October 22, 2024 • 16 mins
As we get older, our lips naturally change. They lose their plumpness, the space between the nose and upper lip gets longer, and the pink part of the lip starts to wrinkle and lose its color.
Filler can definitely make your lips look fuller, but it's more about the shape than the size but there are other options for the lip as well. A lip flip uses Botox to relax the muscles in the upper lip and rotate the lip. Botox can also be used to fix a gummy smile.
Lip lift surgery shortens your upper lip and makes your lips look fuller, shorter, and shapelier. It’s a good option for people who want a more permanent change.
With so many choices out there, it can be tough to figure out what's best for you. Dr. Bass explains how your lips change as you age, what your options are, and how to decide which one is right for you.
Learn more about Botox, dermal fillers, and laser peels
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to Park AvenuePlastic Surgery Class,
a podcast where we explore controversiesand breaking issues in plastic surgery.
I'm your co-host, Doreen Wu,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
(00:20):
The title of today'sepisode is Luscious Lips.
We've talked about lips before onthe podcast. What is our focus today,
Dr. Bass, and why are we going there?
Lips are the mostpopular area for fillers.
A beautiful lip is very, veryappealing. So this is a big topic.
We focused a lot on lipshape in our previous episode
(00:45):
and what we do with fillersto promote a youthful,
beautiful shape because there'sthis very complex shape to the
lip.
And we discussed that in somedepth in that earlier episode.
Certainly when we're trying tocreate a fuller lip filler is a
mainstay,
(01:06):
and it's more about shape thanabout the magnitude or size
per se.
So what else should we thinkabout with regard to the lip?
Well, I wanted to speak a littlebit about how the lip ages and what
kinds of issues need to be addressed.
And this brings up other kinds oftreatments besides injectable fillers,
(01:28):
which have a role inaddressing the aging lip,
but also in enhancing lipappearance in young people.
Can you lay out some of theseissues for our listeners?
Well,
let's start by thinking about the skinsurface and move to deeper changes after
that.
So skin of the lip and the vermilion,
(01:50):
the pink part,
that has issues as we age of
texture, smoothness andeventually wrinkles.
And there's a whole range of treatmentsto chase this from makeup to home
skincare products, chemical peels,
various laser treatmentsincluding laser peels and RF
(02:10):
microneedling, all for skin smoothing.
And more recently,
there are superficialfillers that can be used to
chase wrinkles on thelips and even to create a
smoother vermilionwhere you get that rough
surface to the pink part of the lipsand some of the superficial fillers
(02:35):
can even help with that.
And these issues were often seenearlier in the skin around the
eyes and the mouth,
and it probably affects those areasdisproportionately at any given age
compared with the skin onthe remainder of the face.
But these were really issues that applyto skin all over the face as well as
(02:58):
skin on the neck, décolletage, hands,
and on the body as well.
So sometimes we're only treating thefocused areas around the eyes or mouth,
but often we're doing aglobal facial treatment.
Even when we treat the entire face,
we're still going to adjust ourparameters, how the treatment's done.
(03:22):
Fine tuning for the degreeof aging in each individual
zone of the face.
What are some other agingchanges associated with the lip?
The lip loses volume as we age,
becoming on average 41% less in thickness.
(03:43):
In one MRI study looking at women's lips,
comparing 20 to 30 year oldswith people 65 to 80 years old.
This study was performed by a plasticsurgeon named Patrick Tonnard,
who's in Ghent, Belgium.
The same study showedthat the lip becomes 19%
(04:04):
longer in the older group of women.
So that lip length or whatwe call filter length,
the lip length right down the centerfrom the bottom of the nose to the
top of the pink, thatincreases and becomes longer.
Just like when people get older, theysay you're long in the tooth. Well,
(04:25):
that's the result of gumsrecessing and exposing more of our
teeth. This is something different.
And while lip aging is notextremely well understood,
these two changes,
loss of thickness or volume,
put another way and increasein lip length point to
(04:48):
most of the goals of what we're tryingto chase and treating aging lips
and those techniques arethen adapted and applied to
enhancing lip shape in younger people.
The volume loss in lengtheningresults in a roll in of
vermilion, the pink part of the lip.
(05:11):
This is accompanied by straighteningof the shape of the upper lips.
So the curviness that we have inyouth with bulges and depressions
becomes straighter and more uniform.
Underlying bony volume lossfurther contributes to roll
in and sagging.
(05:31):
And the debate has always been whetherit's volume loss or skin sagging.
