lip swelling that will take several weeks to subside but that is more of a social issue not a physical limiting one from a recovery standpoint.
Q: Dr. Eppley, I have been interested in upper lip advancement (vermilion advancement) for a few years. My lips are full but very narrow toward the outer third. is there a maximum measurement of lip advancement that can be done in this area?
A: A vermilion lip advancement can be done to any part of the lip or its entirety. The only limits to vermilion advancement are aesthetic…you do not want the sides of the lips obviously fuller than the central part. Vermilion advancements of the outer third of the lips are not rare in my experience as many people have adequate central upper lip fullness but it tapers quickly down the sides into the mouth corners. This vermilion arrangement creates a mismatch between the vermilion fullness across the upper lip. Advancing only the sides of the vermilion upward is a simple and permanent solution to this aesthetic lip shape imbalance problem. It is done in the office under local anesthesia. There is usually minimal swelling and no bruising with a very quick recovery. The change in the vermilion shape is instantaneous and permanent. The only trade-off is the small fine line scar at the vermilion-cutaneous junction which certainly needs to be carefully considered.
Q: Dr. Eppley, I have a vermilion lip advancement a few years ago and am not too happy with the results. My scars are healed but it is too large which makes the distance between my nose and upper lip too close. My bottom lip is also too large that makes opening and stretching my lips difficult. Overall, my lips look unnatural and is too big for my face. My question is: is it possible to cut the vermilion again to bring it down making the size of the lips smaller and improve the shape? I don’t think a lip reduction will work because my vermilion will still sit to high. What would you recommend? Thank you.
A: Once skin is removed from the upper lip, whether it is from below the nasal base in a subnasal lip lift or above the upper lip in a lip advancement, there is no way to put the skin back. These are permanent lip enhancement procedures that change the skin-vermilion relationship by excision. The vermilion can not be moved back down, short of a skin graft which would look like a patch and be aesthetically worse than before.
Q: Dr. Eppley, I am 32 but since I was born my upper lip has never had shape or definition. It’s quite flat. I want to know if it’s possible to have lovely Rihanna type lips. I know there are lots of different types of lip enhancement procedures but I don’t know what would work for me if any of them will.
A: I don’t know whether you could ever have lovely lips like Rihanna, since I don’t know what type of lips you have now. But procedures such as lip lifts, li advancements and other filler volumizing techniques (fat injections, lip implants, synthetic fillers) can go a long way to improving the size and shape of your lips. Depending upon how flat (lack of a cupid’s bow) your upper lip is, either a subnasal lip lift (if it is sort of flat) or a lip advancement (if it is completely flat) can help create a much more prominent cupid’s bow.
A subnasal lip lift can improve the prominence of an under projected upper lip cupid’s bow. If no cupid’s bow is present at all, a lip advancement can completely create a well defined cupid’s bow shape. Adding volume with these excisional lip procedures can complement the additional shape achieved.
Q: Is the V-Y plasty the same thing as a lip advancement? If so, is that a procedure that can raise the height of the lower lip to have less tooth show? That is an option that I am exploring.
A: A lip advancement and a V-Y advancement are two completely different operations with varying effects on the lower lip. A lower lip advancement removes a horizontal strip of skin on the outside so the vermilion can be rolled outward making the lower lip look bigger. It will not raise up the lower lip but is done to make the lip look fuller. (have more vermilion show) A V-Y advancement is a internal vertical mucosal procedure done on the inside of the lower lip. It is designed to try and lengthen the height of the lower lip and/or release any contracture or shortening of the anterior mandibular vestibule.
Raising the height of the lower lip is challenging and there is no one single procedure that can consistently do so. It usually require a combination of procedures through mucosal lengthening and vermilion augmentation to create such an effect.
Q: Dr. Eppley, I am interested in a lip lift. I have very thin lips and a long upper lip. I want them to have more shape and size although I don’t want them to be too big. I have read about lip lifts but am not sure what I really need. I would like your opinion. I have attached a front and side view of my lips for your recommendations.
