ARTICLE | LIP ENHANCEMENTS | Skin
Orbicularis muscle
Vermillon
Vermillon border
Mucosa Teeth
Bone
1. On the upper lip: fine and deep wrinkles (in brown & red) 2. Vermilion (in pink) 3. Vermilion border (in red)
4. Philtrum with its columns (in blue)
Figure 1 Anatomy of the lips
Loss of shape of philtrum, philtrum columns and Cupid’s bow The philtrum, this ‘finger print of God on the mouth of a newborn’, loses its definition and the shape of its columns by flattening. These columns correspond to the skin insertion of the depressor anguli oris (which doesn’t stop at the lip corner) and also of the fibres of the buccinator [1]. It is probably the loss of tonicity and atrophy of these muscle fibres which cause the flattening (Figures 3 and 4).
Scales Understanding of the anatomy, physiology and the ageing process allow us to formulate many kinds of scales to qualitatively assess volume, eversion, wrinkles, ageing and the length of white lip. Red lip and volume Red lip and ageing White lip and length White lip and wrinkles.
Many authors (Carruthers [5], Nahai [6], Zbili [7]) have devised scales. In our opinion as injectors, the red lip is the most
important because it is responsible for the volume. However, the apparent volume is dependent of the length of the white lip. We therefore choose these parameters – volume of red lip and length of white lip – to formulate a 5-step scale.
Thin red lip with normal length of white lip The red lip is at the same level of its posterior teeth–bone support, resting on it (Figures 1 and 3). Any filling at this level both enhances volume and gives better anterior
In our opinion as injectors, 16 ❚
the red lip is the most important because it is responsible for the volume.
March 2011 |
prime-journal.com
Figure 2 Artistic anatomy of the lips
projection and eversion due to this posterior support. This is the perfect scenario.
Thin red lip with long white lip The red lip can drop below the teeth–bone level. Due to the length of the white lip, the red lip can’t rest on this posterior support. This situation is uncommon in young patients. We see these cases with ageing due to the loss of tonicity of lip and the orbicularis muscle. Any filling of the red lip doesn’t allow the posterior osteodentin support to project anteriorly and evert the red lip. If the white lip is really too long, enhancement can be poor and disappointing. In this case, we sometimes
Figure 3 Lip ageing
Figure 4 Lip ageing
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