But common sense and a growing body ofdata suggests that there are multiple
factors that add up to contribute to themagnitude of the aging changes that are
seen.
Understanding the causes and thesechanges is all well and good, Dr. Bass,
(05:52):
but I'm most interested in hearing howplastic surgeons are able to address
these changes.
Well, for loss of visibility of thevermilion, there are multiple approaches,
and it's kind of like the reconstructiveladder in plastic surgery that we've
talked about a lot on the podcast.
It starts simple and the optionsbecome increasingly involved.
(06:15):
So the simplest thingis makeup techniques,
things like over lining,
and if you do a little bitof that to give a little
increase to the appearanceof the size of the lip,
that's okay.
If you do that in a overblown
(06:35):
way, kind of looksunnatural. So that's good.
If you only need a little,
as we said at the beginning of thisepisode, filler is the big one.
It's the most popular area to treat
at any age in any country.Lip is number one,
(06:58):
and unfortunately it's also theleast durable area in terms of how
long that filler lasts.
Nowadays we have lip specific fillers,
fillers that have been formulatedto have the softness flexibility,
but also the fullness specifically
to inject in the lip areafor enhancement of lip
(07:22):
shape.
Another option that peopletry either alone instead of
filler or sometimes in additionto filler is what's called
the lip flip.
And so this is taking Botoxor another neuromodulator and
injecting it in the lip,
and the idea is to relax the muscle,
(07:48):
allowing the lip to roll out further,
showing more of the vermilion.
Now there's an importantfine point here because
the muscle around the lips
is called the orbicularis oris.This muscle has two layers.
(08:10):
The superficial layer iscircumferentially oriented,
but the deeper layer is morevertically oriented and it's that
deeper layer that needs tobe injected. For a lip flip,
we often inject the superficialportion to the extent that we can
separate which one we're injecting,
(08:30):
which may or may not be true to try to
reduce vertical lip lines.
The final option is the lip lift,
and this is a surgicalprocedure that shortens the lip
and rolls out the vermilion.
(08:51):
What is the right choiceamongst all these options?
How do I know what's right for me?
Well, obviously it depends on theindividual filler, what most people use,
along with minor makeup enhancement.
While there's been a lot ofmedia play about lip flip,
I find the effect modest andfocus more on Botox and other
(09:13):
neuromodulators for somesoftening of those dynamic
vertical wrinkles in the upper lip.
Lip lift is surgical,
which means there's recovery andyou're making a permanent change,
but that provides a robust correction.
It's a very powerful techniqueand it has durability
(09:38):
at the same time as giving us morevermilion show and making the lip
look fuller.
We're addressing that increasein lip length that occurs with
aging at the same time.
So is the lip lift for aging lips?
It's good in the aging. It gives afuller looking lip and a shorter lip,
(10:00):
which is a younger looking lip,
but it's also for younger peoplewho want to roll out more vermilion,
make the lip moreprominent or shape the lip.
So the use in young people is really to,
in a durable way,
increase vermilion showand fullness of the lip.
(10:22):
How is the lip lift performed? Giveme a general overview of the steps.
So a wedge of skin is removedat the top of the upper
lip just beneath the nostrils.
This is then carefully repairedwith sutures to hide the incision
at the crease betweenthe nose and the lip.
(10:44):
What does the recovery looklike and what are the risks?
So there's always some swelling,typically a little bruising,
and that's going to settlebasically over two to three
weeks.
But the incision is still healing.
The scar is maturing there.
That's going to be red fora lengthy period of time,
(11:09):
two to three months forthe lip to fully soften.
And scar maturity is at least six months.
And the risk with aprocedure like this is it's
permanent. If you don'tlike the look or shape,
you can't put the skin you took out back.
It could be revisedshape, could be adjusted,
(11:33):
but that points up that it'sbetter to remove the skin
conservatively becauseif you really had to,
you could come back and takemore, but once you take it out,
you can't put it back.
The big issue with thelip lift is the scar.
This usually looks good,
but it's based on your individualwound healing. Everyone worries a lot
(11:57):
about facelift scars, the incisionthat's in front of the ear,
but that area of facialskin is much more forgiving
than the upper lip.
There's a lot of talk aboutimperceptible lip lift scars,
and you can always show an exampleof a patient who's a good healer,
(12:17):
who got a really faintor imperceptible scar,
but not everybody healsthat way. And again,
that's honestly more about yourbiology than it is about the surgeon.
