Does my bottom lip protrudes out too much, or does my upper lip not protrude enough? What can I do? (photo)

Question

I would like your honest opinions if you think I should have anything changed, and if so, what it should be?

Michael Kulick, MD, DDS · Answer

Having lip asymmetry is a very common concern. The most common agent that is used to fill one's lips is hyaluronic acid, a compound that allows for a natural fullness and exists in owns body already. Other fillers include one's own fat. I'm not a advocate of the later is that it's resorption is variable and the fat that survives may change with one's body weight. You do not want your lip size to change if you gain weight! 
Another option to consider is to have a more lasting lip augmentation result. The web link provided shows some long term, 3-4 year results using a dermal augmentation where there was such asymmetry as yours. Look at case # 2958. 
Hope this helps.
Michael Kulick MD, San Francisco, Ca
ASAPS, ASPS member 
Recipient of the Klingbeil Award from ASAPS = Teaching Safe Techniques and Advanced Technologies

Janet Allenby, DO · Answer

Hello,Thank you for your question and picture. Without seeing the entire area, it is difficult to give an opinion. Based on the picture, it looks like you have symmetrical lips, so you may just want to make a change based on preference. Please consult with a local physician to determine the best course of action. Good luck!

Jacqueline Anne Luong, MD · Answer

Sam, Before investing money in your lips, I would consult an oral surgeon or orthodontist for evaluation of your bite. To me, it almost looks like your maxilla (the upper jaw) does not project adequately. They would be able to identify such an issue and offer options for correction. 
Good luck, Dr. Luong

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  From the profile photo, the lips do not seem to be an issue however the chin itself is very weak.  I have performed many facial shaping procedures, including Chin Augmentation with dermal fillers or silastic chin implants, for over 30 years.  When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy, the lower face looks short, de-emphasizes the lips and allows early formation of a "double chin".  
 Proper placement of a silastic chin implant adds forward projection to the chin thereby creating harmony and balance to the lower face.  Using the same incision, liposuction can be performed to reduce the fat and further shape the neck.  Excess skin, from below the chin, can also be removed through the same incision.  
 I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty (requires extensive tissue dissection, bone cuts and placement of metal screws and plates to secure the cut segments of bone).  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.  
 When consulting with surgeons perhaps ask not only is your chin weak but do they have experience performing chin augmentation?  The selection of the proper size, shape and thickness as well as the proper placement of the silastic chin implant are all "key" elements in creating a naturally looking chin.  If too large of an implant is used in a woman, the chin can look relatively masculine.  That's where experience, performing chin implant surgery, comes into play.  There are numerous shapes and sizes of silastic chin implants, some of which are rather old shapes that do not yield the desired "natural" aesthetic results.  The Curvilinear shape is an example that is similar to the old "button" implants (had no wings or lateral tapering elements of the newer EAC design) that created a "pharaoh" shaped chin.  The EAC or extended anatomical chin implant style offers, in my experience and humble opinion, the most natural, aesthetic result when augmenting the chin.   I prefer placement of a  silastic chin implant through a small, curved incision under the chin (submental) instead of through the mouth for the following reasons:
*The submental approach is sterile while the intra-oral approach is not.
*The submental approach requires limited dissection as it is much closer to where the chin implant needs to be placed along the center (front) and lower most sections of the chin on each side (where the wings are placed).  The intra-oral approach by contrast requires dissection all the way down the entire section of the chin in order to reach the same areas for chin implant placement.  The intra-oral leads to several issues in my humble opinion.  The attachment of the chin muscle to the bone must be cut during the tissue dissection, the sensory nerves (mental) and motor nerves (marginal mandibular nerve) that move the muscles of the lips and mouth) are all in much greater jeopardy of injury because of the added dissection required.
 In my opinion and experience there is no need to secure a silastic chin implants with sutures and screws when the following conditions are met:
 * Select a silastic chin implant ( I prefer the EAC) that doesn't have too much projection (thickness) as this becomes a problem stabilizing the implant under the periosteum when the implant is too thick.
 * Place the implant through a small curved incision under the chin which allows direct access to the periosteum (under the mentalis muscle) while preserving the muscle attachments.  This prevents upward migration of the implant which can occur when the intra-oral approach is used that severs the muscle attachments.
 * While the center or body of the chin implant should be placed at a perpendicular angle the chin bone in order to provide the proper forward projection to the chin, the "wings" of the implant should be at a lower level and follow the inferior (bottom) edge of the jaw line on either side of the chin.  When properly dissected and placed, this will be below the mental nerve foramen and be just wide enough of a dissection to accommodate the tapering wing.  There isn't enough room in this technique to allow the wings to migrate upward and contact the mental nerve.  In contrast if the dissection, along the sides of the chin (jaw line) are performed too high...this will place the mental nerve in danger and if the side dissection is too wide, the wings will have a space within which to migrate upward.
 * We have all of our chin implant patients avoid touching and feeling their chin implant for 1 month post op.  We also ask that they sleep on a U-shaped airline pillow for the same time.
  Our experience when following the technique described above is that the silastic chin implant does not need to be secured with sutures or screws and does not move.  I have placed silastic chin implants in military, SWAT, LE, professional fighters, as well as actors and many regular people who are active.  In addition, I have had the opportunity on numerous occasions to replace silastic chin implants (placed by others) that had been screwed into the bone.  During the replacement it was evident that the metal screws pushed right through the soft silastic implant as it was tightened down on the hard chin bone.  Which makes perfect sense.  So in the long run, these fixation methods alone are no guarantee that the implant won't move.  Proper placement, proper implant pocket creation and meticulous closure of all the tissues layers is what is required in my humble opinion.  Which is better, chin implant or sliding genioplasty.  We place silastic chin implants through a small, curved incision under the chin using local anesthetic in 30 minutes or less.  This is "far" less invasive than a sliding genioplasty that requires cuts in the bone with plates or screws.  For that reason and because the aesthetic results are so good with a properly placed silastic chin implant of the correct shape and size...in my humble opinion there's no comparison.  The chin implant is quicker, easier, with far less surgery and healing, less unwanted side effects with results that are highly effective and reliable.Hope this helps.

Tom Jodlovich, MBBS, MPH (license suspended) · Answer

Thank you for your question and submitted photo.
While there is substantial variation in the amount of volume and protrusion desired by patients for their lips, I would recommend given your self awareness of your lips, that an improvement in both volume and protrusion to your lips can be achieved using the correct dermal filler and injecting technique. I would recommend administering the correct amount of dermal filler to both your upper and lower lips.
I recommend that you consult an experienced and highly trained practitioner.
Best wishes.

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