Is it possible to define the ideal lips?

Functional and esthetic reconstruction of composite lower lip defects with a motor-innervated chimeric facial artery buccinator myomucosal-submental island flap

OBJECTIVE

This study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower lip reconstruction.

METHODS

This retrospective study included five patients who underwent lower lip tumor resection and BMM-SIF reconstruction at the Hospital of Stomatology, Sun Yat-sen University, between August 2021 and February 2023. Lip function was evaluated using water leakage, cheek puffing tests, and superficial electromyography. Lip appearance was observed using photographs and evaluated through subjective interviews. Donor-site conditions, including facial symmetry and mouth opening, were monitored.

RESULTS

All the BMM-SIFs survived. Drooling was the main complication observed shortly after surgery. The water leakage test showed complete oral competence for liquid holding in the 7th month; however, moderate air leakage was present in two patients. Electromyography revealed myoelectric signals from the innervated buccinator at the recipient site. Facial expression and food intake were typically managed. The shape and projection of the vermilion were harmonious and satisfactory for each patient. Neither microstomia nor mouth opening limitation was observed, with an average inter-incisor distance of 37.25±4.4 mm.

CONCLUSION

Chimeric motor-innervated BMM-SIF effectively reconstructed large full-thickness lower-lip defects with satisfactory functional and esthetic outcomes.

Anthropometry and Current Aesthetic Concept of the Lower Third of the Face and Lips in Caucasian Adult Population: A Systematic Review and Meta-Analysis

BACKGROUND

The lack of standardization of the norms and aesthetic concept of the lower third of the face and lips creates challenges in reconstructive surgery and aesthetic procedures. A large-scale, anthropometric measurements summary poses an alternative for establishing universal patterns.

METHODS

A systematic review was conducted by searching PubMed, Embase, Google Scholar and Web of Science using keywords: lip, face, aesthetics, beauty, anthropometry and Caucasian. Seventy records were included in the review and checked in detail in terms of available data.

RESULTS

The study contains a meta-analysis of twelve parameters with sufficient quantitative data-lip width, nose width, facial width, lower third of the face height, midline mandible height, total height of the upper and lower lip, upper and lower vermilion height, cutaneous upper lip height and nasolabial and mentolabial angle.

CONCLUSIONS

The review provides a detailed database of primary anthropometric studies of lips and perioral regions of the healthy Caucasian population. The attractiveness of the region is focused on uniformity of proportions. Notably, results acquired with different methods of measurement are not interchangeable. Despite many published anthropometric studies, systems for conducting the measurements and reporting the results are not sufficiently unified to quantitatively assess meticulous key aesthetic clinical parameters.

LEVEL OF EVIDENCE I

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 Table of Contents or online Instructions to Authors www.springer.com/00266 .

Proprioceptive innervation of the human lips

The objective of this study was to analyze the proprioceptive innervation of human lips, especially of the orbicularis oris muscle, since it is classically accepted that facial muscles lack typical proprioceptors, that is, muscle spindles, but recently this has been doubted. Upper and lower human lips (n = 5) from non-embalmed frozen cadavers were immunostained for detection of S100 protein (to identify nerves and sensory nerve formations), myosin heavy chain (to label muscle fibers within muscle spindles), and the mechano-gated ion channel PIEZO2. No muscle spindles were found, but there was a high density of sensory nerve formations, which were morphologically heterogeneous, and in some cases resemble Ruffini-like and Pacinian sensory corpuscles. The axons of these sensory formations displayed immunoreactivity for PIEZO2. Human lip muscles lack typical proprioceptors but possess a dense sensory innervation which can serve the lip proprioception.

A Review of Aesthetic Considerations for Treating the Transgender Patient

BACKGROUND

As gender diversity becomes increasingly embraced by society, and despite growing recognition of the unique needs of transgender patients, the literature remains devoid of guidelines for gender affirming facial feminization or masculinization techniques.

OBJECTIVE

The authors seek to identify and discuss target feminine and masculine facial features, as well as an armamentarium of surgical and nonsurgical strategies to effectively address and achieve them in the transgender population.

METHODS

A search of the National Library of Medicine database (PubMed) was undertaken to identify the existing literature on gender-affirming facial feminization and masculinization techniques.

RESULTS

The importance of assessing proportional relationships between the bitemporal, bizygomatic, and bigonial distances is discussed; ideal masculine faces possess a rectangular face shape, with ratios for these 3 areas tending toward 1:1:1. Conversely, the ideal female face is heart shaped with projection at the zygoma and a tapered jawline. Strategic positioning of the cheek apex serves as an anchor in sculpting a distinctly masculine or feminine face. Other considerations include the enhancement of skin quality and implications of hormonal therapy.

CONCLUSION

The aesthetic considerations provided in this study can serve as a valuable guidance for aesthetic physicians seeking to deliver optimal care for their transitioning patients.