Once you put an incision someplace,you can never 100% remove it.
That being said,
there are a lot of treatmentoptions today to help take a less
(12:40):
than ideal scar and makeit much more favorable.
We inject anti-inflammatory medicines.
We do compression or apply scar gels,
and we use fractional lasers on scars.
But my general advice about thelip lift is if you can't accept
even a minimal scar, don't do it.
(13:03):
Now, Dr. Bass, you mentioned shaping.
What kind of shaping ispossible with the lip lift?
As I said, mostly we're rollingthe lip out centrally to show more
vermillion, but depending onthe shape of the excision,
which areas from side to side are a little
(13:24):
taller, where we're removing more skinand which areas are a little shorter,
where we're removing less,
that's going to affect which partsof the lip are pulled up and how
much, which parts arerolled out and how much
there are other steps atdeeper levels that facilitate
(13:47):
control of these issues.
And typically it's mostlycentral where the effects are.
There are some techniquesthat focus extra,
especially centrally toaccent the cupid's bow.
Some people have beautiful shape thereand others it's a lot flatter and if
(14:10):
you're trying to really accent that,
there are ways of fashion inyour lift to try to amplify
that effect. On the other hand,particularly in aging lips,
there's sometimes theouter part of the upper lip
is hanging or hooded or the corner of
(14:32):
the mouth is drooping.
This is sort of the smiley face thatwe have in youth turning into a frowny
face. That's another aging change.
And by having more excision laterally,
sometimes extending around to the sideof the nostrils and not just the bottom
of the nostrils allows adjustment of
(14:54):
those outer portions of the lip.
Dr. Bass, what should our listenerstake away from today's episode?
Nowadays we have multiple options forlip fullness and we always like having
options. It gives us different ways to go,
what might work betterfor us individually,
but it also makes life morecomplex because it means we have to make a decision.
(15:19):
Lip lift has a big role,especially in the aging lip,
but increasingly in youngerpeople who want durability
and shape. The big concernwith the lip lift is the scar,
which may not be imperceptibledepending on how you heal,
and the lip continues tobe a very popular area.
(15:41):
Everyone has their own aesthetic,but everyone wants a beautiful lip.
Very well put.
Thank you Dr. Bass for sharingyour insight and expertise with us.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that's
(16:04):
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email at podcast@drbass.netor DM us on Instagram
@drbassnyc.
Welcome to Park AvenuePlastic Surgery Class,
a podcast where we explore controversiesand breaking issues in plastic surgery.
I'm your co-host, Doreen Wu,
a clinical assistant at BassPlastic Surgery in New York City.
I'm excited to be here with Dr. LawrenceBass, Park Avenue plastic surgeon,
educator, and technology innovator.
(00:20):
The title of today'sepisode is Luscious Lips.
We've talked about lips before onthe podcast. What is our focus today,
Dr. Bass, and why are we going there?
Lips are the mostpopular area for fillers.
A beautiful lip is very, veryappealing. So this is a big topic.
We focused a lot on lipshape in our previous episode
(00:45):
and what we do with fillersto promote a youthful,
beautiful shape because there'sthis very complex shape to the
lip.
And we discussed that in somedepth in that earlier episode.
Certainly when we're trying tocreate a fuller lip filler is a
mainstay,
(01:06):
and it's more about shape thanabout the magnitude or size
per se.
So what else should we thinkabout with regard to the lip?
Well, I wanted to speak a littlebit about how the lip ages and what
kinds of issues need to be addressed.
And this brings up other kinds oftreatments besides injectable fillers,
(01:28):
which have a role inaddressing the aging lip,
but also in enhancing lipappearance in young people.
Can you lay out some of theseissues for our listeners?
Well,
let's start by thinking about the skinsurface and move to deeper changes after
that.
So skin of the lip and the vermilion,
(01:50):
the pink part,
that has issues as we age of
texture, smoothness andeventually wrinkles.
And there's a whole range of treatmentsto chase this from makeup to home
skincare products, chemical peels,
various laser treatmentsincluding laser peels and RF
(02:10):
microneedling, all for skin smoothing.
And more recently,
there are superficialfillers that can be used to
chase wrinkles on thelips and even to create a
smoother vermilionwhere you get that rough
surface to the pink part of the lipsand some of the superficial fillers
(02:35):
can even help with that.
And these issues were often seenearlier in the skin around the
eyes and the mouth,
and it probably affects those areasdisproportionately at any given age
compared with the skin onthe remainder of the face.
