The face is divided in thirds from both the front and the side views.
The forehead is the upper one third. The middle one third is from the eyebrows to the base of the nose. The lower third is from the base of the nose to the bottom of the chin on the frontal (face-on) view.
The lower third is again divided into an upper one third and a lower two thirds. The upper third constitutes the upper lip and stretches from the base of the nose to the stomium which is where the upper and lower lips meet. The area where the lips meet is called the ‘wet/dry vermilion border’ since it marks the transition from the dry external vermilion of the lips to the wet mucosal lining of the lips on the oral cavity or mouth side. The lower two-thirds constitute the lower lip and the chin and extends from the stomium to the lower part of the chin.
The lower lip is usually twice as large as the upper lip in the vertical dimension. The ‘magic’ lower lip to upper lip ratio is 1.5:1 to 2:1. Although the upper lip is smaller in a vertical dimension, it projects in front of the lower lip on the profile view. The upper teeth should also be in front of the lower teeth (Class I Occlusion). If you look at a profile picture and draw a line from the base of the nose where it meets the lip to the crease (sub-labial crease) below the lower lip, you will see the different projections of the upper and lower lip.
The skin of the upper lip extends from the base of the nose to the upper lip. The upper lip is divided into three parts. There is central portion with an obtuse ‘V’ shaped upper edge called the ‘Cupid’s bow’ and two ‘philtral’ columns which extend vertically to the base of the nose. On each side of the Cupid’s bow is a straight upper lip extending to the angle or commissure where the upper and lower lips meet. Any enlargement of the upper lip with fat or fillers should account for this anatomy and preserve the three-part structure. In contrast, the lower lip consists of two ‘pillows’ that meet in the middle and often create a groove and a small depression. Often, patients like this midline delineation in the lower lip and want to preserve it, although it is not as important as the three-part structure of the upper lip.
The ideal width of the mouth is ideally between two vertical lines dropped from the inner margin of each iris.
The ideal length of the skin of upper lip above the cupid’s bow, in the midline, is about 11-13 mm. With aging the skin of the upper lip lengthens and the red part of the lip thins and may become almost invisible. The lip begins to hide the upper teeth at rest. Some people may also have long upper lips and thin lips in their youth and if so, their facial aesthetics can be improved by shortening the upper lip and enlarging the lips with or without orthodontia to correct any underlying bite or dental deformities. Ideally, one should have about two mm of ‘dental show’ of the upper teeth. The ration of upper lip skin to upper lip vermilion is ideally somewhere between 1.5:1 and 1:1.
Before and After photos
67 year-old 5 months after surgery. This second patient needed lip injection and a greater lip lift but did not want either. It is important to overcorrect and remove usually at least 6 mm from the upper lip. A portion of the orbicularis muscle, under the nose, can also be removed to increase the effect of the lip lift. The scar can be placed into the floor of the nostril but in cases where there is a well developed roll or ’sill’ in the floor the scar should be placed just below it to avoid distorting the natural anatomy.
Aging and Rejuvenation of the Mouth Area
Aging is associated with lengthening of the upper lip skin and thinning of the vermilion of both the upper and lower lips. Changes also occur in the nasal tip which often drops and the chin which loses projection. These signs of aging can also be corrected with rhinoplasty and chin augmentation.
The upper lip should NOT be the same size or larger than the lower lip (unless the patient wants this). This will a give a ‘trout pout’ appearance. Lips can be enlarged specifically with attention to the edge of the lip known as the ‘vermilion white roll’ or else just the vermilion itself which is the red part of the lip. Vermilion white roll augmentation can be used to add definition to the lip edge as well as to smooth out smokers’ lines. Filling of the vermilion part of the lip can be used to smooth out vertical lines in the vermilion as well as to increase the vertical height and/or give more projection to the lips.
A lip shortening procedure should address not only the vertical length of the skin of upper lip but also the shape and fullness of the vermilion white roll, the vermilion of the upper and if necessary, the lower lips as well. The procedure can be done under local anesthesia. The most important aspect of the procedure is to do the lip shortening first followed by any fat or filler injection to the lips. The skin excision is immediately below the nose in the crease below the nostril rim (alar) and the columellar, which is the skin between the two nostrils. The incision extends into the floor of the nostril so as to minimize its visibility. After skin is excised, a portion of the orbicularis iris is also excised and resuspended to the base of the nose so as to give a more durable result and also to evert the upper lip.
Skin sutures are removed at 48 hours. This procedure can also be done in conjunction with a nostril narrowing and/or debulking procedure. Adjunctive procedures such as a rhinoplasty, chin augmentation, and a face-lift, can be done at the same time.
Notes and References:
An Index for Quantitative Assessment of Lip Augmentation, Gottfried Lemperle, MD, PhD, Russell Anderson, MS, MBA, Terry R. Knapp, MD, Aesthetic Surgery Journal, 30(3) 301–310
Philtrum – is the vertical column in the middle area of the upper lip. The ideal philtrum range for females is 11-13 mm and 13-15 mm for males. To find your ideal philtrum height, measure the iris of your eye! Your philtrum should be equal to your iris. In females, a long philtrum is not desirable. A short philtrum signifies youth and beauty. Whereas a long philtrum makes a female’s face less feminine.
FACT TABLE: PHILTRUM HEIGHTS FOR AGE 8 TO 90 FOR THE AVERAGE FEMALE & MALE
Credit: Zankle A, Eberle L, Molinari L, Schinzel A. Growth charts for nose length, nasal protrusion, philtrum length from birth to 97 years. Am J Med Genet 2003; 119:95-8. About the Study: This study involved 2,500 healthy individuals of Central European origin ranging in age from birth to 97 years old. The data above showed the average philtrum height in both females and males.