Lip Enhancement
Stuff@night Magazine - December 5, 2001

Quick, what do Julia Roberts, Angelina Jolie, and Pamela Anderson have in common? Not sure? What if I added Mick Jagger and hometown favorite Steven Tyler to that list?

The answer, of course, is memorable lips.

Now, I can’t be certain that lip appearance is the primary source of their celebrity, but it certainly hasn’t hurt. After all, lips are a prominent facial feature, and a primary means by which we express our emotions. Smiling lips, frowning lips, pursed lips, puckered lips – each tells us something different; we get important nonverbal communication by watching the lips (and that’s just the start of why lips are important to us). Obviously, such an important and expressive body part commands attention.

Unfortunately, not everybody was born with the lips they deserve. You may feel youthful, energetic, and sensual but have thin lips that convey stern, strict, or angry. And, cosmetics can only go so far despite your best efforts with liner pencils and lipstick tricks. So how can you get pouty, kissable, full, soft, gentle, luscious, bee-stung (you get the picture) lips?

The key to lip enhancement is to maintain natural shape and softness, just more sensual, and fuller. There are many available methods, which range from (relatively) inexpensive and quick with minimal recovery (although temporary augmentation), to expensive and requiring a few days off (but possibly with permanent results).

One of the most common approaches is to inject a filler into the lips. Choices are plentiful now, and range from bovine (animal) derived collagen, to human derived collagen, to synthetic materials (polymers, silicone), to fat cells, and new products appear all the time. Most of the synthetic injectable fillers are not approved for use in the United States, and while they usually provide a permanent change, if you don’t like the results it is difficult (or impossible) to undo. For these reasons, most surgeons choose to recommend the temporary collagen injections.

The key with any material is placement into the correct location. Your lips have several different parts. For example with the upper lip there is the red area, the skin colored area rising towards your nose, and the border between the two where red turns to skin color. This border is called the vermilion border and should have a bit of projection and roll to it. Lack of projection of the vermilion border contributes to the appearance of flat, droopy, or thin lips. Thus, one of the first places a cosmetic surgeon will place the injectable material is into this border. Now if you look closely, you’ll notice that the vermilion border changes shape in the middle and the overall appearance of the upper lip vermilion border resembles that of an archer’s bow. In fact, the natural shape of this border is often referred to as having a “cupid’s bow” appearance. An experienced physician will avoid significant injection into the center of the cupid’s bow as it can distort that natural shape and make lips look unnaturally swollen, rather than soft and full. Injections may also be placed into the red of the lip after the border has been augmented in order to further increase the fullness.

Collagen comes in different formulations (as you know, we’ll talk about that some other time), but all of them are temporary. Many people can have results last 4 months, but for some the effect may seem to wear off in as little as 6 weeks. Fat injections involve placing fat cells (taken from your thigh or belly) into your lip and hoping that they develop a new blood supply and stick around forever providing a natural enhancement. For some people this works great with one try, but usually some of the cells “take” and some don’t so you need to repeat the procedure in order to get a long lasting good appearance. With most injections you’ll be swollen for several hours after the procedure, so the size of your lips when you leave the doctor’s office is bigger than what you’ll end up with. And, in most cases the injections hurt (after all, think how sensitive your lips are). You’ll really feel like you have “bee-stung” lips for a while! Fortunately, there are ways to make the procedure much more comfortable and local anesthesia can be given if you want.

If you know you like the look of enhanced lips, but dislike the regular injections, more permanent (or permanent) implants can be placed. These are implanted in the office and are a minor surgical procedure (you get a very small hidden incision, and usually have 2-4 stitches). Lips can be quite swollen afterwards for several days, so don’t plan a big night out for the same day as your surgery. The implants range from strips of your own skin and fat, to scars from other parts of your body, to human derived processed skin, to synthetic materials. The synthetic materials are the most reliably permanent, but require more experience to place correctly.

In some cases other less common procedures may be recommended. These include removing a bit of the skin above your lip to make more of the red lip visible, advancing the lips by incisions within your mouth, and even having a skilled medical tattoo artist add some color to increase the visible red of the lip (the tattoos should only be done after having augmentation of the lip roll). These techniques may sound odd, but for the right person they do work well – and they’re not as strange as some of the lip enhancement products you can buy. If you look, you can find a “pump” which applies a vacuum to your lips and makes them swell for up to six hours. There are even lip balms which contain hot pepper oil or other irritants to make your lips swell. And, some people will vigorously massage their lips before social situations. These last three methods are very short lasting, and could even cause bruising or other problems (not to mention seeming a bit silly).

So, what do Angelina Jolie, Julia Roberts, and the others do? Well, I don’t know (at least, I don’t know for all of them), but a good cosmetic surgeon can tell you how to get where they are – lipwise, anyway…

Jeffrey Spiegel, M.D. is a Facial Plastic and Reconstructive Surgeon at Boston Medical Center and teaches at Boston University School of Medicine. Feel free to contact Dr. Spiegel about this procedure.