Cheiloplasty: Ethnic Differences, Aesthetic Perceptions, Techniques and Approaches in Lip Augmentati

Despite it being the centre of facial harmony and beauty, the lips is often neglected in facial rejuvenation procedures, until recently. This could be attributed to the greater focus by surgeons and patients on other features such as the eyes and nose, inability to recognize imperfections, inexperience with lip lifting, or dissatisfaction with current techniques. Regardless the reasons, it is important for an aesthetic practitioner to pay attention to all aspects of a patient’s face, as it is essential to achieving superlative results in overall facial rejuvenation.

While genetics may predispose patients to dysmorphologies in the lower third of the face, ageing also alters the overall facial harmony and balance proportion in a predictable manner. Over the last 3 to 5 years, there is a significant increase in number of patients seeking cheiloplasty/lip augmentation procedures with the focus on having a more nuanced structure and shape rather than just wanting to have them look "full”.

With the growing demand for such procedures, it is reported that, in US alone, an average lip surgery costs between US$1,000 to US$3,000, with prices going higher in more expensive areas, such as New York City, where such surgery can cost up to $7,000, while in Beverly Hills, costs can run up to $10,000 per lip.

Ethnic Differences: Asian vs. Caucasian

As cheiloplasty become increasingly popular, a performing surgeon must take into account ethnic differences, as it plays an important role, not just in terms of facial dimensions and proportion, but in the evaluation and perception of beauty as well.

Although it is generally thought that the ideal vertical height ratio of upper to lower lip is the well-documented 1:1.6, this suggested “ideal” ratio is based on literatures referring to Caucasian anthropometric measurements, without consideration for other factors. In fact, many studies have been conducted, and results show that the perception of a perfect lip measurement differ not just between the general ethnicity such as Asians and Caucasians, but also amongst sub-ethnicities such as Chinese and Korean.

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Thick Lips vs. Thin Lips

Studies have also shown that Caucasian women were found to have thinner lips than Asians, with the smallest upper lip height and volume. While comparing sub-ethnicities such as Korean and Chinese women; the former have a higher ratio of upper lip to lower lip, while the latter, a thicker lower lip and greater upper lip volume.

In terms of measurement, Chinese women were found to have a mean ratio of 1:1.25 when measured both by caliper and surface distance for the upper lip (measured from the midline of the upper lip vermilion border) to lower lip height ratio, while Korean women were found to have a ratio of 1:1.11 when measured by caliper and 1:1.25 when measured by surface distance. Caucasian women, however, have the smallest ratio at 1:1.43, as when measured both by caliper and surface distance.

Similarly, Caucasian women were found to have an overall lip index between 50 and 100, while Asian women had a lip index between 100 and 200 - because a larger lip index correlates with fuller lips, the study suggested that Asian women have fuller lips on average than Caucasian women.

In comparison to the many differences between female lips, male lips were found to be much more similar to each other than expected across all ethnic groups; although, Caucasians men may have the thinnest lips, whilst men of Chinese descent have a larger total lip volume. In fact, men of all three ethnicities (Caucasian, Chinese, and Korean) were all found to have a mean lip ratio of 1:1.25 with no significant differences.

At any rate, it is undeniable that “ideal” lip dimensions vary greatly not only across different ethnic and geographic backgrounds but also within certain ethnic and geographic backgrounds.

Aesthetic Perceptions

Due to different socio-cultural and ethnic backgrounds, what one ethnic perceives to be an attractive pair of lips could differ from what another believe to be - therefore, any suggested golden ratios or “ideal” proportions should not be considered as universally applicable and must be viewed in context.

While fuller and plumper lips are all the rage among women in the Western culture, a trend has got women in Asia going under the knife to achieve a totally opposite look; as more Asian women in their 20s and 30s, particularly in Thailand and South Korea, have reportedly been seeking lip reduction procedures in the recent years.

Despite so, some studies have shown that what constitute to a pair of attractive lips by the 3 different ethnicities, is the shared parameters of a smaller upper lip surface midline height, smaller paramedian lip surface height, and smaller lower lip volume.

Techniques and Approaches

Just as the perception of beauty and concept of what constitute to a pair of sexy lip differ depending on the various factors mentioned above; there are different techniques and approaches to lip augmentation - be it for reduction of thick lips or adding of volume to thin lips.

Although the most common and standard lip lift techniques are subnasal resection (indirect) and vermilion advancement (direct), both of which leave a continuous cicatrix; there are other techniques that are considerably more advanced, including, but not limited to mouth corner elevation and philtral reduction. While surgical procedures are popular, lip augmentation procedures are not restricted to just these options. Patients who wish to add volume or address minor corrections, may opt for non-surgical methods such as fillers, injectables or even thread lifts.

Fillers, Injectables and Thread Lifts: Caucasian lips are considered to be thinner than that of Asians, therefore, many Caucasian women seek correction for a pair of fuller and plumper lips. One of the most commonly sought after non-surgical procedures is the use of fillers and injectables. A practitioner can choose to make thin lips appear fuller and plumper by adding volume using fillers and injectables, or if lifting is required, thread lifting techniques may be employed to not only lift the desire areas, but also shape and contour the lips to a relatively significant extent.

The advantages of adopting non-surgical approach is that results can be observed almost immediately, and post-procedure down time is minimal to non-existent. In addition, it also allows for reversal if complications develop or if patients are unsatisfied with the results. However, some of the disadvantages of using fillers and injectables are; risks of filler migration and overfilling, while thread lifting technique do not pose such risks. Lastly, results achieved by non-surgical methods are non-permanent.

Philitral Reduction: Located in the center of the face, the philtrum is the concave part between the nose and the upper lip, and has a significant impact on impression. A long philtrum makes the overall facial shape look elongated, affecting the harmony in relation to nasolabial angle, thickness and volume of the lips, as well as width of nose alar. In the case of Asians, the upper part of the philtrum would usually appear sunken and slanted, causing the mouth to look excessively protruded.

Because Asians women generally have thicker lips compared to women of Western descent, Asian women usually seek correction for a pair of thinner lips. It is possible for a performing surgeon to correct thick lips by the technique of philitral reduction. This allows the surgeon to correct the philtrum to the ideal length through surgical means, and by doing so, increases the proportion of exposed lips and lip volume for a pair of more youthful and rejuvenated lips as well as overall impression of the face.

Trends and Future of Lip Augmentation

Today, cheiloplasty procedures continue to gain steady recognition in the fields of aesthetic medicine; hence, it is crucial for a medical professional to continuously and progressively stay ahead of trends, and at the same time, seek to understand the various Ethnic Differences, Aesthetic Perceptions, Techniques and Approaches in Lip Augmentation - just as it is equally important to be equipped with the latest and most cutting-edge techniques to better deliver best results to patients.

Hope you have enjoyed the article! Stay tuned for our future posts about more techniques and information related to our advanced aesthetic and cosmetic training courses!

References:

https://academic.oup.com/asj/article/37/7/828/2623671

https://doi.org/10.1016/B978-0-323-39393-5.00011-X

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