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Sturm A. Lip Lift. Otolaryngol Clin North Am 2022; 55:835-847. [PMID: 35750522 DOI: 10.1016/j.otc.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The perioral area can be an important feature to convey femininity, particularly when speaking and smiling. A feminine lip has a shorter distance between the nasal sill and the vermillion border, fullness of the vermillion, and a few millimeters of tooth show with the mouth slightly open. The keys to a good outcome are incision design that respects the natural anatomy, placing the tension of the lift deep to the dermis to take tension off of the skin incision, determining the appropriate amount of lift for the patient's anatomy, and not violating the orbicularis oris.
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Affiliation(s)
- Angela Sturm
- Private Practice; Department of Otolaryngology-Head and Neck Surgery, University of Texas Medical Branch, Galveston, TX, USA.
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Ding A. The Ideal Lips: Lessons Learnt from the Literature. Aesthetic Plast Surg 2021; 45:1520-1530. [PMID: 33649926 DOI: 10.1007/s00266-021-02190-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/07/2021] [Indexed: 11/26/2022]
Abstract
Defining the ideal dimensions and proportions of the human face has been attempted for centuries, popularised in the Renaissance period by artists including Leonardo Da Vinci. The lips are part of the lower third of the face and are central to lower face aesthetics and the overall symmetry of the face. They also place an important part in conveying facial emotions and expressions. Full lips with well-defined Cupid's bow have always been associated with youth and beauty. The approval of hyaluronic acid use for tissue augmentation and the prevalence of social media have caused an exponential increase in lip augmentation procedures (Linkov et al. in Arch Plast Surg 46(3):248-254, 2019), as such researchers and aestheticians have focused on characterising the ideal lips mathematically to help guide clinicians. This narrative review will summarise the available evidence in the literature pertaining to the ideal lips, taking into account age, ethnicity and gender differences. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Anni Ding
- Department of Otolaryngology, Torbay Hospital, Newton Road, Torquay, TQ2 7AA, UK.
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Alarbeed S, Jaafo MH. Analysis of upper lip appearance after surgical lip augmentation procedure "VY in VY": Progress of results. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:248-256. [PMID: 33771741 DOI: 10.1016/j.jormas.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/27/2021] [Accepted: 03/12/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Many materials and techniques were used for lip augmentation, whereas in the last years all attention is paid for filling material, and long-lasting surgical techniques were ignored. MATERIALS AND METHODS This study includes 12 candidate patients for upper lip augmentation; all are females, their age range 21-24 years. Standardized anterior and lateral photographs of each subject were taken at: preoperative, 2, 4, and 12 months later, and were analysed using digital imaging software to quantify postoperative changes. We used t-test of correlated samples to detect any statistical significance and Interclass correlation coefficient test (ICC) for reliability that proved the reliability and reproducibility of our method. RESULTS there were statistically significant improvements in al parameters that characterize the fullness of the upper lip. These changes was observed from the 2nd month (P<0.05) and continued improving until the 4th month (P<0.05), after that they appeared to be stable (P>0.05). These changes were at the 12th month postoperative in: upper white lip (-9%), upper red lip (53%), upper red lip area (63%), protrusion (41%) and nasolabial angle (-7%). There was no statistical significance in the change of Cupid's bow curvature (P-value = 0.104 > 0.05). CONCLUSIONS VY in VY for upper lip augmentation improves the parameters that define the youthful and fully appearance of the upper lip and the progress of results may be predictable. These improvements appear to be stable from the 4th month. Also, it doesn't change the Cupid's bow curvature.
