Our lips are one of the main areas of aesthetic attraction and also one of the areas where, for better or for worse, aesthetic medicine and surgery has intervened most. Over and above the clichés regarding the treatments undergone by public figures’, the demand for lip treatment is always high because beautiful, turgid well defined lips are, in any case, always the most sensual aspect in the aesthetics of a face. The defects that we can point out refer to the volume and proportions of the vermilion, to the presence of vertical wrinkles on the upper or lower lip, and to the downward line of the corners of the mouth, which gives a sad appearance to the whole face.
Many of these problems can be solved with non surgical methods, thanks to the use of fillers. The medical-aesthetic treatment options are essentially of two types: increasing the volume and greater definition with merely aesthetic goals (this is usually requested by young patients, who want more turgid lips) or redefinition of the outline and restoring the natural tone of aged lips (this is a more common request from more mature patients, and aims at fighting the physiological ageing of the lips. The treatments are carried out using fillers like hyaluronic acid (Juvederm®, Restylane®, Emervel®), which produce temporary but lasting results, whilst respecting the tissue of the anatomy, leaving the lips soft and mobile. In any case a conservative approach and a moderate, unostentatious result are recommended. The lips can be improved by accentuating the outline and shape, making them, on the whole, more harmonious, without modifying the volumes, in other words they can be increased when they are too thin, or emphasized by increasing the turgidity and the projection. The corners of the mouth can be filled and raised giving a more serene, relaxed appearance to the face and eliminating the sad look.
Art and anatomy of beautiful lips
The success of international beauty contests proves the existence of a cross-cultural canon in aesthetic evaluation, particularly of a face, whose perfection is identified from the definition of volumes and contours, from a well-polished skin, from the look and finally the size and shape of the lips. In particular, the harmony that is created between the eyes and lips creates a perfect triangle in the lower summit, which in the eyes and cheekbones in the points of attraction of the upper third of the face, while the lips are the lower third point of attraction, and have as their main aesthetic characteristics of the fullness and definition.
Full lips, swollen, well defined, giving the feeling of youth, sensuality and freshness. In contrast, thin lips, drooping, and the ill-defined profile creates a flat appearance and almost senescent. And 'perhaps for this reason that today the aesthetic medical treatment of the lips is a pivotal point for the correction of facial blemishes, it made a more' effective intervention through secure injectable materials reliability '.
In addition to purely aesthetic correction, designed to emphasize, especially in younger patients, the natural beauty, then there is the great theme of rejuvenation and labial perilabial tissues, where the use of minimally invasive techniques allows results impressive, with contributions by minimal impairment of social life. Aging of the lips we must distinguish intrinsic aging of components to the labial anatomical structure and one of the extrinsic components. The first and 'characterized by loss of volume and fullness of the mucosa, loss of shape and definition of the vermilion border (asssottigliamento / flattening), and loss of verticality' of the red lip, where the cupid's bow cusps become less obvious, nearly flat, the tubercles labial atrophy, the forgiveness volume corners. The aging of the components does not own, and 'characterized by loss of bone support, dental, and adipose, with increase of verticality' of the white lip, the lip white elastosis with appearance of vertical wrinkles, primarily of the upper lip, and finally the appearance of creases to commissure, contextual accentuation of the nasolabial folds. The corrective and aesthetic approach is therefore necessary to improve the shape, restore volume, preserve or recreate the cupid's bow and filter them ridges, correct the contour, the nasolabial folds and creases of the commissure, supporting also and above all the white lip bottom and corners. Equally important and 'correction of vertical perioral wrinkles, that more' than any other sign give the lips a senescent appearance.
In the evaluation of the lip correction process we must always be aware of what is' the mother of all medical disciplines, the anatomy. The macroscopic aesthetic parameters of the face, were already 'been defined by Leonardo da Vinci for which the harmony between the various units' anatomy of the face was an absolute necessity for a beauty not artificial. The lips are part of the joined 'oral-perioral aesthetics, which in turn represents a subunit' of the joined 'lower aesthetics of the face. The main morphological and aesthetic parameters to be observed are then represented by the distance between the nose and upper lip (18-20 mm), the distance between the chin and lower lip (about 36- 40 mm), but mainly from the relationship between the upper lip and lip lower. This report, usually about 0.6 / 1 and 'critical because her lower lip (which has a height of about 10 mm) and' more and more 'full of the superior. This ratio must be maintained even after a correction using a volumetric filler. correct lips without respecting this report often appear exaggerated and fabricated for an abnormal emphasis on the upper lip. The lateral extent of the mouth, in respect of Leonardo's aesthetics, must not exceed a hypothetical line through the tangent medial iris. The lateral projection of the lips must then comply with a line stretched between the nostrils and the chin, that is tangent to the upper lip and the lower one (Steiner line). The angle nasolabial finally must have a value between 85 ° and 105 °. The microscopic anatomy of the lips, in turn, affects our chances' of intervention with a filler. At the bottom of coating epithelium, lamina propria and 'a loose structure with fibers that intersect in various directions, forming nets with large meshes. The submucosa and 'formed by some adipose cell and the ground substance in which they are mainly collagen fibers, which are also mixed with elastic fibers and reticular fibers. The collagen fibers branch out and come together to form a network to very large meshes within which and 'stretched a thin web of reticular fibers and elastic fibers arranged to form a closely knit network (honeycomb). Below, finally, we find the muscular plane. Lamina propria and submucosa canvas whole thus constituting a soft, flexible structure, sliding, extensible and easily movable. All of these notions allows to optimize those procedures, achievable in the vast majority of cases with a more 'types of fillers, able to emphasize or redefine the shape of the lips in harmony with the face, and restore or renovate the volume, for a natural projection.
