PICTURE A BEAUTIFUL PAINTING—a colorful and intricate Van Gogh or an idyllic garden scene by Monet. Proper display of fine art accentuates the work without distracting from it; an appropriate frame completes the picture.
The relationship between a smile and the surrounding lips is the same. The two individual elements should complement one another for a balanced, harmonious look.
Lips come in many shapes and sizes, and each pair can be esthetically pleasing in its own way. Furthermore, what people consider attractive can vary. I treat many patients who present with perfectly “normal” lips, yet they desire to correct small asymmetries and imperfections or to achieve fuller, more prominent lips. Regardless of societal influences, lips that appear aged, congenitally underdeveloped, or asymmetric can adversely frame the smile and therefore the completion of the picture.
In a youthful lip, the ideal vertical height ratio of the upper lip to the lower lip is 1:1.6. This fits within the framework of the golden ratio (or phi), 1:1.618, which is commonly noted in measurements of beauty and symmetry (figure 1). The cutaneous upper lip houses the philtral columns that serve to support the peaks of the cupid’s bow and connect the nose to the lip. The vermilion border has a gentle slope, demarcating it from the cutaneous portion of the lip. The bodies of the upper and lower lips appear full and hydrated.
Figure 1: Symmetrical, youthful lips
In an aged lip, the landscape changes noticeably, and many of the esthetic features of a youthful lip are lost (figure 2). The upper cutaneous portion of the lip lengthens, diminishing the philtral columns and losing the well-defined vermilion border of the upper lip. Most lips will now show radial wrinkles (or rhytids) due to intrinsic factors of aging, such as loss of collagen and elastin and the long-term effects of sun damage, smoking, and the contraction of the orbicularis oris muscle that has pursed the lips for years, leaving its mark in the thin overlying skin. A flattening of the cupid’s bow is observed, along with generalized volume loss throughout the bodies of the upper and lower lips. The process does not always occur symmetrically, so one side of the lip may be affected more than the other.
Figure 2: Aged lips
Whether I am augmenting aged or youthful lips, I always follow some basic tenets. It’s imperative to keep in mind the ideal proportions and anatomy of the lips to guide your dermal filler placement. I work exclusively with dermal fillers made from hyaluronic acid—a glycosaminoglycan distributed widely throughout the extracellular matrix of the entire body—because of their soft and natural texture, their relative ease of use, their excellent safety profile, and their reversibility with hyaluronidase. The hyaluronic acid fillers I commonly inject in the lips include Juvéderm Ultra, Juvéderm Plus, Juvéderm Volbella, Restylane-L, Restylane Silk, and Belotero. While all can be used to achieve similar results, I may choose one filler over another depending upon the amount of augmentation required in the vermilion border, the vertical dimension of the lips (a greater vertical dimension can more easily hold a more substantive hyaluronic acid filler such as Juvéderm Plus), and of course, the patient’s desires and expectations.
Case examples
Case No. 2: Pretreatment (left) and post–Invisalign and lip augmentation with Juvéderm (right). Note the improvement of the upper lip's proportions and the enhanced balance with the lower lip to frame the smile.
When patients pursue esthetic improvements in their smiles—such as reducing visible wear, correcting staining and discoloration, improving alignment or tooth shape and size—they are seeking to improve their facial artwork and achieve a natural, youthful appearance. By restoring the teeth, we have a unique opportunity to make a dramatic change for our patients. But just as an appropriate frame can enhance fine art, we should not ignore the lips framing the masterpieces we create for our patients. If the lips and surrounding areas have seen the effects of aging, or if they are youthful but have asymmetries or underdeveloped elements that could be improved, there will be disharmony between the lips and a bright, youthful smile. Only when the lips and perioral areas match the new smile are we able to attain a cohesive and balanced look. Our dentistry can help achieve a gorgeous smile, but ensuring that the lips match what they’re framing is the cherry on top of a beautiful case.
Editor's notes: This article is the second in a series about facial injections in the dental practice. The first installment appeared in the September 27 issue of Pearls for Your Practice: The Product Navigator. Click here to subscribe to the Product Navigator. Click here to submit a products article for consideration.
Tracy Shaw Blessing, DMD, maintains a private practice in Miami Beach, Florida. She provides Botox and dermal filler seminars, certification courses, original marketing, and media and consulting services. To learn more about small-group and private training opportunities, contact her at [email protected], or visit her website at tracyshawblessing.com.