Single-Step Full-Face Surgical Treatment of the Facial Profile

The present study was performed to describe how much affordable, feasible, and straightforward is the approach the authors called "single-stage full-face surgical profileplasty," tailored to greatly improve the surgery of the facial profiling setting and achieve complete profile correction at the same time. From January 2010 to May 2019, 113 patients (95 females and 18 males; aged 19 - 63 years) were surgically treated for full-face profile amelioration. Profile correction was performed by using a combination of five procedures out of other various previously experienced: forehead fat grafting, rhinoplasty, lip fat grafting, genioplasty, and submental liposuction. All patients were assessed at 1, 3, 6, and 12 months following surgery for assessing the surgical profile treatment (SPT) outcome and any possible side effects of the combined treatment. Facial profile stability at 1 year was taken as the completion point of this treatment. Arnett et al's "Soft Tissue Cephalometric Analysis" (1999) was used to clinically evaluate the soft tissues before and after the SPT. Patients' satisfaction was measured with the Client Satisfaction Questionnaire-8" at 3 and 12 months after surgery. Statistics were used for Arnett et al's evaluation. Almost all the values were consistent and reached the normal ranges indicated by Arnett et al (p < 0.001), confirming that the desired results of the surgical profileplasty have been achieved. Single-stage full-face surgical profile treatment helps in correcting faults of the global facial deformity, in every single treated area, providing an overall improvement in facial aesthetics and harmony. Obtaining the simultaneous correction in the whole face has also the advantage of avoiding multiple surgical procedures, reducing postoperative discomfort, and the overall risks for the patient due to multiple surgical and anesthetic procedures.

Long-term efficacy and safety of a hyaluronic acid dermal filler based on Tri-Hyal technology on restoration of midface volume

INTRODUCTION

Art Filler Volume (AFV) is a hyaluronic acid (HA)-based filler formulated with "Tri-Hyal" technology, a unique combination of three sizes of HA chains. This study assessed AFV efficacy and safety over 18 months when used to restore midface volume.

METHODS

During this open-label study, a maximum of 1.8 mL AFV was injected into each cheek area on Day 0 (D0). Subjects were evaluated at D21, when, if necessary, a retouch could be performed (maximum 1.2 mL per cheek). Subjects were evaluated at seven follow-up visits through to D540. The primary assessment was based on the evolution of the Medicis Midface Volume Scale (MMVS) grade on D21. Secondary outcomes were local and general adverse events, investigator- and subject-assessed Global Aesthetic Improvement Scale scores and changes in self-esteem.

RESULTS

Of the 79 healthy Caucasians enrolled (mean age 54.8 years), 25 required a second injection. In the intention-to-treat population, mean overall MMVS scores improved significantly from D0 (3.2 ± 0.4) to D21 (1.8 ± 0.6) and D42 (1.7 ± 0.6) (all p < 0.0001). MMVS scores for each cheek also improved significantly, irrespective of retouch on D21: 22% of injections showed a persistent benefit at D540 without retouch. The most common adverse events were pain on palpation (19%), erythema (15%) and edema (13%); most were mild or moderate and resolved within 2 weeks.

CONCLUSION

AFV produces a sustained objective and subjective midface volume restoration in female and male subjects, often without retouching, and was well tolerated.

Exploration of surgical approach to reconstruct smile-like lip shape in East-Asian women

BACKGROUND

To investigate the clinical effects of surgical treatment to improve the lip morphology for a smile-like appearance (joy and happiness) in East-Asian women.

METHODS

From October 2016 to April 2020, 63 patients who had received surgery to lift the commissure of the mouth and adjust the shape of the upper red lip to form a smile-like shape were analyzed and evaluated.

RESULTS

The lip shape of enrolled patients was improved to a certain extent after surgery without any obvious scar hyperplasia, and the satisfaction rate of people after the surgery was 85.71%.

CONCLUSION

For East-Asian women with thin and flat lips, surgical approach can be used to improve the shape of lip, such that the appearance of the lip is in a smile-like shape, which can enhance affinity and also exhibit the aesthetic characteristics of East-Asian women. This treatment can be used for clinical reference.

LEVEL OF EVIDENCE

Level IV.

