Thank you for your question.
You submitted your question with several photos that are extremely helpful.
You’re asking in your question, basically what you can do to help improve the coverage
of your teeth and the appearance of your lips both at rest and when you are smiling as well
as when you’re smiling with your lips together.
Well, certainly I can share with you my approach to counseling my patients for this very popular
procedure of lip enhancement in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Injectable fillers are a big part of my practice and helping people with lip aesthetics is,
as I mentioned earlier, is extremely popular.
At the same time, people are very concerned about not appearing unnatural or as often
is referred to as duck-like after having lip enhancement.
So I think it’s important to follow the simple principle of defining the problem before
you define the solution.
So essentially, what you have observed as demonstrated by your photos is that when you
are smiling, there’s a variability between the way the lip is retracting on one side
compared to the other, the amount of exposure of the teeth.
So when you think about how to address these issues, there are basically two principal
ideas or foundations of anatomy that we want to understand: one is the action of muscles
on the lips.
The lips are very important and the mouth in terms of proper muscle function and action.
However, you can actually manipulate that muscle function and action and create enhancement.
So without giving you a full understanding of all the details of muscle anatomy, let’s
get specific about the way the lip retracts on one side compared to the other when you
smile.
And that area of retraction is reflective of the activity of a muscle and this muscle
is called the depressor anguli oris muscle or DAO.
And this muscle can be selectively relaxed with a neurotoxin such as Botox®, Dysport
or Xeomin.
Now when you relax this muscle, that part of the lip elevates which will result in the
area of the teeth that you want to see more coverage improving.
Now of course, people are very concerned about doing Botox® around the mouth.
That’s understandable basis.
You don’t want to have disfigurement or irregularities.
But it is a procedure which we often refer to as the lip lift or the Botox® lip lift
where the corners of the mouth can actually elevate as a result of relaxing the depressor
anguli oris muscle.
Something to also understand about neurotoxins, the dosing can be very minimal and it can
be also added upon.
We generally do in our practice, although there is a pretty safe dosing range for this
particular muscle, because we see our patients after two weeks and we evaluate.
We have the patient do actions such as showing their lower teeth to see the effect of that
muscle action and then have them smile or just see what the lips look like at rest and
you get a sense of the effectiveness of the neurotoxin.
And sometimes, you have to tweak a little bit and add a little bit more to get the full
result or refine.
The other aspect of this challenge is looking at the lips and seeing where is there an opportunity
to add volume to further provide teeth coverage.
And I would say that judging by the photos, probably in the outer aspect of the lower
lip, there may be some opportunity to add volume.
This type of assessment is based on photos and not on a physical exam and evaluating
you in person.
But it is important when it comes to lip volume to understand proportionality.
When we consider lip aesthetics, the principle of the Golden Ratio is so important.
And this is the ratio also known as phi or 1:1.6 and that ratio is the relative size
of the upper lip in comparison to the lower lip.
Sometimes, we look at lips in a way which is a little bit easier to remember, one third,
two thirds.
The point is that you want to add volume strategically so that the lips look very natural and that
is typically done in terms of the actual materials with a filler such as the hyaluronic acid
filler such as Restylane.
Now that being said, you can combine the two.
You can combine a neurotoxin as well as a filler on the same visit.
And our goal is to minimize bruising and minimize swelling.
And so I generally employ a technique where I use what is referred to as blunt cannulas
to enhance lips so that the patients can see the improvement and get fewer pokes.
Now of course, that’s a personal approach and I don’t in any way want to put down
anyone else’s approach because every doctor chooses what they like and what works for
them.
And I have been doing this for a long time, 20 years in practice and a lot of techniques
along the way and I find that the use of blunt cannulas for lip enhancement has been very
nice.
It’s actually, essentially, an extension if you will of what we were doing such as
the pre-injectable fillers with fat where we use blunt cannulas to place fat.
But in the modern world, we have wonderful options when it comes to fillers and I really
don’t use fat for lip enhancement at this stage.
So learn more about these options and meet with doctors and see how comfortable you are
with the doctor you go to.
You can always start conservatively and see how things look.
And also understand that the human body is naturally asymmetric.
And of course, review the photos with your doctor.
What I do usually is I’ll place the photos up in the screen and I’ll review them with
my patients so that they see what their lips look like before and then we see patients
in follow up and review again to see the before and after and that’s often a lot of fun.
So I hope that was helpful, I wish you the best of luck and thank you for your question.