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Affiliation(s)
- Shadi Alarbeed
- Department of Oral and Maxillofacial Surgery, University of Damascus Dental School, Mazzeh Highway, Damascus, Syria.
| | - Mhd Hassan Jaafo
- Department of Oral and Maxillofacial Surgery, University of Damascus Dental School, Mazzeh Highway, Damascus, Syria
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Jeon FHK, Griffin M, Varghese J, Butler PEM. Oro-facial fibrosis in systemic sclerosis: a reconstructive journey. BMJ Case Rep 2020; 13:13/10/e236663. [PMID: 33040038 DOI: 10.1136/bcr-2020-236663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Oro-facial fibrosis presents a significant disease burden in patients with systemic sclerosis, but there remains no established treatment modality. Autologous fat grafting is a minimally invasive surgical procedure that is now increasingly recognised for its regenerative capacity, propagating an expansion of heterogeneous indications beyond volume restoration, including fibrotic diseases such as systemic sclerosis. We present a 42-year-old woman with oro-facial involvement of systemic sclerosis leading to severe limitation in mouth opening and closure, with marked retraction of the lower lip and gingival display. We describe the reconstructive journey over a 12-year period, where the antifibrotic effect of autologous fat grafting served as the basis on which a series of surgical procedures were performed to achieve functional and aesthetic improvement. Autologous fat grafting provides a novel treatment modality for oro-facial skin fibrosis, previously considered a non-treatable disease manifestation of systemic sclerosis.
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Affiliation(s)
- Faith Hyun Kyung Jeon
- Division of Surgery & Interventional Science, University College London, London, UK .,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Michelle Griffin
- Division of Surgery & Interventional Science, University College London, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Jajini Varghese
- Division of Surgery & Interventional Science, University College London, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
| | - Peter Edward Michael Butler
- Division of Surgery & Interventional Science, University College London, London, UK.,Charles Wolfson Centre for Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK.,Plastic & Reconstructive Surgery, Royal Free London NHS Foundation Trust, London, UK
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Gomi T, Imamura T. Comprehensive histological investigation of age-related changes in dermal extracellular matrix and muscle fibers in the upper lip vermilion. Int J Cosmet Sci 2020; 42:359-368. [PMID: 32274802 PMCID: PMC7496161 DOI: 10.1111/ics.12622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/02/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Few histological studies have directly examined age-related changes within the lips, although non-invasive investigations of such changes are increasing. Therefore, this study aimed to provide histological and molecular data on age-dependent alterations in the vermilion. METHODS Upper vermilion specimens from 15 female Caucasian cadavers (age range, 27-78 years) were investigated histologically or immunohistochemically. RESULTS Histologically, age-dependent decreases in areas occupied by hyaluronan and collagenous fibres in the dermis of upper vermilion were demonstrated. Elastic fibre content varied widely between individuals. The area occupied by muscle fibres in the orbicularis oris muscle region within the vermilion also correlated negatively with age. Immunohistochemically, signals of four proteins were attenuated in vermilion from older individuals compared with young individuals: procollagen type I, hyaluronan synthase (HAS)1, myosin heavy chain (MYH)2 (a component of fast-twitch oxidative muscle fibres) and MYH7 (a component of slow-twitch muscle fibres). In contrast, signals of cell migration inducing hyaluronidase 1 (CEMIP) were intensified in vermilion from older individuals. No marked differences between young and older individuals were seen in procollagen type III, HAS2, HAS3, hyaluronidase (HYAL)1, HYAL2, MYH1 or MYH4. CONCLUSION Age-dependent decreases of hyaluronan in the dermis of vermilion were prominent, possibly due to both the decrease in synthesis (HAS1) and the increase in degradation (CEMIP). Furthermore, age-dependent decreases in collagenous fibres and two types of muscle fibre in the vermilion were also identified histologically. Type I collagen, MYH2 and MYH7 appear to represent the molecules responsible for these respective decrements.