Cosmetic Surgery and the Diversity of Cultural and Ethnic Perceptions of Facial, Breast, and Gluteal Aesthetics in Women: A Comprehensive Review

An increasing number of people are opting for cosmetic surgeries. For many years, the physical and aesthetic appearance of Caucasians has been considered to be ideal. However, it is now commonly acknowledged that attractiveness and aesthetic standards vary among cultural backgrounds and ethnic groups and that Western attractiveness criteria no longer apply to all. Herein, we conducted a comprehensive review of studies that examined cultural and ethnic variations in preferences for facial, breast, and gluteal aesthetics, as well as reviewed studies that investigated ethnic disparities in attitudes and motivations for cosmetic surgery. A total of 4532 references were identified, 66 of which met the inclusion criteria. Several studies have reported that facial golden ratios are invalid for representing perceived attractiveness standards among different ethnicities. The majority of studies also indicated that facial aesthetic interventions should not aim to Westernize but to optimize ethnic traits. Significant ethnic differences in preferences for upper- and lower-pole breast proportions have been reported. The size of the buttocks and waist-to-hip ratio were identified as the main factors of buttock aesthetics, with buttock size preferences having a high ethnic diversity. Interest in cosmetic surgical procedures while maintaining ethnic identity continues to grow among young women worldwide. This comprehensive review strongly suggests that accommodating cultural and ethnic differences in aesthetic standards in cosmetic surgery planning can lead to more acceptable cosmetic outcomes.

Buccal Myomucosal Flap for Reconstruction of Red Lip Defects Close to Mouth Angle

BACKGROUND

Owing to the special esthetic and functional role in the face, red lip reconstruction presents a challenge to plastic surgeons. Various reconstructive techniques can be employed to fix the red lip defects close to the mouth angle. The purpose of this study was to demonstrate that the buccal myomucosal flap could be an available option to repair red lip defects with preservation of its esthetics and function.

METHODS

A single-center, retrospective study of 7 patients with red lip defects who were treated with buccal myomucosal flap was conducted between June 2017 and March 2022. All patients were followed up for at least 6 months including questionnaires and photography.

RESULTS

Of these 7 patients, 2 were women, and 5 were men. The average age was 14.3 years (range, 1-32 y). All the buccal myomucosal flaps survived well. All the donor sites were closed directly without complications. The average follow-up time was 33.4 months (range, 6-57 mo). All patients were satisfied with the aesthetic and functional results.

CONCLUSION

The buccal myomucosal flap is versatile and reliable, with the advantages of rich vascularity, flexible design, and easy access. This study was presented to highlight that the flap could be a good candidate to treat red lip defects close to the mouth angle.

The Science Behind Nefertiti's Beauty: A Plastic Surgeon's Analysis

Introduction  The famous stucco limestone coated "Bust of Nefertiti" housed in the Neues Museum, Germany dated 1,345 BC is an icon of beauty. Sculpted around three millennia ago by Thutmose, the bust still emits a charm that leaves its audience spellbound. However, no one, to the best of author's knowledge, has analyzed this sculpture or its photographs objectively to determine if there is any scientific basis to its attractiveness. Materials and Methods  High-resolution photographs of the bust were anthropometrically analyzed in frontal and right lateral profile views using neoclassical canons and Farkas' studies. Results  The photographs of the bust exhibit many of the neoclassical canons and proportions of Farkas' studies exactly, while many of the remaining are very close to these measurements. A few measurements are out of range of what is considered acceptable these days; however, her overall appearance is pleasing. Conclusion  Despite passage of more than three millennia, the proportions and parameters defining beautiful faces have largely remained unchanged.

Influence of Lip Appearances and Tooth Shade on Smile Attractiveness Perception

This study determined the effect of lip thickness, lipstick color, and tooth shade on the smile attractiveness perceptions of dentists, laypersons, dental students, and other faculty students. A set of 27 smile photographs was prepared with different lip thicknesses (Tk, thick; M, medium; and Tn, thin), lipstick shade (R, red; P, pink; and O, orange), and tooth shades (0M1, 0M3, and A1). A total of 212 Thai participants in four rater groups (dentists, laypersons, dental students, and other faculty students) rated smile attractiveness using a visual analog scale (VAS). Statistical analyses were performed using the Kruskal-Wallis test and pairwise analysis at a 0.05% level of significance. Tk or M lip thickness was associated with more smile attractiveness than Th lip thickness. The R lipstick is more attractive than the P and O lipsticks. The 0M1 tooth shade appeared to be the most attractive for laypersons and other faculty students, whereas tooth shades (0M1, 0M3, or A1) did not influence the smile attractiveness perception of dentists and dental students. The smile attractiveness perception was influenced by the lip appearance and tooth shade for each rater group, which are essential for an attractive smile design.

CUPID Lip Lift: Advanced Lip Design Using the Deep Plane Upper Lip Lift and Simplified Corner Lift

BACKGROUND

Upper lip lift is achieved with a variety of techniques but many questions remain about the benefits and drawbacks of each technique. The CUPID deep plane or modified upper lip lift procedure has recently been introduced to help mitigate risk and optimize outcomes.

OBJECTIVES

The aims of this study were: (1) to better characterize and simplify the complex and artistic decision-making process involved in upper lip lift and corner lip lift; (2) to present a mathematical guide to maintain the natural balance of the upper lip, optimizing muscle function, and to indicate when to add a corner lift; and (3) to elucidate design elements, aging, and future treatment considerations.

