The lips and the eyes boost facial beauty, and have been highlighted since ancient times. Eyes and lips are considered to be the two most beautiful areas of the face for both genders.

The lip region is an extremely important area when it comes to facial aesthetic enhancement. The face depicts a sculpture and voluptuous lips are often portrayed as a symbol of youth and associated with sex appeal and romance.

Clinical case study

A woman in her mid thirties presented to me with a cleft lip. She wanted a minimal invasive correction. She had no complaints of speech or eating difficulties.

A cleft lip is a congenital anomaly that mandates correction at younger age. A cleft lip, with or without a cleft palate, occurs approximately in 1 to 2 per 1,000 births. A cleft lip can be isolated or part of multiple syndromes due to chromosomal errant or environmental influences (1).

On examination, the left lip seemed to be abolished with no left cupid, slight vermilion line and no philtrum. Also a linear scar extended from the vermilion on the left aspect of the upper cutaneous lip to the left nasal ala.

The first proposal given was fractional laser followed after a month by a temporary filler injection to correct the defect. Lip augmentation is practiced with increasing frequency by cosmetic practitioners using a variety of different filling substances.

The total volume augment was measured as an increased volume of 1 cc.

Topical anesthesia was administered before the injection with eutectic mixture of lidocaine and prilocaine (EMLA 5%).

Two modality of fraxal lasers were employed; namely, 1- Co2 fractional laser and 2-Asclepion MultiPulse laser.

A satisfying esthetically pleasing result was instantly revealed as the lip contour with lip definition was constructed on the left side. The patient’s upper lip symmetry was restored and had achieved an augmented volume. There was no localized lip swelling post the injection procedure as the patient came for a follow up.

On this patient there was an actual immediate volume increase with lip definition, which the patient was able to appreciate straight away. Sequential photography was taken at the follow up visits to track the changes happening and necessity of a touch-up injection. This can also be used to track the persistence of volume and of augmentation over a period of time.

This technique had improved the patient’s body image and self-esteem, boosted her confidence and her quality of life.

Discussion

One should always bear in mind that the key is ‘less is more’, and should understand that the application of fillers is both an art and a science. A poor technique can result in dissatisfaction and complications.

Hyaluronic acid (HA) dermal fillers have been used extensively in recent years for facial soft tissue augmentation, including lip augmentation, due to their longevity and low immunogenic potential. Some HA is believed to be strongly hydrophilic, where it attracts and binds water and thus incur swelling. HA is stabilized through the cross-linkage which make it more resistant to enzymatic degradation, thus increased its life span within tissues. Moreover, it stimulates collagen synthesis (2).

Reference

(1) Schweiger ES, Riddle CC, Tonkovic-Capin V, et al. Successful treatment with injected hyaluronic acid in a patient with lip asymmetry after surgical correction of cleft lip. Dermatol Surg. 2008; 34(5):717-9. 3.

(2) Luthra A. Shaping Lips with Fillers. J Cutan Aesthet Surg. 2015; 8(3): 139–142.