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Affiliation(s)
- T Gomi
- Cell Regulation Laboratory, Bionics Program, Tokyo University of Technology, Graduate School of Bionics, Computer and Media Science, 1404-1 Katakura, Hachioji, Tokyo, 192-0982, Japan.,Frontier Research Center, POLA Chemical Industries Inc, 560 Kashio-cho, Totsuka-ku, Yokohama, Kanagawa, 244-0812, Japan
| | - T Imamura
- Cell Regulation Laboratory, Bionics Program, Tokyo University of Technology, Graduate School of Bionics, Computer and Media Science, 1404-1 Katakura, Hachioji, Tokyo, 192-0982, Japan
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Application of a Layered Muscle Flap Technique for the Reconstruction of the Cupid's Bow and Vermilion in the Repair of Secondary Cleft Lip Deformities. J Craniofac Surg 2020; 30:e723-e727. [PMID: 31261342 DOI: 10.1097/scs.0000000000005714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
In the repair of unilateral cleft lip, the Cupid's bow, and vermilion on the affected side are sometimes lowered excessively. Methods involving skin and mucosa flaps have been used to correct this issue, but they pose some risk of scarring. The authors here describe a layered muscle flap technique that was based on the anatomical research of nasal-labial muscles, especially the levator labii superioris alaeque nasi muscle. This technique can be used to suspend the Cupid's bow and vermilion in secondary unilateral cleft lip repair. Forty-five patients with secondary unilateral cleft lip with excessively lowered Cupid's bows and vermilion on the affected side were included in this study, which lasted 3 years. These patients were treated using the layered muscle flap surgical technique. The heights of specific bilateral landmarks were measured on patient photos and used to define the symmetry of bilateral Cupid's bow and vermilion. The comparison between post-operative and pre-operative symmetries was used to evaluate the post-operative results, and most of them were satisfactory. The results were also mostly well retained in follow-up investigations. This layered muscle flap technique could be effective in selected cases.
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Kar M, Muluk NB, Bafaqeeh SA, Cingi C. Is it possible to define the ideal lips? ACTA OTORHINOLARYNGOLOGICA ITALICA 2019; 38:67-72. [PMID: 29756617 DOI: 10.14639/0392-100x-1511] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/27/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY The lips are an essential component of the symmetry and aesthetics of the face. Cosmetic surgery to modify the lips has recently gained in popularity, but the results are in some cases disasterous. In this review, we describe the features of the ideal lips for an individual's face. The features of the ideal lips with respect to facial anatomy, important anatomical landmarks of the face, the facial proportions of the lips and ethnic and sexual differences are described. The projection and relative sizes of the upper and lower lips are as significant to lip aesthetics as the proportion of the lips to the rest of the facial structure. Robust, pouty lips are considered to be sexually attractive by both males and females. Horizontal thirds and the golden ratio describe the proportions that contribute to the beauty and attractiveness of the lips. In young Caucasians, the ideal ratio of the vertical height of the upper lip to that of the lower lip is 1:1.6. Blacks, genetically, have a greater lip volume. The shape and volume of a person's lips are of great importance in the perception of beauty by humans. The appearance of the lips in part determines the attractiveness of a person's face. In females, fuller lips in relation to facial width as well as greater vermilion height are considered to be attractive.