But these were really issues that applyto skin all over the face as well as
(02:58):
skin on the neck, décolletage, hands,
and on the body as well.
So sometimes we're only treating thefocused areas around the eyes or mouth,
but often we're doing aglobal facial treatment.
Even when we treat the entire face,
we're still going to adjust ourparameters, how the treatment's done.
(03:22):
Fine tuning for the degreeof aging in each individual
zone of the face.
What are some other agingchanges associated with the lip?
The lip loses volume as we age,
becoming on average 41% less in thickness.
(03:43):
In one MRI study looking at women's lips,
comparing 20 to 30 year oldswith people 65 to 80 years old.
This study was performed by a plasticsurgeon named Patrick Tonnard,
who's in Ghent, Belgium.
The same study showedthat the lip becomes 19%
(04:04):
longer in the older group of women.
So that lip length or whatwe call filter length,
the lip length right down the centerfrom the bottom of the nose to the
top of the pink, thatincreases and becomes longer.
Just like when people get older, theysay you're long in the tooth. Well,
(04:25):
that's the result of gumsrecessing and exposing more of our
teeth. This is something different.
And while lip aging is notextremely well understood,
these two changes,
loss of thickness or volume,
put another way and increasein lip length point to
(04:48):
most of the goals of what we're tryingto chase and treating aging lips
and those techniques arethen adapted and applied to
enhancing lip shape in younger people.
The volume loss in lengtheningresults in a roll in of
vermilion, the pink part of the lip.
(05:11):
This is accompanied by straighteningof the shape of the upper lips.
So the curviness that we have inyouth with bulges and depressions
becomes straighter and more uniform.
Underlying bony volume lossfurther contributes to roll
in and sagging.
(05:31):
And the debate has always been whetherit's volume loss or skin sagging.
But common sense and a growing body ofdata suggests that there are multiple
factors that add up to contribute to themagnitude of the aging changes that are
seen.
Understanding the causes and thesechanges is all well and good, Dr. Bass,
(05:52):
but I'm most interested in hearing howplastic surgeons are able to address
these changes.
Well, for loss of visibility of thevermilion, there are multiple approaches,
and it's kind of like the reconstructiveladder in plastic surgery that we've
talked about a lot on the podcast.
It starts simple and the optionsbecome increasingly involved.
(06:15):
So the simplest thingis makeup techniques,
things like over lining,
and if you do a little bitof that to give a little
increase to the appearanceof the size of the lip,
that's okay.
If you do that in a overblown
(06:35):
way, kind of looksunnatural. So that's good.
If you only need a little,
as we said at the beginning of thisepisode, filler is the big one.
It's the most popular area to treat
at any age in any country.Lip is number one,
(06:58):
and unfortunately it's also theleast durable area in terms of how
long that filler lasts.
Nowadays we have lip specific fillers,
fillers that have been formulatedto have the softness flexibility,
but also the fullness specifically
to inject in the lip areafor enhancement of lip
(07:22):
shape.
Another option that peopletry either alone instead of
filler or sometimes in additionto filler is what's called
the lip flip.
And so this is taking Botoxor another neuromodulator and
injecting it in the lip,
and the idea is to relax the muscle,
(07:48):
allowing the lip to roll out further,
showing more of the vermilion.
Now there's an importantfine point here because
the muscle around the lips
is called the orbicularis oris.This muscle has two layers.
(08:10):
The superficial layer iscircumferentially oriented,
but the deeper layer is morevertically oriented and it's that
deeper layer that needs tobe injected. For a lip flip,
we often inject the superficialportion to the extent that we can
separate which one we're injecting,
(08:30):
which may or may not be true to try to
reduce vertical lip lines.
The final option is the lip lift,
and this is a surgicalprocedure that shortens the lip
and rolls out the vermilion.
(08:51):
What is the right choiceamongst all these options?
How do I know what's right for me?
Well, obviously it depends on theindividual filler, what most people use,
along with minor makeup enhancement.
While there's been a lot ofmedia play about lip flip,
I find the effect modest andfocus more on Botox and other
(09:13):
neuromodulators for somesoftening of those dynamic
vertical wrinkles in the upper lip.
Lip lift is surgical,
which means there's recovery andyou're making a permanent change,
but that provides a robust correction.
It's a very powerful techniqueand it has durability
(09:38):
at the same time as giving us morevermilion show and making the lip
look fuller.
