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Over ninety percent of our office visits for lip enhancement are female, but we’ve had men fly to our office in San Diego from New York, Chicago, San Francisco, and elsewhere for permanent lip enlargement, lip shaping, and lip adjustments for improved facial expression. Subtle features of lip appearance influence facial balance and beauty, and are emojis communicating to others our age, our sentiments, and our mood. If patients just wanted lip filler, they could get it near home. Some of them tried lip filler before travelling to us for a better solution.
Everyone as created by nature describes perfection in their own way, and nobody’s definition of beauty is more correct or important than anyone else’s. Aesthetics is subjective. Still, features believed beautiful by sample groups of human opinion have been studied. Particular elements are generally accepted for men and women of all ethnicities. Lip filler is easily available, but not universally beneficial. Lip filler volumizes but the foundation of alluring lips is not built on volume alone. Lip volume is not even the most important factor. Volume and proportion with other facial features count, but not as much as lip position. Along with lip position, lip shape and curvatures communicate our emotional state. Lips may be more or less attractive depending on the attitude, symmetries, and facial expressions that lips impart.
1. Along with lip shape, relationship of the upper and lower lips to the upper and lower teeth are the most important elements of beautiful lips.
Lips must be in the expected position on the face. Too high and the smile is “gummy.” Too low and the face appears aged or unhappy. The vertical length of the upper lip beneath the nose should be short and gentle separation of upper and lower lips from one another in a relaxed expression should show three to five millimeters of upper central teeth. Either no lower teeth will be visible in such position or maybe a minimal rim at the upper edge of lower teeth behind the upper teeth. Lip position cannot be adjusted by injection of filler. Depending on facial skeletal dimensions, lip position, and other factors, a surgical procedure is usually required. Minor office plastic surgical procedures such as upper lip lift by trained and experienced professionals may lift a vertically long upper lip, lift a sagging lower lip (lower lip lift), or otherwise change lip position. Sometimes, dental or maxillofacial procedures are indicated for improvement of both jaw function and lip appearance.
2. Lip shape is another fundamental element of beautiful lips.
Symmetry need not be perfect, but within the range of preferred. Lip 
shape reveals mood, sentiment, and emotion to some degree. A frown shape is sadness, a smile shape more pleasant. The “interlabial commissure” is the line of shadow between upper and lower lips when they are together. A line describing gentle delight is more inviting than neutral, and neutral is more appealing than a grimace. Human perception of one another is very sensitive to subtle variations in shape of the interlabial commissure. Small changes in the shape of this line characterize a wide range of emojis. In youth, corners of the lips elevate slightly, contributing to a naturally pleasant expression. Cheek descent of aging pulls lip corners downward, sometimes creating an unintended appearance of sadness. Other elements of shape such as the vermilion (red margin of the lips) borders vary individually but many variations can be beautiful. Horizontal visibility (“show”) of upper and lower vermilion should be generally even.
3. Lip Volume is most robust in youth.
Volumizing the lips can restore an appearance of youth when lips are well positioned and shaped. If filling the upper lip covers upper teeth, the aesthetic effect is detrimental and will advance aging and produce an unpleasant result. Volumizing lips can also obscure fine skin wrinkles around the periphery of the lips, a nice enhancement when well done. For lip volume, more is not always better. A subjective boundary separates naturally beautiful and artificially disproportionate. Our observation is that larger is attractive 
provided lip position and shape are alluring, and also if relationships with nose, chin, cheeks, eyes, and other surrounding features remains proportional. Individual preferences are respected. Lip enlargement is a service we offer for others. Our approach is to understand individual patient preferences, and to volumize lips as requested after the process of informed consent. Your opinion and your desired result are more important for your lips than our opinion. Extra-large lips is a statement some want to make, but we’ll never try to sell you more than you want. The hyaluronic acid fillers we use most often (Juvederm®, Restylane®, Belotero®, Monalisa®, Captique®, Esthelis®, Elevess®, Hylaform®, Perlane®, Prevelle®, Teosyal®, Stylage®, Remedium®, Desirial®, Filorga®, Rejeunesse™, Aquashine™, Aliaxin™, Perfectha®, Pluryal®, Princess®, Revanesse®, and other brands) may be reduced, dissipated, and dissolved by injection of the enzyme hyaluronidase, commercially available as Hylenex®, so overfilling can be resolved if necessary. Permanent lip enlargement may be achieved with fat transfer (microfat or “nanofat”), Aquamid®, dermal grafts, or alloplastic implants (Teflon®, silicone, others). We avoid calcium hydroxyapatite (Radiesse®), polymethylmethacrylate (PMMA, Bellafill®), and poly-L-lactic acid (Scuptra®) in the lips because if disappointing, they can be very difficult to remove or adjust. Each off-the-shelf lip filler product is associated with a risk profile to consider in advance of a long-lasting or permanent lip augmentation procedure. When we use them, we prefer lip implants that can be easily and completely removed if necessary.
Steve Laverson MD, https://feelbeautiful.com, phone 858-294-4001