METHODS

A PubMed (United States National Library of Medicine, Bethesda, MD) search was performed in October 2021 for all journal articles published on upper lip lift and corner lip lifts. The search covered from 1950 to the present day in all languages and without exclusion criteria. Outcomes and the evolution of deep plane upper lip lift design over the last 6 years were analyzed.

RESULTS

By following the patterns demonstrated in over 2440 consecutive lip lifts, the authors have been better able to understand the nuances involved in proper design that will avoid acceleration of aging and exaggeration of appearance, and reduce the need for revision while maximizing results.

CONCLUSIONS

Upper lip lift design is more complex than most practitioners realize. The mathematical concept described herein makes it possible to obtain more aesthetically pleasing and consistent outcomes. This novel approach to lip lift design enables the practitioner to improve lip balance, facial harmony, and tooth show, and obtain adequate exposure of the lateral vermillion.

LEVEL OF EVIDENCE: 4

Effects of perceived quality on consumer attitudes and satisfaction: Focus on lip products

BACKGROUND

Growth of national and economic development industrial and economic standards has raised women's social status, and the consumption value of aesthetic pursuit, which is the mainstream among women's diverse needs as consumers, has been increasing in quantities.

AIM

This study attempted to investigate what are the consumer selection criteria for lip products represented by the lipstick effect that creates continuous demand even in the COVID-19 era, and the main factors driving the continuous demand for lip products.

METHODS

We collected research data through a survey targeting 600 male and female consumers who had purchased lip products through online/offline stores during the COVID-19 period (2020-2021) in Korea.

RESULTS

As a result of examining the effect of perceived quality on consumer attitude formation on lip products, the factors of usability sensitivity and price had a positive effect on consumer attitude formation. Consumer awareness of lip products naturally acts as a bridge to consumer satisfaction.

CONCLUSION

This study focused on consumers' perception and potential for development of lip products whose demand has rather rebounded due to the lipstick effect during the COVID-19 crisis. It is thought that this will act as a positive mechanism for the formation of a favorable attitude toward lip products by consumers.

Influence of Lip Projection and Chin Position on Facial Profile Preferences Among Various Layers of Polish Population. Part 1

Purpose

This study aims to evaluate how the extent of altering lip projection in women and chin position in men influences the 22-year-old Caucasian's facial profile attractiveness, in relation to respondents' sex, age and place of residence.

Materials and Methods

One female and one male orthognathic (SNA angle = 79-85°, Z angle = 75-78°) face profiles, with lips correctly positioned in relation to the E-line were photographed and digitally modified. This processing resulted in 30 photographs varying as for 1. the SNA angle determining orthognathic, prognathic (SNA angle >85°), or retrognathic (SNA angle <79°) profile and 2. lip projection/chin position: normal or protruded/retruded by 1 or 2 mm. The photographs were always shown in the same order to 418 respondents (306 women and 112 men) aged between 15 and 73 years, who provided their place of residence. The 11-point visual analogue scale (VAS) was used for the assessment of the facial profile attractiveness.

Results

All respondents found the prognathic profile with correct lip position in woman and correct chin position in man most attractive. Each major deviation from the norm resulted in a decrease in the scores awarded. Men ranked rethrognathic profiles significantly (p < 0.05) higher than women. The respondents under and over 25 years also differred (p < 0.05) in their evaluation: the older viewers were more critical regarding all female profiles with an exception of the retrognathic profile with 2 mm lips protrusion. The respondents' place of residence did not affect the rating.

Conclusion

1 mm modification of lip projection and chin position significantly alter ranking the face profile attractiveness, thus any aesthetic medicine applied in this area requires extreme caution. Moreover, visualizing the results should be mandatory, especially in women older than 25 years of age, who are the most critical evaluators.

Holistic Symmetry Assessment Using Pedobarography after Treatment of Pertrochanteric Fractures in Elderly Patients

Pertrochanteric fractures (PFs) are life threatening due to the prolonged immobilization of the elderly patient that affects, indirectly, the function of most organs. PFs may have an impact on the symmetry of the human body and contribute to poor global alignment. The aim of the study is to evaluate the functional, pedobarographic and radiological outcomes in a group of subjects with PFs treated with either a dynamic hip screw (DHS) or an intramedullary gamma nail fixation. A study group of 40 patients, admitted to hospital for pertrochanteric fractures between 2015 and 2019, at a mean age of 74.87 (range 65–99), were enrolled. A control group included 20 subjects free from significant disorders of the musculoskeletal system and any other disorders that might induce a compensatory abnormal gait pattern. Functional results were assessed by the Harris Hip Score, and the plantar pressure distribution and arch index were measured with a pedobarographic examination. Radiographic parameters were assessed based on the preoperative and postoperative standing AP pelvic radiographs and axial projection of the hip. The obtained results were evaluated at 9-month follow-up. The obtained results showed no significant difference between both study groups within the scope of the variables under study. To sum up, surgical treatment, either with DHS or intramedullary gamma nail fixation, and rehabilitation treatment support the symmetry of the musculoskeletal system. However, the full return of symmetry was not achieved at 9-month follow-up compared to the control group.