In 1981, thanks to the placing on the market collagen, began the era of non-surgical correction of cosmetic defects of the face and among them also the treatment of the lips. The introduction of injectable hyaluronic acid for aesthetic use, in 1996, then opened an era of security, cosmetic effectiveness, wide compliance, easy to perform. Since then millions of women (and men) have requested and received hyaluronic acid plants for the increase, the correction or the rejuvenation of the lips.
The labial mucosa tissue is excellently infiltrated by a non-particulate material (such as collagen or hyaluronic acids not stabilized which unfortunately determine a short-term correction). The macroparticellari gel, on the other hand, may be diverted from fibrillar structures with the possibility 'of having areas with greater or lesser density' plant. For a full correction of the lips, then we can use different products but synergistic, including the NASHA hyaluronic acids do the lion's share. The classic stabilized hyaluronic acid (Restylane and Perlane) will be useful for correcting or tracing the outline, the filter them ridges and creases of the commissure, but also to support and fill the structures do not own labial, as the white lower lip or nose fold -labiale. To add volume and texture to the lips will use a hyaluronic acid gel made up ipercompattate and cohesive particles, which, injected into the mucosa, fit together perfectly and glide together to form inside the lip a compact and homogeneous structure, continues, but very flexible with a dynamic, three-dimensional aesthetic result (Restylane Lipp).
The thin perioral wrinkles may in turn be treated using a more fluid hyaluronic acid gel (Restylane Touch), able to give a more plastic result. The possible association of botulinum toxin then reduces slightly the basic tone of the orbicularis muscle, followed by a slight eversion of the labial mucosa, and to determine the block of microcontratture the muscle responsible of vertical lines, with a longer duration effect fillers. In our daily experience the corrective treatment of the lips is no longer 'proposed on the basis of the type of material and with the limitation related to the contents of a vial, but as synergy of useful treatments to achieve the best possible result, which is identified today in possibilist to achieve natural results, measured, and in harmony with the rest of the face. The association of more 'materials and methods, and' for the lips and for the rest of the face, the best way to get a comprehensive non-invasive rejuvenation. In conclusion, the correction of the lips, whose objective is the pure aesthetic embellishment of the mouth or its rejuvenation, can not do without a careful evaluation anatomical aesthetic unit oral-perioral, and then the bone, dental tissue, adipose and perioral muscle, by an assessment of how this unit 'fits harmoniously into the lower third of the face in relation to the remaining two-thirds, and finally an in-depth knowledge of the type of fabric to be treated and the materials to be used.
Surgical lip treatments
For correction of the lips of the surgical methods also exist as the WY plastic, which allows to evert the mucosa by increasing the volume of the lip or the facelift techniques that are performed through a small incision below the nostrils and the lifting of the underlying tissue, which leads to eversion of the upper lip with increase in the volume of its red part. The volume of the lips can also be reinstated through the use of own fat with the method of lipofilling. In addition, the vertical wrinkles around the mouth can be mitigated in the long term with the use of lasers or deep chemical peels. All non-injecting methods cited here are performed under local anesthesia and do not require hospitalization, but involve some convalescence with swelling (in case of surgical methods or lipofiling) or crusting (in the case of laser treatments or peeling of the region). Although botulinum toxin can contribute to improving the aesthetics of the mouth, when injected in small quantities, in the muscles responsible for the formation of perioral wrinkles.
The association of several techniques often creates a harmonious overall improvement of the region, allowing you to avoid those aspects sometimes unnatural and excessive exaggerated typical filler injections.
Lip treatment with filler
The results obtained on the lips with hyaluronic acid fillers absorbable are consistently good, but have the disadvantage of not indefinite duration. This disadvantage, certainly not negligible, causes many people to apply for the injection of a longer duration substances that allow definitive results.
The permanent fillers are made of materials, usually of synthetic origin, non-biodegradable as part of our organism. The injection of these products may result in the lips, although not always, early inflammatory reactions or even important late. Initially they may present redness and pain up to real infections, while at a distance of many years can they manifest the visible and painful nodules with a tendency to ulceration of the skin and mucosa or late infections with the product migration from the seat initial insertion. Not to mention the effects, sometimes grotesque, excess filler which, when run with permanent products, it becomes final.
These problems may occur because all these products are synthetic and are not recognized by the fabric, causing the body to a continuous reaction to the foreign body.
This is the reason for which it appears necessary great caution in the choice of material to be injected and our orientation is to use only biodegradable products, such as hyaluronic acid. Especially in the past, however, is some use of non-resorbable materials and still is done may experience complications, even after some time. In these cases you may need treatment. Sometimes simply the use of antibiotics and anti-inflammatory systemic route to reduce an inflammatory situation. In other cases you may use local injection of small amounts of a steroid drug with the aim of reducing the reactivity of the organism to the foreign body. But in some cases this may not be sufficient and it is necessary to resort to surgery groped for the removal of the foreign body, which also can be complex, involve important demolitions and also leave significant secondary deformities. If the problem is instead only the excessive volume of the lip without severe inflammatory reactions, it is possible to a surgical reduction of its volume which, however, is not able to totally eliminate the foreign body and the results of which are thus only partially predictable.