A: Thank you for sending the pictures. What they show to me is that unequivocally need a vermilion advancement and not a sub nasal lip lift. Your lips are very thing from corner to corner, has little cupid’s bow shape and there is a long distance between the base of the nose and the upper lip. This is a contraindication to a subnasal or bullhorn lip lift as it will only move up the central third of the upper lip but leave the rest of the lip behind, potentially creating an unusual and unpleasing shape. Only moving the physical location of the vermilion-cutaneous border, from corner to corner, of both lips can you make a significant improvement in the size and shape of your lips. I have attached an example of upper and lower lip vermilion advancements although this patient is older and she wanted a more dramatic change. The change from a lip advancement procedure is adjusted by the vertical size and shape of the skin excision and can be in any degree desired. The ‘test’ of the change a patient wants with a vermilion advancement is done by having them draw on the new border and shape of the lip with an eyeliner pencil. Then that becomes how much lip advancement is done.
Q: Dr. Eppley, I had an operation on my lips in order to have bigger ones. I had the operation about six months ago. I did not like the result of the operation and two months later I had a second operation. I had scar and asymmetric shape so I did not like the result again. I am regretting my decision for surgery and am missing my previous lips. My problems are the philtrum height is very short, my teeth does not appear because of mucosa and the lips have been stretched too much. I hope you can help in this regard. I am very unhappy indeed. I want you to remedy this situation soon. I really miss my old thin lips. I have attached some pictures of my lips before and after the procedures.
A: Thank you for sending your lip pictures. You did not say what procedure was done but it appears to have been a lip or vermilion advancement on the upper and lower lips. Unfortunately there is no turning back, so to speak, when it comes to a lip advancement. Once the skin is removed to do the procedure, it can not be replaced later. In essence, you can not reverse a lip advancement procedure. There is no operation to return your lips to their once thinner appearance. The only potential improvement that I can envision is lip edge mucosal resection to achieve a bit of an inner lip roll in and expose more of the teeth.
Your case illustrates why it is always best ti be conservative in a lip advancement. You can always do more but can never do less.
Q: Dr. Eppley, I am interested in getting a lip advancement procedure that would make my upper lip at least equal to my lower lip. My lips are significantly out of proportion. I have sent 3 pictures as references. Would you be willing to make such a drastic lip change to make them equal in size/appearance. I really would not be happy with the results if this outcome isn’t achievable. I live out of state and would have to fly in the night before the surgery and then fly out the day after. Would that cause any problems with the procedure and healing process. I am a very healthy 38 year old male with no health conditions. I have had anesthesia for a prior procedure. I am in the health field so I could perform most of the post care protocols. Thanks for your help.
A: Through a lip advancement your upper lip could be made almost even, if not completely even, to that of your lower lip. This is a procedure that could be performed under either local anesthesia (office) or IV sedation (procedure room) Many lip reshaping patients of mine come from afar so distance is not a concern in terms of healing or a cause of any after surgery problems. As you undoubtably know, the only issue with the lip advancement is the fine line scar along the vermilion border which is why it is not as commonly done in men as in women…although this does not mean the scar is any different. I don’t know of you are going to have upper lip hair or not after the procedure so the scar may or may not be of significant consideration.
A: Other than some moderate lip swelling, there usually is no bruising with lip advancement surgery. Patients report little to no pain as the upper lip will have some temporary numbness. So the recovery is very quick as there are no physical restrictions after surgery. The scars from lip advancements heal very quickly and are minimally visible in 3 to 4 weeks after surgery although that will be somewhat dependent on the patient’s age and the preoperative shape of the lip. (younger patients take a little longer than older patients) Full scar maturation is a process and one should anticipate that the final appearance of the scar is one of months and not weeks. As there will always be a permanent lip scar, one has to have a thin and small lip that justifies that trade-off. One can wear lipstick one week afetr surgery so scar camouflage is easily done through the scar maturation process.