In Search of the Most Attractive Lip-Proportions and Lip-Volume -An Eye Tracking- and Survey-based Investigation

BACKGROUND

Despite various aesthetic trends, the ideal lip proportion and lip volume still remains elusive. Thus, the aim of this study was to investigate the aesthetic perception of various lip shapes to identify the most attractive lips.

METHODS

59 Caucasian study participants with a mean age of 32.73 (9.4) years were asked to assess lips of various proportions and of various volumes. Gaze assessment and aesthetic rating of the same set of modified lip images were performed.

RESULTS

The results revealed that the lip proportion which was rated to be most attractive was the 1:1.6 ratio (upper:lower lip, 4.21 out of a possible 5). This lip proportion, however, was not the first one to be viewed upon initial image display (1.20 sec) and had the shortest duration of a stable eye fixation within the 6 sec image display interval (2.18 out of 6 sec). The lip volume which received the highest aesthetic rating was the 100% volume (original lip size) with 4.56 out of a possible 5. This lip volume however, had the third longest interval between initial image exposure and the first stable eye fixation (0.81 sec) and had the shortest duration of stable eye fixations during the 6 sec of image display (2.22 out of 6 sec).

CONCLUSION

The results presented could be potentially reflective of the internal cognitive processes during the involuntary and voluntary assessment of lip attractiveness.

CAPSULE SUMMARY

The results revealed that the lip proportion and lip volume which was rated to be most attractive was the 1:1.6 ratio and the non-augmented, natural volume. Eye tracking showed that attractive lips captured the observer's attention less quickly and were viewed for a shorter time.

Recognizing Drug Hypersensitivity in Pigmented Skin

The imagery of pigmented skin is underrepresented in teaching materials such as textbooks, journals, and online references, and this has resulted in poorer diagnostic and management outcomes of skin pathology, including delayed cutaneous drug hypersensitivity reactions. In this review, we use clinical images to highlight factors that impact clinical presentations and sequelae of drug hypersensitivity reactions in pigmented skin compared with nonpigmented skin. We describe clinical features in some anatomic sites that aid diagnosis or are associated with more severe sequelae. Finally, we discuss strategies that may aid the diagnosis and management of these reactions in pigmented skin.

The Concept of an Ideal Lips of Caucasian Male: An Anthropometric Analysis of the Lower Third of the Face

BACKGROUND

The lips play a significant role in determining the aesthetic perception of a human face. However, there is little data on the perioral region morphometry of attractive males.

OBJECTIVES

This study investigates the morphology of the lower third of the face, including the lips and jawline, of attractive young Caucasian males.

METHODS

A complex semi-automatic photogrammetric analysis of faces of male photo models (n=300) of the Caucasian race, aged 18-39 years old, was performed. Linear, angular, and surface area parameters were evaluated. In addition, an Average Body Contours (ABC) image was created, providing the graphical summarization of facial size and shapes of all analyzed individuals.

RESULTS

The height of the lower third of the face equaled 0.35 ± 0.03 of the total facial height. The average lip width was 50.98 ± 3.74 mm. The upper vermilion height was found significantly lower than the lower vermilion height (5.9 ± 1.62 vs. 11.15 ± 1.88 mm, p<0.01). The lip obliquity angle was found to be 1.01 o ± 0.73 o. The area surface of the lower lip vermilion was considerably larger than the vermilion of the upper lip (p<0.01).

CONCLUSIONS

The vast amount of morphometric data, including the novel presentation method as an ABC image, on the attractive male's lower third of the face, may provide the surgeons with practical guidelines for lips surgical and nonsurgical rejuvenation procedures. It may also support the perioral region reconstruction and sex reassignment surgery in achieving satisfactory results.

Efficacy and safety of hyaluronic acid fillers for lip augmentation in a Chinese population

BACKGROUND

Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients.

METHODS

From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the "three-point" injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications.

RESULTS

All 70 patients were followed up for 12 months. Statistically significant improvements were observed in the height of lips within 6-9 months post-treatment (p < 0.05). The LFS improved significantly at follow-up compared with baseline (p < 0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1 week. No other serious adverse events and complications were reported in the remaining patients.

CONCLUSIONS

Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The "three-point" technique is simple, safe, and effective and does not cause serious complications.

Evaluation and treatment of facial feminization surgery: part II. lips, midface, mandible, chin, and laryngeal prominence

Facial feminization surgery (FFS) refers to a set of procedures aimed at altering the features of a masculine face to achieve a more feminine appearance. In the second part of this twopart series, assessment and operations involving the midface, mandible, and chin, as well as soft tissue modification of the nasolabial complex and chondrolaryngoplasty, are discussed. Finally, we provide a review of the literature on patient-reported outcomes in this population following FFS and suggest a path forward to optimize care for FFS patients.