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Affiliation(s)
- M Kar
- Kumluca State Hospital, ENT Clinics, Antalya, Turkey
| | - N B Muluk
- Kırıkkale University, Faculty of Medicine, ENT Department, Kırıkkale, Turkey
| | - S A Bafaqeeh
- King Saud University, Faculty of Medicine, ENT Department, Riyad-Saudi Arabia
| | - C Cingi
- Eskisehir Osmangazi University, Faculty of Medicine, ENT Department, Eskisehir, Turkey
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Goldman A, Wollina U. Polymethylmethacrylate-induced nodules of the lips: Clinical presentation and management by intralesional neodymium:YAG laser therapy. Dermatol Ther 2018; 32:e12755. [DOI: 10.1111/dth.12755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 09/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Alberto Goldman
- Clinica Goldman; Hospital Moinhos de Vento; Porto Alegre Rio Grande do Sul Brazil
| | - Uwe Wollina
- Department of Dermatology and Allergology; Städtisches Klinikum Dresden; Dresden Germany
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9
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A New Method for Reconstruction of Vermilion Deficiency in Cleft Lip Deformity. Plast Reconstr Surg 2017; 140:1251-1255. [DOI: 10.1097/prs.0000000000003889] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim SW, Rousso DE. Determining the 2-Dimensional Threshold for Perception of Artificial-Appearing Lips. JAMA FACIAL PLAST SU 2017; 19:392-398. [PMID: 28384792 DOI: 10.1001/jamafacial.2017.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Recognizing the perceptual threshold for artificial-appearing lips is important to avoid an undesirable outcome of treatment. Objective To characterize the quantitative measurements for the perceptual threshold of artificial- and unnatural-appearing lips. Design, Setting, and Participants Photographs of a female model's lips were digitally altered incrementally in 5 sets of features (the upper lip, lower lip, upper and lower lips, and shape of the Cupid's bow). From December 1, 2013, to January 30, 2014, participants viewed the photographs in random sequence using an online survey and responded to 2 questionnaires after each photograph. The participants were prompted to respond whether each altered photograph of the lips appeared to have received any cosmetic treatment, and whether the lips looked attractive and natural or artificial and unnatural. The measurement of each lip at which 50% of the observers perceived the lips as being treated and 50% of the observers perceived the lips as being artificial was determined. The difference in these 2 measurements was defined as dTA50, which represents the threshold differential between the perception of treated lips and artificial lips for 50% of the observers. Main Outcomes and Measures Survey responses of the participants to the appearance of the lips in the photographs. Results A total of 98 participants (76 females and 22 males; mean age, 42 years) provided usable responses to the survey. Each area of the lips had a unique quantitative measurement at which the observers perceived the lips as being treated and artificial. Enhancement of the upper lip alone had a narrower margin for artificial appearance (dTA50, 0.9 mm) compared with enhancement of both the upper and lower lips (dTA50, 1.5 mm). Any alteration to the Cupid's bow resulted in the narrowest margin for artificial appearance (dTA50, 0.3 mm). The difference in the perceptual threshold between the age of the observers was the most significant for the upper lip. Conclusions and Relevance The perceptual threshold for treated and/or artificial appearance is unique for each area of the lips. Level of Evidence NA.
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Affiliation(s)
- Sang W Kim
- Natural Face Clinics, Syracuse, New York
| | - Daniel E Rousso
- Rousso Facial Plastic Surgery Clinic, Birmingham, Alabama.,Department of Surgery, University of Alabama at Birmingham
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Popenko NA, Tripathi PB, Devcic Z, Karimi K, Osann K, Wong BJF. A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness. JAMA FACIAL PLAST SU 2017; 19:261-267. [PMID: 28208179 DOI: 10.1001/jamafacial.2016.2049] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Aesthetic proportions of the lips and their effect on facial attractiveness are poorly defined. Established guidelines would aid practitioners in achieving optimal aesthetic outcomes during cosmetic augmentation. Objective To assess the most attractive lip dimensions of white women based on attractiveness ranking of surface area, ratio of upper to lower lip, and dimensions of the lip surface area relative to the lower third of the face. Design, Setting, and Participants In phase 1 of this study, synthetic morph frontal digital images of the faces of 20 white women ages 18 to 25 years old were used to generate 5 varied lip surface areas for each face. These 100 faces were cardinally ranked by attractiveness through our developed conventional and internet-based focus groups by 150 participants. A summed ranking score of each face was plotted to quantify the most attractive surface area. In phase 2 of the study, 4 variants for each face were created with 15 of the most attractive images manipulating upper to lower lip ratios while maintaining the most attractive surface area from phase 1. A total of 60 faces were created, and each ratio was ranked by