Monday, March 26, 2018

Lip Lift: Getting the Perfect Pout

Dr. Andrew Jacono: “Choosing a lip procedure should be dependent upon the structure of the dentition in relation to the lip as well as the structure of the lip.”
by Delia von Neuschatz

Do you desire fuller, poutier more youthful lips?
  Have you tried injectable fillers but came away dissatisfied?  Perhaps the procedures resulted in the dreaded trout pout or maybe you’ve tired of the frequency and cost of repeated treatments.  Still, you are not ready to give up on a desirable kisser.  So, are there any lasting procedures that will render natural results?

Enter the surgical lip lift.  Once reserved only for older, light-skinned patients due to the scarring potential, advancements in techniques and technology now allow surgeons to perform lip lifting procedures on patients as young as 20, regardless of skin color.  If you’re not ready to commit to a surgical procedure with permanent results, however, the Botox Lip Flip described in further detail below, will let you test drive the proposition by giving your upper lip a temporary lift. 

“In the past three years, lip lifts have become dramatically more popular,” says Beverly Hills plastic surgeon and lip lift specialist, Dr. Ben Talei, who sees a wide age range in the patients asking for this type of lip augmentation.  “The lip lift is having a moment because people are starting to realize that it’s often more rejuvenating and balances the face better than filler,” says New York City facial plastic surgeon, Dr. Dara Liotta A pioneer in lip lift surgery, New York City facial plastic surgeon, Dr. Andrew Jacono, now performs this surgery on patients ranging in age from their 20s all the way up to their 80s.
Dr. Ben Talei: “It is important to understand that not all lips will benefit from fillers.  The lift gives the upper lip a lighter and more defined appearance with greater volume and tooth show. The end result of a lip lift is subtle, but the benefits are substantial.”
The increasing popularity of surgical lip lifts is due to several factors.  Injections with fillers such as Juvéderm, Volbella and Restylane, over time, can result in scarring.  The repeated needle or canula jabs can eventually cause some fibrosis.  That is a positive in the sense that it can actually add a little bit of volume over time, but it’s a negative in the sense that the results are not very elegant, explains Dr. Liotta.

The biggest downside of injectable lip fillers, however, has to do with anatomy.  If someone already has a long distance between the nose and the lip, fillers will only elongate that distance because they will weigh down the lip, causing it to droop further.  The aesthetic ideal is a little bit of tooth show when relaxed lips are parted.  As we age, the upper lip tends to lengthen and a lack of tooth show gives the sense of a loss of sexuality or sensuality, says Dr. Talei.  A shorter upper lip on the other hand results in a more youthful face because it restores balance.  It makes the whole face look a little bit smaller and more petite. 

The incision of a bullhorn lip. Photo: Dr. Jacono
While a well-proportioned face is the goal, there is no ideal distance between the base of the nose the top of the lips. “A lip lift creates a gentle amount of fullness on the upper lip. It looks pretty. It looks full, but it doesn’t look crazy and it can be dialed up depending upon how much somebody needs or wants,” says Dr. Jacono who, by his own estimate, has performed more than 2,000 such procedures.

There are several types of surgical lip lifts. The most popular one is the bullhorn or subnasal lip lift.  This method shortens the distance between the lip and the nose by excising a strip of skin below the nose via an incision that resembles a bull’s horns. The top lip is rolled out and elevated resulting in a wider smile and improved tooth show.

In the past, the bullhorn lift had two main drawbacks: scarring and changing the base of the nose. There was a considerable amount of scarring because the incision doubled in and out of the nose, crossing the nasal sill, thereby creating effacement or loss of definition at the base of the nose. And once you lose the “nose meat” in Dr. Talei’s words, you can’t get it back. “Even though during the healing period with a bullhorn lift you have more stitches that are visible, in the long term, the incision heals much better, much more naturally to the eye than going inside the nose and coming back out,” says Dr. Liotta.
Further amplifying the scarring and also shifting the nasal base was the way the skin was anchored. Skin was stretched and stitched onto skin, creating tension. Today, that tension is released by securing the skin onto ligaments that surround the bones at the base of the nose. “The name of the game is controlling the scarring which changes the base of the nose,” says Dr. Talei. Because this is now a tension-free lift and because the incision is made in the natural creases of the nose, the scarring is virtually undetectable and the base of the nose remains unaltered.
Bullhorn lift. Photos: Dr. Jacono
Bullhorn lift. Photos: Dr. Jacono
Bullhorn lift. Photos: Dr. Talei
Bullhorn lift. Photos: Dr. Talei
Bullhorn lift. Photos: Dr. Talei
Bullhorn lift. Photos: Dr. Talei
Bullhorn lift. Photos: Dr. Talei
Bullhorn lift. Photos: Dr. Talei
“It all has to do with technique,” says Dr. Jacono, “but results also depend on the doctor’s aesthetic sense.”  If a doctor doesn’t have a good sense of aesthetics, warns Dr. Jacono, and removes too much skin, you can’t reverse that. “You can always go back and take a little bit more, but you can’t put it back in when you’ve taken away too much.”