Lip Reshaping with LOVE Approach: A Prospective Analysis Based on Two Hyaluronic Acid Fillers

Aesthetic improvement of the lips with hyaluronic acid fillers is a popular procedure. A comprehensive, modular, and highly individualizable method has been developed: the Lip Omnicomprehensive Volume Enhancement (LOVE) approach. The present study assessed the safety and effectiveness of LOVE across different patient age groups.

Injectable platelet-rich fibrin for perioral rejuvenation as assessed by 3D lip volume imaging

BACKGROUND

Various injectable autologous platelet aggregate preparations have been developed and used for facial rejuvenation. Limited evidence exists for the use of these for augmentation of the lip.

OBJECTIVES

This prospective, uncontrolled, single-center study evaluated the qualitative and quantitative effects of an injectable platelet-rich fibrin preparation (known as i-PRF+) for lip augmentation.

PATIENTS/METHODS

PRF^® PROCESS system technology was used to prepare i-PRF+ supernatant. Ten healthy females were included in the study and received a single intradermal injection of i-PRF+ in the upper and lower lips (5 ml in each quadrant, total ~2 ml). Participants were followed for 3 months post-procedure. The efficacy of the procedure was assessed qualitatively by a subjective patient-reported outcome (FACE-Q) assessment and quantitatively by objective 3D skin surface volume analysis (ProFace^® ) at baseline and after 3 months.

RESULTS

FACE-Q scales that measure satisfaction with skin and lip showed a statistically significant improvement from baseline (p = 0.04 and p = 0.02, respectively). Satisfaction with lip lines showed a numerical improvement with mean total scores for adverse effect scales related to the skin and lips reduced at 2 weeks post-procedure (p = 0.03 and p = 0.13, respectively). Overall lip volume at 3-month follow-up was unchanged (p = 0.11). The treatment was well tolerated with only minor adverse effects.

CONCLUSIONS

A single session of i-PRF+ injections resulted in significant lip rejuvenation at 3-month follow-up, shown by improved patient-reported outcome measure. No significant change in lip volume was observed.

The Ideal Lips: Lessons Learnt from the Literature

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 .

Male lip filler-Aesthetic enhancement is not just limited to females: A case report

BACKGROUND

Lips play an important role in facial aesthetics. Hyaluronic acid fillers have been widely used for lip augmentation in females but very few men seek this treatment due to the fear of feminization of lips. However, there are very few case reports published for correction of lips using fillers in men.

AIM

To assess the effectiveness of hyaluronic acid dermal fillers for enhancement of lips in males.

METHOD

A 52-year-old male underwent two sessions of treatment for inturned lips. In the first session, 2 ml hyaluronic acid dermal filler (Juvederm Ultra Plus-JUP) with 27G × 8 mm needle via bolus and retrograde linear thread technique was used. Assessment of lips was done after one week. Second session of treatment was done after 30 months of first treatment with 1 ml of filler.

RESULTS

Injection of filler not only led to a significant improvement in vermillion show, but also improved the overall facial appearance. The results of this treatment were long lasting and even after 30 months from the first treatment the patients' vermillion body still showed ten per cent improvement from the original.

CONCLUSION

Dermal lip filler treatment in men can be a very satisfying and rewarding procedure. Its awareness should be spread afar to increase its acceptability.

The Impact of the Philtrum on Facial Attractiveness, Perioral Proportions, and Perceptions of Facial Aging

BACKGROUND

Lip enhancement continues to be one of the most popular facial procedures. State-of-the-art lip enhancement involves sculpting of perilabial soft tissue, in particular, the philtrum, but it is unclear how patients perceive their philtral contours.

OBJECTIVES

The aim of this study was to test the impact of the philtrum on attractiveness, and on the perception of facial proportions and age.

METHODS

Respondents (1100, including 50 aesthetic specialists) were presented with 2 sets of identical portraits, 1 set of a young Caucasian female and 1 set of an aged Caucasian female, with 1 portrait in each set having an upper lip lacking any philtral contours. The respondents were asked to choose which upper lip was more attractive, appeared longer, and looked older. Rankings were analyzed according to population demographics.

RESULTS

Overall, most respondents considered the young face (84%) and the aged face (68%) with philtral contours to be more attractive. Moreover, the majority of respondents (81%) considered the upper lip of the young face without a philtrum to appear longer in a craniocaudal orientation (67% for the aged image), and 67% of respondents described the image of the young woman with no philtral definition as appearing older (55% for the aged face with no philtrum).

CONCLUSIONS

This study confirms the authors' hypothesis that the existence of philtral contours exerts a significant impact on perioral attractiveness, and that its absence can be related to a longer appearance of the upper lip as well as an older facial appearance.