attractiveness by 428 participants (internet-based focus groups). In phase 3, the surface area from the most attractive faces was used to determine the total lip surface area relative to the lower facial third. Data were collected from March 1 to November 31, 2010, and analyzed from June 1 to October 31, 2016. Main Outcomes and Measures Most attractive lip surface area, ratio of upper to lower lip, and dimension of the lips relative to the lower facial third. Results In phase 1, all 100 faces were cardinally ranked by 150 individuals (internet-based focus groups [n = 130] and raters from conventional focus groups [conventional raters] [n = 20]). In phase 2, all 60 faces were cardinally ranked by 428 participants (internet-based focus groups [n = 408] and conventional raters [n = 20]). The surface area that corresponded to the range of 2.0 to 2.5 × 104 pixels represented the highest summed rank, generating a pool of 14 images. This surface area was determined to be the most attractive and corresponded to a 53.5% increase in surface area from the original image. With the highest mean and highest proportions of most attractive rankings, the 1:2 ratio was deemed most attractive. Conversely, the ratio of 2:1 was deemed least attractive, having the lowest mean at 1.61 and the highest proportion of ranks within 1 with 310 votes (72.3%). Conclusions and Relevance Using a robust sample size, this study found that the most attractive lip surface area represents a 53.5% increase from baseline, an upper to lower lip ratio of 1:2, and a surface area equal to 9.6% of the lower third of the face. Lip dimensions and ratios derived in this study may provide guidelines in improving overall facial aesthetics and have clinical relevance to the field of facial plastic surgery. Level of Evidence NA.
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Affiliation(s)
- Natalie A Popenko
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
| | - Prem B Tripathi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
| | - Zlatko Devcic
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
| | - Koohyar Karimi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
| | - Kathryn Osann
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
| | - Brian J F Wong
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Beckman Laser Institute and Medical Clinic, University of California, Irvine2Department of Biomedical Engineering, University of California, Irvine
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Richardson MA, Rousso DE, Replogle WH. Long-term Analysis of Lip Augmentation With Superficial Musculoaponeurotic System (SMAS) Tissue Transfer Following Biplanar Extended SMAS Rhytidectomy. JAMA FACIAL PLAST SU 2017; 19:34-39. [PMID: 27684045 DOI: 10.1001/jamafacial.2016.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance To our knowledge, long-term, objective results of lip augmentation using superficial musculoaponeurotic system (SMAS) tissue transfer beyond 1 year have not been previously described. Objective To evaluate the efficacy, longevity, and safety of lip augmentation using SMAS tissue transfer. Design, Setting, and Participants A retrospective single-blind cohort study was designed to evaluate all patients who underwent surgical lip augmentation using SMAS following rhytidectomy between January 1, 2000, and November, 16, 2015, at a private facial plastic surgery practice in Birmingham, Alabama. Preoperative photographs of each patient served as controls and were compared with postoperative photographs at 3 months, 1 year, and 5 years after lip augmentation. A total of 104 images (from 26 individual patients) were reviewed by 12 blinded observers using a validated lip augmentation grading scale. Exposures Lip augmentation using SMAS. Main Outcomes and Measures Median lip volumes of all patients at each postoperative interval (3 months, 1 year, and 5 years) compared with preoperative lip volumes. Secondary outcome measures included postoperative complications. Results A total of 423 patients were identified who underwent surgical lip augmentation using SMAS. Sixty patients with approximately 5 years or more of postoperative photographs were reviewed for complications. Twenty-six patients had 3-month, 1-year, and 5-year postoperative follow-up photographs and were included in the photographic evaluation. The mean age of these patients at the time of surgery was 54.6 years (range, 41.2-80.6 years. Fifty-nine of the 60 patients (98.3%) were female. Two of 60 patients (3.3%) with 5 years or more of postoperative follow-up developed complications requiring intervention. Both the superior lip and the inferior lip showed statistically significant increases in volume at 3 months, 1 year, and 5 years (P ≤ .004 for the superior lip after 5 years; P ≤ .001 for all other comparisons) after SMAS lip augmentation. The greatest median increase was observed in the superior lip at 3 months, while the smallest median increase was observed for the inferior lip at 5 years. The degree of increase in median volume seemed to weaken slightly over time, but remained statistically significant even at 5 years. Conclusions and Relevance SMAS lip augmentation is an effective and safe method for lip augmentation that can yield natural, long-lasting results with minimal risk. The degree of augmentation tends to fade slightly over time, but remains significant for at least 5 years postoperatively. Level of Evidence 3.