A very subtle option in lip lifts is a modification on the bullhorn procedure. Called an Italian Lip Lift, this method creates two shorter incisions underneath the nostrils. Because the incisions do not go across the base nose, this operation has the advantage of producing a more limited scar. “It looks pretty. It looks extremely natural,” says Dr. Jacono, “but it does not lift the center or cupid’s bow part of the lip.”
The Italian lip lift: two short incisions are made underneath the nose creating a subtle lift on the sides of the mouth. Photo: Lamperti Plastic Surgery.
Italian lip lift. Photos: Dr. Jacono
Italian lip lift. Photos: Dr. Jacono
A delicate lift is also achieved with a Corner Lip Lift. Usually requested by older patients, this procedure corrects persistent drooping at the corners of the mouth via the removal of two triangular slivers of skin. According to Dr. Jacono, “The Corner Lip Lift provides an alternative to patients who desire a more permanent solution to the management of deep oral commissure grooves (grooves at the corner of the mouth that drift down towards the chin, often referred to as a drool groove).” Care must be taken to place the incisions along the vermillion border of the lip.
The Corner Lip Lift raises downturned corners. Photo: Lamperti Plastic Surgery.
Corner lip lift. Photo: Dr. Jacono
On the other end of the subtlety spectrum is the V to Y lip augmentation. It is effective for those who have ample tooth show, but thin lips. With this type of augmentation, incisions are made inside the lip, rolling it out from the inside out, creating pillowy corners. This procedure can be performed on both the top and bottom lips.

“The V to Y lip augmentations is for patients who want more of an Angelina Jolie look,” says Dr. Jacono who does not recommend this procedure to the majority of his patients. For one thing, the recovery is lengthy – 4 to 6 weeks due to the considerable swelling. For another, the results are dramatic. “Generally speaking,” says Dr. Jacono, “a woman who’s trying to fly under the radar, who’s from the Upper East Side, does not want a V to Y lip augmentation.” It is mostly young patients who request this procedure. “I think young patients are in it for the bigger is better: bigger breasts, bigger butt, bigger lips. They do a little bit too much!” declares Dr. Jacono.
Before and after V to Y lip augmentations. Photos: Dr. Jacono
A V to Y lip augmentation. Photos: Dr. Talei
Additionally, there is the Gull Wing Lift. As with the Bullhorn Lift, the lip is raised via the removal of a strip of skin. The incision here, however, is placed all along the vermillion border of the lip. But this lift leaves a visible scar and consequently,  is not as desirable.
The incision in a Gullwing lift is placed along the vermillion border. Photo: Lamperti Plastic Surgery
Gullwing lip lift. Photos: Dr. Jacono
And lastly, on the surgical front, there’s the option of using tissue from your own body to augment the lips. This does not involve fat injections which are temporary for the majority of patients as the fat gets reabsorbed. With this procedure, a strip of tissue is removed from the face during a facelift or from a C section and pulled through the lip via a small cut in the corner of the mouth. This is a very common procedure to do in combination with a facelift, reveals Dr. Jacono. When taken from the face, it’s called a SMAS — Superficial Musculo-Aponeurotic System — graft.
SMAS lip augmentation. Photos: Dr. Jacono
SMAS lip augmentation. Photos: Dr. Jacono
When a C section incision is used to remove tissue, the procedure is called a dermal fat graft. The block of tissue removed is similar to the SMAS. If the patient doesn’t have a C section scar, a small linear incision is made above the pubic region. This type of graft “creates a natural fullness to the lips that looks normal. It’s your own body tissue and it’s permanent,” explains Dr. Jacono. But, you don’t have to choose a dermal fat graft over a lip lift. “It depends upon what the goals of the patient are.”
Dermal fat graft lip augmentation. Photos: Dr. Jacono
Lip lifts are 30 to 45-minute in-office procedures performed under local anesthesia. Expect a fair amount of swelling for about a week. You may also experience some tightening for 6 to 8 weeks, but the area won’t look restricted says Dr. Jacono. Costs in New York and Los Angeles vary from about $4,000 to $8,000.
Dr. Dara Liotta: “Before you talk about doing a lip lift, I like to try the Botox Lip Flip for people because that augments the volume on the top as opposed to filler which can give you weight and pull down the lip.”
So, you think you may benefit from a surgical lip lift, but are afraid to take the plunge? A Botox Lip Flip provides a temporary lift to the lip that will give you an idea of the results you can expect with a more permanent solution. “Basically, what you’re doing with a lip flip is using Botox’s ability to relax the very top layer of the orbicularis oris, the muscle around the mouth,” informs Dr. Liotta.  Botox injections on the vermillion border serve to roll the lip gently outward, flipping out the lip line. The perfect candidate, according to Dr. Liotta is someone with thin lips which disappear when they smile.
With the Lip Flip, Dr. Dara injects Botox at 4 different point along the vermillion border.
But would Botox in the lip impair normal function? “Would I drool as I’m eating, for example, or would I be able to drink through a straw?” I ask the surgeon. That muscle around the mouth is very thick, explains Dr. Liotta, so relaxing a little bit of the surface won’t compromise the function of the lips, like pursing or smiling. “You’re relaxing just the little fibers that interdigitate with the skin around the lip line and allow it to flip outward a little bit and increase the volume of the upper lip.”

As for the amount of lift achieved with a Lip Flip, it depends on the individual’s anatomy, but patients can expect to see a rise of between 2 to 3 millimeters. Results last between 3 to 6 months and the cost is $300.  All in all, those looking for a natural looking pout are in luck for subtle lip lifting techniques to suit a variety of budgets and anatomies abound.
Expert tip: “An easy way to help add definition and drama to the eyes is to step up your eyelash game,” advises Dr. Liotta.  “Longer, thicker, darker eyelashes without mascara or extensions are magical.  I use Talika Lipocils Expert Platinum Day and Night serum.”

For more beauty tips and information, follow Delia on Instagram: @chasingbeautywithdvn