Anatomy and Aging of the Perioral Region

Perioral region, although severely impacted by facial aging, is often overlooked in texts on facial rejuvenation. Sun exposure, bone resorption, dynamic contraction of the sphincteric and nonsphincteric oral musculature, gravitational pull, histological changes of the skin, and unhealthy habits all take their toll in this area. Fine wrinkling on the lips, deep nasolabial and mentolabial folds, elongation and flattening of the upper lip, downturned corners of the mouth, marionette lines, diminished vermillion and upper teeth show and chin irregularities are the main signs of this process, raising great concern amongst patients and making the perioral region the most demanded area for facial rejuvenation treatment. A huge armamentarium of surgical and nonsurgical techniques, with or without complex technology, are available to tailor patient's specific needs, from chemodenervation and mild chemical peels to operations designed to restore the size and shape of the lips. In this article we perform a comprehensive review of the contemporary treatment of the aging perioral area, detailing the most common techniques and their nuances.

Aesthetic Enhancement of the Vermilion Using Dermofat Graft in Patients With Cleft Lip Deformity

BACKGROUND

There is an increasing patient expectation for better esthetics, manifesting through anatomical harmony, projection, and volume of the upper lip relative to the lower lip, in patients with cleft deformity. The aim of this study is to investigate the outcome of vermilion augmentation using autologous dermofat graft (DFG) to enhance the lip using both quantitative and qualitative assessment.

METHODS

Patients with secondary cleft lip deformity who received the surgical treatment in our institution from 2015 to 2018 were recruited. Panel assessment was performed on standardized preoperative and postoperative digital photographs. A patient questionnaire was used for the reported outcome. Image processing and analyses were applied to measure the lip change. Statistical analyses were performed.

RESULTS

A total of 91 patients were included. The mean age at operation was 22.7 years, and postoperative follow-up was 3.6 years. There were no complications in the study group. The panel assessment showed significant improvement (P < .00001) on upper lip vermilion in both frontal and lateral profile views. Ninety-five percent of patients reported improvement of the upper lip projection and volume. Quantitative image analysis showed an increase in the upper lip vermilion ratio in 97% of the cases in frontal views and improvement of the vermilion projection in 87% of the cases in the superimposed lateral views.

CONCLUSIONS

The use of DFG is an effective and reproducible method for vermilion augmentation and aesthetic enhancement in patients presenting with upper lip insufficiency relative to the lower lip.

Lip Augmentation

A heightened cultural emphasis on youth and beauty has resulted in an increase in cosmetic surgery in the Western world. Lip augmentation is one of the most popular cosmetic procedures done because full lips are considered youthful and voluptuous. With reliable and improved techniques, it is possible to change the appearance of the lips utilizing injectable materials and surgical techniques. This article focuses on popular materials and techniques utilized to augment the size and volume of the lips-the most common are dermal fillers. Lip augmentation requires a thorough understanding of anatomy and managing patient expectations, available materials, and techniques.

A Safe and Effective Lip Augmentation Method: The Step-by-Step Φ (Phi) Technique

The shape and fullness of the lips are essential in facial aesthetics. We describe a safe injection technique of hyaluronic acid (HA), based on the well-known golden number Φ (phi), for lip augmentation.

Correlation between facial attractiveness and facial components assessed by laypersons and orthodontists

Background/purpose

Relationship between facial attractiveness and facial components is not completely clear. The aim was to analyze the correlation between facial attractiveness and facial components assessed by laypersons and orthodontists.

Materials and methods

The attractiveness of 100 adult patients (50 males and 50 females with their frontal, lateral, and frontal smiling photos), before orthodontic treatment, was assessed by 24 laypersons and 24 orthodontists using visual analog scale. Pearson correlation coefficient and stepwise regression were used for statistical analysis.

Results

When laypersons assessed, a significant correlation was found between facial attractiveness and the chin (r = 0.671), eyes (r = 0.669), lips (r = 0.585), hair (r = 0.527), teeth (r = 0.338), and nose (r = 0.247); the chin was responsible for 45.1% of the variation in facial attractiveness, the eyes for 14.3%, and the lips for 0.8%. When orthodontists assessed, a significant correlation was found between facial attractiveness and the lips (r = 0.789), eyes (r = 0.646), hair (r = 0.613), chin (r = 0.565), nose (r = 0.264), and teeth (r = 0.221); the lips were responsible for 62.2% of the variation in facial attractiveness, the eyes for 8.2%, the chin for 1.4%, and the hair for 0.5%.

Conclusion

When laypersons evaluate, the chin contributes the most to facial attractiveness, and when orthodontists evaluate, the lips contribute the most. Whether in the evaluation of laypersons or orthodontists, the contribution of teeth to facial attractiveness is significantly less than that of the lips and chin.

[Clinical application of autologous costal cartilage transplantation in repair of upper lip depression in secondary repair of cleft lip]

OBJECTIVE

To discuss the clinical application and effectiveness of autologous costal cartilage transplantation in the repair of upper lip depression in the secondary repair of cleft lip.