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Affiliation(s)
| | | | - William H Replogle
- Department of Family Medicine, University of Mississippi Medical Center, Jackson
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Lighthall JG, Fedok FG. Treating Scars of the Chin and Perioral Region. Facial Plast Surg Clin North Am 2017; 25:55-71. [DOI: 10.1016/j.fsc.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Lee KC, Perrino M. Alar width changes due to surgically-assisted rapid palatal expansion: A meta-analysis. J Orthod Sci 2017; 6:115-122. [PMID: 29119091 PMCID: PMC5655960 DOI: 10.4103/jos.jos_31_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A major objective of orthognatic surgery is the aesthetic outcome. Treatments only correcting for dentoskeletal deformities are not sufficient for optimal facial results because undesirable soft tissue changes may accompany skeletal manipulations. The primary objective of this study was to investigate alar base width (ABW) changes a minimum of 6 months following surgically-assisted rapid palatal expansion (SARPE). The following electronic databases and citation indices were searched: PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Virtual Health Library. The search included articles published until September 2015 without language restriction. The intervention was SARPE with maxillary vestibular incision from first molar to contralateral first molar, a modified LeFort I osteotomy with or without pterygomaxillary disjunction, and a V-Y closure. The primary outcome was the unstandardized mean difference between pre and postoperative ABW. A random effects meta-analysis was performed to combine study results, and included studies that were assessed for statistical heterogeneity using a Chi-square test for independence. The results of this meta-analysis (N = 41) showed a significant + 1.74 mm, 95% CI [0.14, 3.34] ABW increase in patients submitted to SARPE. There was no statistical heterogeneity among included studies (χ2 = 0.03; df = 2; P = 0.98). ABW increases were observed despite including cinched patients in the analysis. None of the three included studies were completely free of bias. The most prominent flaws were measurement bias, limited sample size, and patient recruitment.
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Affiliation(s)
- Kevin C Lee
- Division of Oral & Maxillofacial Surgery, Columbia University, College of Dental Medicine, New York, USA
| | - Michael Perrino
- Division of Oral & Maxillofacial Surgery, Columbia University, College of Dental Medicine, New York, USA
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16
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Systematic review of "filling" procedures for lip augmentation regarding types of material, outcomes and complications. J Craniomaxillofac Surg 2015; 43:883-906. [PMID: 25957105 DOI: 10.1016/j.jcms.2015.03.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The ideal lip augmentation technique provides the longest period of efficacy, lowest complication rate, and best aesthetic results. A myriad of techniques have been described for lip augmentation, but the optimal approach has not yet been established. This systematic review with meta-regression will focus on the various filling procedures for lip augmentation (FPLA), with the goal of determining the optimal approach. METHODS A systematic search for all English, French, Spanish, German, Italian, Portuguese and Dutch language studies involving FPLA was performed using these databases: Elsevier Science Direct, PubMed, Highwire Press, Springer Standard Collection, SAGE, DOAJ, Sweetswise, Free E-Journals, Ovid Lippincott Williams & Wilkins, Willey Online Library Journals, and Cochrane Plus. The reference section of every study selected through this database search was subsequently examined to identify additional relevant studies. RESULTS The database search yielded 29 studies. Nine more studies were retrieved from the reference sections of these 29 studies. The level of evidence ratings of these 38 studies were as follows: level Ib, four studies; level IIb, four studies; level IIIb, one study; and level IV, 29 studies. Ten studies were prospective. CONCLUSIONS This systematic review sought to highlight all the quality data currently available regarding FPLA. Because of the considerable diversity of procedures, no definitive comparisons or conclusions were possible. Additional prospective studies and clinical trials are required to more conclusively determine the most appropriate approach for this procedure. LEVEL OF EVIDENCE IV.
