The face is divided into thirds.
– Upper Third from hairline to nose, between eyebrows. Forehead is upper one third.
– Middle third from eyebrows to base of nose where nose meets upper lip. Nose is middle third.
– Lower third from base of nose to bottom of chin. Peri-oral area (upper lip, lower lip, chin) is lower third.
The lower third of the face is divided into an upper one third and a lower two thirds. The upper third includes the upper lip, from base of the nose to where the lips meet or the ‘stomium’. The lower two-thirds is the lower lip from the stomium to the lower part of the chin.
The zone where the lips touch, is the ‘wet/dry vermilion border’. This is the transition between dry outer vermilion where we have to apply chap stick and wet mucosal lining within the mouth.
The vertical length of the lower lip is, ideally, twice as large as the upper lip. The magic lower lip to upper lip ratio is 1.5 to 1 to 2 to 1. Although the upper lip is smaller in the vertical dimension, it projects in front of the lower lip on the side view (see below). Upper front incisor teeth should be in front of and touching the lower teeth. This is known as Class I Occlusion. If you look at a profile picture and draw a line from the base of the nose to the crease below the lower lip (sub-labial crease), you will see the difference in projections of the upper and lower lip in front of the line.
From the front view, the facial skin of the upper lip extends from the base of the nose to the roll at the edge of upper lip vermilion. The upper lip vermilion edge is divided into three, a middle bow and two sides. The middle part has a bow shape known as the Cupid’s bow. At each end of the bow area, a ridge or philtral column, extends vertically to the nose. The hollow in the bow area, between the columns, is the philtrum. The point where the bow meets the column is the peak. On each side of the peak the upper lip edge extends out to the corners of the mouth.
Any enlargement of the upper lip with fat or fillers should consider this anatomy of youth and preserve the ideal relationship of the upper to the lower lip and the three-part structure of the upper lip.
The lower lip consists of two parts or ‘pillows’ that meet in the middle. Between the two pillows there may be a groove or a small depression. Patients often like this midline separation in the lower lip and want to preserve it.
The width of the mouth is ideally, the distance between two vertical lines dropped from the inner angle of each eye. Julia Roberts has a particularly wide mouth whereas Saoirse Ronan has a more classic width.
As we age, the upper lip gets longer. It can get quite ‘horsey’ looking. The upper lip is the skin that stretches between the base of the nose and the red part of the upper lip. In contrast, the red part of the upper lip (as well as the lower lip), known as the vermilio’, loses volume and becomes shorter in a vertical dimension. As the upper lip lengthens, the teeth disappear. In the youthful mouth, about 1/8th of an inch of the upper teeth are visible with the lips at rest.
Upper lip skin can be long and lips can be thin, in youth also. If so, facial aesthetics are improved by shortening the upper lip and enlarging the lips. Enlarging the upper lips with filler or fat, without shortening the upper lip, will result in a visually shorter upper lip. The larger vermilion makes the upper lip skin proportionally smaller.
With age, there are changes in the nasal tip and the chin. The tip of the nose gets bigger and drops. The result may be a hooked nose. The fat in the chin fat pad loses its projection and its attachments to the jawbone. The chin fat sags resulting in a crease under the chin. This known as the witch’s chin deformity. The appearance of a drooping nasal tip and a hooked nose, combined with a witch’s chin gives the appearance of a fairytale witch in profile.
These additional signs of aging may be corrected with a nasal tip rhinoplasty and a chin augmentation. See below.
The edge of the lip known as the vermilion white roll, can be enhanced. The red part of the lip or vermilion can be filled and plumped. Vermilion white roll injection adds definition to the edge of the lip fills in smoker’s lines. Filling of the vermilion, smooths creases and can increase lip height and projection. When enlarging the lips, the upper lip should not be the same size or larger than, the lower lip. It is a marker of a bad lip injection technique and is one of the reasons why patients are often scared of having their lips injected. Bigger is not always better. Over-projecting white rolls give an unnatural look. Overly plumped lips and a prominent lip roll combined are known as the trout pout. Lips of an equal size start to look like a vagina.
A lip shortening procedure shortens the vertical length of the skin of upper lip and elevates the vermilion white roll. The procedure is done under local anesthesia and takes about 45 minutes. The most important part of the surgical technique is to do the lip shortening first before fat or filler injection to the lips. The skin excision in the upper lip is shaped like a ‘gull wing’, a ‘Texas Long-Horn’ or a crescent and is sited immediately below the nose, where it meets the lip (Figure 3). This is in the crease below the nostril (alar) rim and the columella (Photo 2). The columella is the bridge of skin between the two nostrils. The skin incision may extend into the floor of the nostril to reduce its visibility. After the skin is removed, a small strip of orbicularis oris muscle (the muscle that pinches and puckers the lips) may also be excised. The muscle is then resuspended to the base of the nose so as to give a more durable lift and to further evert the upper lip. It is better to overcorrect to get the best long-term result.
Skin stitches are removed at two to five days to avoid stitch marks. The procedure can also be done in conjunction with nostril narrowing and debulking. A tip rhinoplasty, chin augmentation, and a face-lift can be done together.
Plastic Surgery Practice in Norwalk CT with clients from CT, NY, NJ – Manhattan, Northern New Jersey towns, surrounding areas of Greenwich, New Canaan, Stamford, Westport, Darien, Wilton, Weston, Easton, Fairfield, Bridgeport, Trumbull, Ridgefield, Danbury, Monroe, Milford, Bedford, Armonk, Mt Kisco, Bedford Hills, Rye, Harrison, New Haven, Mamaroneck, Larchmont, White Plains, Scarsdale, Westchester County, Fairfield County. New York and from around the world.
*Disclaimer: results are not guaranteed, may not be permanent, and can vary per individual. Before and after photographs of surgical results are of procedures performed solely by Dr. Kirwan. Some images on this web site are of models, not actual patients.