The lips dominate the lower part of the face and are a natural focus of attention with a notable place in culture and aesthetics. Their main role is in creating a seal for the mouth, but they have evolved over millions of years with increasing emotional expression in the face, most notably in people due to the evolution of speech. Anatomically the lips are basically an oval shaped muscle (orbicularis oris) with other muscles radiating off so they can move in all directions as well as change shape.
There is a very thin covering of skin that allows the superficial blood vessels to be seen, and this is part of the reason for their colour, although darker skin colours have more melanin (which gives skin its colour) in the lips so mask these blood vessels.
Babies have the classic cherubic look with lots of volume and this is matched by the large amounts of baby fat in the face. The lips are best shaped for suckling and for discovering what objects are like with their huge amounts of touch-sensitive nerve-endings. This is why anything within the grasp of babies will very quickly find its way into their mouths! With growth and development the amount of fat under the skin ‘fits’ the size of the skull better with the best balance in the late teens to early twenties, and at this time the lips appear at their best.
A roll of tissue is present at the junction (the vermillion border) of the lip and surrounding skin. This roll (indicated by the blue dot in the picture) has a ski-jump profile when seen from the side in young lips and is one of the most important parts of rejuvenation for a natural look.
The Cupids bow appearance in the middle of the top lip is present in young lips but is lost gradually with the lips eventually becoming flat and deflated. Over time some of the fat under the skin around the mouth is lost and the muscle thins. This leads to loss of support for the skin (which also loses some of its elasticity) and the appearance of fine lines which radiate out from the lips and create the curse of the ‘lipstick bleed’. Replacing the lost volume around the lips and at the vermillion border is a vital step to helping correct these fine lines and rejuvenating the appearance.
A further change in the lips seen over time is the down turning of the corners of the mouth (the commissures). Fat loss is the cause of this and when combined with sagging cheeks (appearing as jowling), deep lines can appear here. Even at an early stage the mouth has a neutral or even sad appearance.
The Golden Ratio, a classic standard for aesthetics for 2000 years, can be used as a guide for the proportions of Caucasian lips with the lower lip ideally being 1.6 times the size of the upper lip. Normally this is judged as the top lip being 1/3 and the lower lip 2/3 of the overall size of the lips. For African and Asian lips the ratio is closer to a 1:1 ratio, but again this is a guide rather than an inviable figure and every face is subtly different. Famously well-proportioned lips belong to Angelina Jolie and Scarlett Johansson who have large, full lips. This size does not suit everyone and they are genetically lucky in having faces which frame their lips very well.
Similarly famous large lips belong to Rolling Stone Mick Jagger and Steven Tyler. Here they look too big, and this shows that the shape and size of the lips needs to match the face.
The old style of lip rejuvenation was for a voluminous pout for everybody, but this is much less popular nowadays. Although younger women like the look of Angelina Jolie and Scarlett Johansson, older women prefer the look of classic faces such as Audrey Hepburn and Marylin Monroe who had less volumised but still very well defined lips. Something that they all share in these images is the well-defined border of the lip and surrounding skin which is a sign of youth.
When lip shaping is considered, a famous ‘trout pout’ case that is always mentioned is that of Leslie Ash. She had a silicone lip implant that caused a reaction and scarring, unfortunately within the muscle of the lip where it could not be corrected. Now the vast majority of lip treatments are done with hyaluronic acid fillers (hyaluronic acid is found naturally throughout the body) which are designed specifically for the lips and have an excellent record of safety and results.
An often overlooked part of lips is what is behind them – the teeth. If the front teeth are placed further back than normal, or some are missing, the lips will collapse inward and no amount of filler will correct this properly. Where the teeth, or dentures, are very worn the mouth ‘over closes’ with the sides of the lips lost and folds deepening at the corners of the mouth. This correction can be made dentally and makes a very big difference.
There are a variety of treatments for lips and they generally involve hyaluronic acid dermal fillers to recreate lost volume, although botox can also be used to modify the muscle movement. Fillers can redefine the vermillion borders, add volume, create symmetry, reduce or remove lipstick bleed lines and refresh the skin. Around the lips the corners of the mouth can be lifted to correct a ‘sad’ appearance.
Botox can also correct downturned corners of the mouth and reduce fine lines around the mouth. A ‘gummy smile’ where the upper lip lifts in an unaesthetic way can be corrected with botox also.
Lip care is as important as skin care, and as the skin of the lips is thinner than normal skin it is more vulnerable to dehydration. Most people have experienced dry and chapped lips at some time, especially in the winter. Hydration is particularly important and achievable in various ways. The most straightforward way is drinking water which is important for general hydration. Lipsticks contain emollients so are beneficial and lip balms are excellent, especially those with a sun protection factor (SPF) which are essential for time in the sun.