Reading Your Lips

The size and shape of your lips may affect how you are perceived.

In comparison to attractiveness, which is highly subjective, beauty is often conceptualized as a combination of symmetry and proportion, which is perceived to be objective and universal. During the renaissance, the concepts of “Divine Proportions” and the “Golden Ratio” were used to help define beautiful dimensions of a person or object. The face is an especially prominent example of where these proportional concepts of beauty are on display. With their central position on the face and their association with sensuality, the lips are considered to be one of the most important features in determining a person’s overall appearance .Several factors can play into how an individual’s lips are perceived, including culture, age, and cosmetic enhancements.

As facial plastic surgeons, we approach the aesthetic evaluation of a face with the aid of universal linear and angular measurements using anatomic landmarks of the face while also taking into account additional features such as skin quality, contour, texture, and volume. One study revealed that surgeons and patients agree that the most attractive lip ratio of the upper and lower lip is 1.0 to 1.0. Interestingly, lip size preferences were found to differ across patients based on geographic region, with those living in Latin American reporting a preference for the largest lips, followed by those living in North America and in Europe. Patients living in Asia preferred smaller lips compared to people from other geographic regions. These findings highlight the cultural and regional variations in lip size preference as they relate to beauty and attractiveness.

As people age, there is a shift in “beauty points” from the skin and nose to the jawline and lips. Aging of the lips and surrounding areas can be influenced by volume loss, skin loosening, and resorption of bone. In ideal proportions, the youthful upper lip distance (from the bottom of the nose to the red lip) is 40% of the distance from the nose to the chin. As we age, the upper lip length becomes longer and moves closer to a proportion of 50:50. One study found that restoring the original relationship helps to increase ratings of attractiveness and satisfaction.

A range of interventions are successfully used for lip enhancement, including surgical lip lifting, lip fillers, and the botulinum toxin lip flip. Care must be taken to pursue these enhancements with caution. While a surgical lip lift is an option for modifying the anatomy toward a fuller upper lip, this procedure requires an incision placed directly under and across the entire width of the nose, sometimes extending into the nasolabial folds (smile lines). As with any incision, there is always the possibility of undesirable scarring. Too much filler can appear “inflated” or unnatural. The botox lip flip relies on relaxing the orbicularis oris muscle, which is the natural oral sphincter. Overdoing this treatment can lead to speech difficulties and/or the inability to tightly seal the mouth when eating. As with any intervention, moderation is key to keep the lips from looking cartoonish or glaringly unnatural.

In sum, the lips are a central aspect of how an individual is perceived. While formulaic ratios, culture, and age can influence aesthetic norms and anatomic changes, frank and honest conversations between patients and surgeons about goals and realistic outcomes are key to achieving success with any cosmetic intervention.

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