Options for Defining a 'Flat' Upper Lip

Question

I have a problem with my lips. The bottom one is fine but the top lip is pretty flat and has no shape to it. It does not have the youthful/sexy indent or definition. Basically it is almost as flat as my bottom lip. Is there a surgery to permanently change this....I am content with the size of my lips but not the shape. Would I be a canidate for a small lip implant?

Ross A. Clevens, MD, FACS · Answer

You can choose either a lip implant OR a surgical lip augmentation.

	If you choose a "permanent" implant, there are numerous substances that I commonly use as a graft or implant material in the lips. Each option has its own advantages and disadvantages.

	
		AlloDerm is a popular human-donor grafting material that is FDA approved and proven safe in lip augmentation and facial reconstruction. Under a local anesthesia, the material is inserted through tiny incisions made in the inside corners of the mouth. Delicate absorbable stitches that dissolve are used. The material is often absorbed, so that the results are only temporary, lasting from 12-18 months. This procedure takes about 15 minutes in the office under local anesthesia.
	
		Advanta and Gore-Tex have been shown to produce reliable and predictable results with few complications. These materials do not shrink and are never absorbed into the body making the procedure permanent. It also remains in place because scar tissue forms on both ends holding it in place. To insert Advanta and Gore-Tex, a small incision is made in the inside of the lip. The material is then made into the shape of a small tube and it is inserted with a needle.
	
		Fat grafting produces lasting results in most of the people who try it. Although it is possible that the body will reabsorb it, many people choose fat grafting because they are most comfortable with using the fat from their own body to enhance their lips. The fat is harvested from another area of the body, often the abdomen. It is then prepared and inserted with a needle into the lip from more than one point.
	
		SurgiSil is new to the market but promises a safe, definitive solution for permanent tissue augmentation.Surgisil is a patented, FDA approved device designed for tissue augmentation of the lips and has undergone extensive clinical testing to ensure its safety and efficacy. It is made of a soft, solid silicone elastomer using an injection molding process to produce a naturally contoured implant with a smooth, non-porous surface. The implant cannot rupture or deflate, and may be removed at any time. I have see great results with this product.


	If you opt for Lip Augmentation through a Surgical Solution, you will certainly have a permanent result.

	
		Surgical enhancement of the lips provides a permanent alternative to injections and implants.
	
		Surgical enhancement usually takes less than one hour to perform in office under local anesthesia.
	
		Careful and fine incisions are created to shape the lips into their desired shape and form.
	
		Direct Lip Lifting creates a fuller upper and/or lower lip with imperceptible incisions. This precise procedure allows the patient to state just how full you want your lip and that is where I can place the new lip line.
	
		As the lip ages, the corner of the mouth tends to droop. Other procedures such as the Corner of the Lip Lift enable the lip to be reshaped so that the frown can be improved and a youthful upturned lip can be achieved.
	
		Local flaps bring material from inside the mouth outside to enhance the lips. Results are permanent. An incision may be made inside the mouth to push the tissue inside the mouth upward, and outward, into the lip, sometimes in conjunction with grafting. Or, an incision may be along the upper lip line. In this case, skin above the lip is removed, and the lip is then stitched along the line of the incision.


	Being specific with the result that you are hoping for and consult with a Board Certified Facial Plastic Surgeon to determine what technique will be best for you. Best of luck!

	Dr. Clevens

Jeffrey J. Roth, MD, FACS · Answer

Thank you for the question.  My bias is not to have firm permanent substances, (silicone, etc.), in the face in general and the lips in particular.  Your face will change over time, and typically what you put in may have to be removed.  We have taken many implantable devices out of lips.  Some will do a nice job on the lip lift.  It is a surgical procedure, so it must be taken seriously.  My suggestion for now is to continue with the filler.  Best to see a Board Certified Plastic Surgeon or Otolaryngologist, (ENT).  They will help make a plan for you.

Douglas Wu, MD · Answer

While photos would be helpful, it is possible and easiest to reshape your upper lip using a hyaluronic-acid dermal filler such as Restylane Silk. If you like the look, you may want to move on to surgical implants. However, these may not give you the subtle and natural shape you desire. Please consult with a board-certified dermatologist to audition a new lip shape with Restylane or Juvederm.

Andrew P. Trussler, MD · Answer

The upper lip has 3 defined elevations where the lower lip has 2. The lower lip should always be larger than the top however many patients have a thin upper lip, either they were born that way or through aging. This thinning or elongation can cause flattening of the upper lip. This can be easily corrected with a combination of fillers and possible surgical shaping. I would have to see your upper lip before recommending an individual plan, but start with a hyaluronic acid gel filler like Juvederm, which can be used to shape the lip and add volume to it. After you have seen what this does I would add a permanent lip lift which can shape and elevate the lip with a small incision under the nasal sill. A graduated approach would be important so you can decide what you like and remember that some of these steps are reversible. Permanent lip implants have a high rate of scarring and stiffness, and the last thing you need is a stiff upper lip! Let me know if this helps. Dr. Trussler

David Hansen, MD · Answer

Lip implants come in various sizes, shapes and types whereas we can easily customize them to what you want for $1500-2000 per implant and take about 20 minutes to put in under local anesthesia.  Sincerely,

	David Hansen,MD

Mohsen Tavoussi, MD, DO · Answer

In order to reshape to lip you will need surgical lip lift. Filler can achieve some degree of reshaping if done correctly. They will enhance what you already have and sometimes that is all you need. Implants add volume and do not usually reshape the lips.

Barry L. Eppley, MD, DMD · Answer

When it comes to adding volume to a lip, there are a wide range of options from fillers to actual lip implants. But the first place to start is to determine if adding volume to the upper lip will create the look you are after. Therefore, get a temporary lip injection treatment first using all of the fillers that are composed of hyaluronic acid compositions, such as Restylane or Juvederm. If that achieves the desired lip result then you can consider whether you want to continue with temporary fillers and something more permanent like an implant.

S. Randolph Waldman, MD · Answer

I have tried all of the different methods including the use of permanent implants, surgical augmentation with lip lifting and lip advancement, and use of fat or fascia. Yet I still believe use of HA's (Hylauronic Acid fillers) is still the very best option in the right hands. Make sure that your injector is an experienced aesthetic physician, has a good eye for beauty, and has all of the "tools" in their "tool box".

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

Pictures, of your upper lip, would help.  You can use fillers like Restylane or Juvederm to fill in the lip border or lip augmentation implants like Alloderm or silastic....all work very well.

Mitchell Schwartz, MD - Account Suspended · Answer

Juvederm or Restylane are the best options for lip enhancement. Injectable fillers have many advantages over implants. One obvious advantage is that surgery is not required. Another is that you can get either a rapid or a gradual correction depending upon how many syringes you have injected and you can decide as you go exactly how much correction looks good. Also, as your face ages it changes over the years, touch up treatments are constantly being modified to fit the changing face. Please remember, your results depend upon the skill and experience of your physician injector.

Options for Defining a 'Flat' Upper Lip

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