We're addressing that increasein lip length that occurs with
aging at the same time.
So is the lip lift for aging lips?
It's good in the aging. It gives afuller looking lip and a shorter lip,
(10:00):
which is a younger looking lip,
but it's also for younger peoplewho want to roll out more vermilion,
make the lip moreprominent or shape the lip.
So the use in young people is really to,
in a durable way,
increase vermilion showand fullness of the lip.
(10:22):
How is the lip lift performed? Giveme a general overview of the steps.
So a wedge of skin is removedat the top of the upper
lip just beneath the nostrils.
This is then carefully repairedwith sutures to hide the incision
at the crease betweenthe nose and the lip.
(10:44):
What does the recovery looklike and what are the risks?
So there's always some swelling,typically a little bruising,
and that's going to settlebasically over two to three
weeks.
But the incision is still healing.
The scar is maturing there.
That's going to be red fora lengthy period of time,
(11:09):
two to three months forthe lip to fully soften.
And scar maturity is at least six months.
And the risk with aprocedure like this is it's
permanent. If you don'tlike the look or shape,
you can't put the skin you took out back.
It could be revisedshape, could be adjusted,
(11:33):
but that points up that it'sbetter to remove the skin
conservatively becauseif you really had to,
you could come back and takemore, but once you take it out,
you can't put it back.
The big issue with thelip lift is the scar.
This usually looks good,
but it's based on your individualwound healing. Everyone worries a lot
(11:57):
about facelift scars, the incisionthat's in front of the ear,
but that area of facialskin is much more forgiving
than the upper lip.
There's a lot of talk aboutimperceptible lip lift scars,
and you can always show an exampleof a patient who's a good healer,
(12:17):
who got a really faintor imperceptible scar,
but not everybody healsthat way. And again,
that's honestly more about yourbiology than it is about the surgeon.
Once you put an incision someplace,you can never 100% remove it.
That being said,
there are a lot of treatmentoptions today to help take a less
(12:40):
than ideal scar and makeit much more favorable.
We inject anti-inflammatory medicines.
We do compression or apply scar gels,
and we use fractional lasers on scars.
But my general advice about thelip lift is if you can't accept
even a minimal scar, don't do it.
(13:03):
Now, Dr. Bass, you mentioned shaping.
What kind of shaping ispossible with the lip lift?
As I said, mostly we're rollingthe lip out centrally to show more
vermillion, but depending onthe shape of the excision,
which areas from side to side are a little
(13:24):
taller, where we're removing more skinand which areas are a little shorter,
where we're removing less,
that's going to affect which partsof the lip are pulled up and how
much, which parts arerolled out and how much
there are other steps atdeeper levels that facilitate
(13:47):
control of these issues.
And typically it's mostlycentral where the effects are.
There are some techniquesthat focus extra,
especially centrally toaccent the cupid's bow.
Some people have beautiful shape thereand others it's a lot flatter and if
(14:10):
you're trying to really accent that,
there are ways of fashion inyour lift to try to amplify
that effect. On the other hand,particularly in aging lips,
there's sometimes theouter part of the upper lip
is hanging or hooded or the corner of
(14:32):
the mouth is drooping.
This is sort of the smiley face thatwe have in youth turning into a frowny
face. That's another aging change.
And by having more excision laterally,
sometimes extending around to the sideof the nostrils and not just the bottom
of the nostrils allows adjustment of
(14:54):
those outer portions of the lip.
Dr. Bass, what should our listenerstake away from today's episode?
Nowadays we have multiple options forlip fullness and we always like having
options. It gives us different ways to go,
what might work betterfor us individually,
but it also makes life morecomplex because it means we have to make a decision.
(15:19):
Lip lift has a big role,especially in the aging lip,
but increasingly in youngerpeople who want durability
and shape. The big concernwith the lip lift is the scar,
which may not be imperceptibledepending on how you heal,
and the lip continues tobe a very popular area.
(15:41):
Everyone has their own aesthetic,but everyone wants a beautiful lip.
Very well put.
Thank you Dr. Bass for sharingyour insight and expertise with us.
Thank you for listening to the ParkAvenue Plastic Surgery Class podcast.
Follow us on Apple Podcasts,
write a review and sharethe show with your friends.
Be sure to join us next time to avoidmissing all the great content that's
(16:04):
coming your way. If you want tocontact us with comments or questions,
we'd love to hear from you.
Send us an email at podcast@drbass.netor DM us on Instagram
@drbassnyc.
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