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17
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Moragas JSM, Vercruysse HJ, Mommaerts MY. “Non-filling” procedures for lip augmentation: A systematic review of contemporary techniques and their outcomes. J Craniomaxillofac Surg 2014; 42:943-52. [DOI: 10.1016/j.jcms.2014.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 01/03/2014] [Indexed: 10/25/2022] Open
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19
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Maloney BP, Truswell W, Waldman SR. Lip augmentation: discussion and debate. Facial Plast Surg Clin North Am 2012; 20:327-46. [PMID: 22910023 DOI: 10.1016/j.fsc.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Brian P. Maloney, William Truswell IV, and S. Randolph Waldman, address questions for discussion and debate:
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Affiliation(s)
- Brian P Maloney
- Maloney Center for Facial Plastic Surgery, Atlanta, GA 30328, USA.
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Wong WW, Davis DG, Camp MC, Gupta SC. Contribution of lip proportions to facial aesthetics in different ethnicities: a three-dimensional analysis. J Plast Reconstr Aesthet Surg 2010; 63:2032-9. [PMID: 20133215 DOI: 10.1016/j.bjps.2009.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 11/07/2009] [Accepted: 12/19/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lip augmentations are commonly performed procedures in the United States, with annual numbers surpassing 100 000. While lips contribute to facial beauty, the relative influence of this feature to whole facial appeal has not yet been established. What is also of increasing interest is the consideration of ethnic differences in the evaluation of beauty. However, most current anthropometric measurements refer to Caucasians, and their use in the treatment of Asian American patients would be inappropriate. METHODS Three-dimensional models of 197 male and female Caucasian, Chinese and Korean subjects were created using surface-imaging technology. The lips and corresponding faces from these models were ranked according to subjective aesthetic appeal by 20 male and female raters of various ages, occupations and ethnicities. The raters' results were subsequently compared with individually measured lip parameters. RESULTS Rankings between lips and their corresponding whole faces differed greatly. Lips that were rated as the most attractive were smaller than average in midline upper lip surface heights, bilateral paramedian lip surface heights, upper lip angles and volume in the lower lip. Both Asian groups exhibited significantly different lip parameters and lip-projection volumes from that of Caucasians. CONCLUSIONS The results from this study suggest that there are indeed measurable differences in the baseline Asian lip morphology as compared with Caucasians. Tailoring lip enhancement treatment to each individual's anatomy, ethnic background and personal goals can optimise outcomes. What is also of interest is that lips did not contribute as much to facial attractiveness as previously thought.
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Affiliation(s)
- Wendy W Wong
- Loma Linda University Department of Plastic Surgery, 11175 Campus Street, Suite CP-21126, Loma Linda, California, USA.
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Sawyer AR, See M, Nduka C. 3D stereophotogrammetry quantitative lip analysis. Aesthetic Plast Surg 2009; 33:497-504. [PMID: 18584237 DOI: 10.1007/s00266-008-9191-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Accepted: 05/16/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Reduction in lip volume is a stigmata of the aging face. There are many lip augmentation techniques but very few studies analyzing how these techniques change the three-dimensional structure of the lips. Furthermore, there is no consensus about whether the lip position should be standardized to either the lips closed or parted. The aim of this study was first to obtain a three-dimensional quantitative analysis of the lips in adults and to look for sexual dimorphism and, second, to compare whether more consistent measurements of the oral region can be obtained with the mouth open compared with it closed. METHODS Seventy young Caucasian volunteers underwent lip dimension analysis using 3D stereophotogrammetry with lips parted and closed. Parameters measured for consistency of results were linear distances (e.g., mouth width, total lip height, upper lip height), surface distances (e.g., upper vermilion), areas (e.g., vermilion upper and lower lip, total vermilion), and volumes (upper and lower lip volume, total lip volume). Analysis also compared lip dimensions between male and female subjects. RESULTS Consistent and reproducible results were seen with the lips closed compared with lips apart. All lip parameters (distances, areas, and volumes) were larger in men than in women. The following measurements had significant differences between males and females: mouth width, upper lip height median, upper white lip height median, upper white lip height lateral, lower vermilion surface distance, and area of vermilion (p < 0.05). CONCLUSION We present a novel technique for aesthetic assessment of the lips that is objective and achieves consistency with the lips in the closed position. Males have greater lip dimensions compared with females.