METHODS

The clinical data of 10 patients of secondary repair of upper lip depression with cleft lip by autologous costal cartilage transplantation between January 2017 and January 2019 were retrospectively analysed. There were 7 males and 3 females with an average age of 24 years (range, 18-33 years). There were 8 cases of bilateral lip fissure and 2 cases of unilateral lip fissure. All of them underwent early lip repair at the age of 2-3 years old. The change of the profile of the soft tissue profile of the upper lip of the patient was quantitatively analyzed before operation and at immediate after operation, including the soft tissue facial angle (G-Sn-Pg'), the nasolabial angle (Cm-Sn-UL), the mentolabial angle (UL-LL-Pg'), the distance between the most salient point of the upper lip to the aesthetic plane (UL-E), the highest point of the frontal part, the projection distance of the most salient point of the upper lip on the plane of the orbital ear (G-UL), and the upper lip protrusion (ULP).

RESULTS

One case had incision infection and healed after dressing change, and in the other 9 patients, the incisions healed by first intention, and no acute infection and other complications occurred. The appearance of the lateral morphology of the upper lip at immediate after operation was significantly improved when compared with that before operation. The value of UL-LL-Pg', UL-E, G-UL, and ULP were significantly increased and G-Sn-Pg' was significantly decreased when compared with preoperative ones ( P<0.05). There was no significant difference in Cm-Sn-UL between pre- and post-operation ( t=0.821, P=0.433). All the 10 patients were followed up 6-24 months, with an average of 15 months. During the follow-up, the soft tissue morphology of the upper lip was good. No long-term complications such as cartilage absorption and cartilage displacement were found.

CONCLUSION

Autologous costal cartilage transplantation is a safe and effective treatment for upper lip depression in the secondary repair of cleft lip.

Characterization and validation of an in vivo confocal Raman spectroscopy led tri-method approach in the evaluation of the lip barrier

Background/Aim

It was the aim to establish and validate in vivo confocal Raman spectroscopy for characterization of the lip barrier in conjunction with transepidermal water loss (TEWL) and skin capacitance assessments. For the first time in vivo, barrier‐relevant components of the lip (derived, natural moisturizing factors (NMFs) and ceramides are described.

Methods

In 32 healthy volunteers, a dental tongue fixation device was inserted to prevent both voluntary and involuntary lip moisturization during measurements. Seventeen individual parameters relating to water, ceramide, and NMF content were assessed via Raman spectroscopy. Additionally, corneometry and TEWL were measured. To give a guidance for the required volunteer group size of future lip barrier studies for all test parameters, coefficients of variation (CV) were calculated and plots showing the required sample size for a given percentage treatment effect.

Results

Raman spectroscopy assessed parameters on the lower lip comprehensively characterized the state of the lip barrier. Parameter variability was sufficiently low to corroborate changes in most parameters using relatively small study populations.

Conclusions

Lip skin is comparatively well hydrated. Biophysical measurement of the lip barrier function is a challenge, as unconscious licking of the lower lip has to be prevented. In vivo confocal Raman spectroscopy provides insightful parameters for the characterization of the lip barrier and sufficiently low inter‐individual variability to assess relatively small parameter changes employing relatively few study subjects. Differences at the molecular level and at a high spatial resolution are detectable, and these insights might provide a breakthrough in the evaluation of lip barrier function and developing solutions for lip care.

Deposition of plant lipids after single application of a lip care product determined by confocal raman spectroscopy, corneometry and transepidermal water-loss

OBJECTIVE

Lip treatment products often incorporate oils and waxes in their formulations, and a desired outcome of their use is to prevent lip dryness and roughness as well as help to repair this condition. The objective of this study was to combine confocal Raman spectroscopy with skin capacitance (corneometry) and transepidermal water loss (closed chamber Aquaflux system) measurements, in the evaluation of the degree of moisturization and lip skin penetration of a fruit wax (Rhus vernicula peel cera) and natural oil-based (Cocos nucifera fruit oil and Olea europea oil) lip care product, following a single application.

METHODS

The study was conducted on a total of 15 healthy female volunteers. Instrumental measurements were performed before and 30 min, 2 h and 6 h after a single application of the product.

RESULTS

Lip skin barrier function as well as lip hydration were significantly improved and penetration of olive oil was maintained for at least 6 h post product application. The deposition of the three component lipids (berry fruit wax, coconut oil and olive oil) into the stratum corneum after a single application of the lip care product was maintained and data significant for 2-6 h post product application. Lipid deposition was regarded as a positive long-lasting skin care (depot-) effect combined with a profound hydrating effect for about 6 h.

CONCLUSION

The tri-method approach taken in this study is deemed relevant and valid for measuring lip hydration offering a complimentary assessment of the barrier function of lip skin and interactive effects of cosmetic ingredients.