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The lip: a histologic and analytical approach of relevance to esthetic plastic surgery. J Craniofac Surg 2009; 20:726-32. [PMID: 19480032 DOI: 10.1097/scs.0b013e3181a14cfb] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This is a study done for the first time to understand the histologic features of the lip deeply, quantitatively, and analytically and identify the differences between the outer, intermediate, and inner parts of the lips. Previous researchers did not tackle the histologic features of the lip from this point of view. Half lip was obtained from different well-preserved cadavers where the upper lip, lower lip, and lip angle were evaluated by coronal histologic sections. A total of 43 slides were studied and photographed using light and digital microscopes (Nikon COOLSCOPE, Nikon Corporation, Tokyo, Japan), respectively. The cadavers (26 men and 17 women) were in the age group of 45 to 65 years old, and older than 65 years. Data were entered on a study pro forma and statistically analyzed. Normal histologic features of the upper lip, intermediate, and the inner lip sections were observed. Fibrous septations that sometimes had muscular components inserting into them could be identified. In between these septations, there were loose areas (chambers). The mean numbers of chambers identified in the upper and lower lips were higher in the red areas, and more septations and chambers were identified in the lower lip. New histologic observations were classified into types 1 to 7. Significant relations were identified between the total number of septations and chambers in relation to age group and sex. Higher means of septations and chambers were detected in the age group older than 65 years, and in women as a whole. In conclusion, the findings detected in this work could explain the congenital lip pits that are familial or syndromic and many post-lip augmentation complications.
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Jacono AA. A New Classification of Lip Zones to Customize Injectable Lip Augmentation. ACTA ACUST UNITED AC 2008; 10:25-9. [DOI: 10.1001/archfaci.10.1.25] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Andrew A. Jacono
- Section of Facial Plastic and Reconstructive Surgery, The North Shore University Hospital, Manhasset
- Division of Facial Plastic Surgery, The New York Eye and Ear Infirmary, New York
- The New York Center for Facial Plastic Surgery, Great Neck, New York
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Abstract
Orthognathic surgery, as it relates to the maxilla, attempts to correct underlying skeletal deformities as well as improve function. In addition, it has the potential to significantly alter the central aesthetic unit of the face, the nasolabial region. A key to achieving a good functional as well as aesthetic result involves both comprehensive surgical planning and an understanding of the effects that orthognathic surgery of the maxilla will have on the soft tissues within the nasolabial region. The LeFort I osteotomy is one of the most commonly performed techniques to correct maxillary dentofacial deformities. The effects of nasal and labial changes after a LeFort I osteotomy, including widening of the alar bases of the nose, changes in the nasal tip, and flattening and thinning of the upper lip, have been previously reported by other authors. This article will discuss the nasolabial region and discuss steps involved in performing a comprehensive aesthetic evaluation, as well how the LeFort I osteotomy may produce specific changes related to the external nasal morphology. In addition, emphasis will be given to the lips, and the effects of reduction and augmentation procedures will be discussed as they relate to the nasolabial region.
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Affiliation(s)
- Cassidy Mitchell
- Department of Plastic and Reconstructive Surgery, University of Miami, Miami, Florida, USA
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Affiliation(s)
- Samson Lee
- Division of Facial Plastic and Reconstractive Surgery, Cosmetic Surgery Center, University of Washington Medical Center, Seattle, WA 98105, USA
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Affiliation(s)
- William H Truswell
- The Aesthetic Laser & Cosmetic Surgery Center 61 Locust St, Suite 2 Morthampton, MA 01060, USA.
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