SKN: Why are more and more people focused on enhancing the appearance of their lips?

Dr. Novick: After the upper third of the face, particularly the eyelids and brows, the lower third is considered the next most important cosmetic unit of the face. And the lips are the showpieces of that region. Any improvements made to them enhance the entire area, even if no other changes are made to the chin, the nose, or the skin immediately above and below them. As with the eyes, rejuvenation in this location contributes significantly to an overall look of health, well being and youthfulness of the entire face.

The lips, like other areas of the face and neck, change with age, typically shrinking slowly over time and losing the sharp definition of their borders along with much of their bulk. Even the philtrum, the so-called Cupid's bow, located centrally above the upper lip and below the nose, becomes more flattened and less defined.

When full and plump, the lips convey youthful softness and sensuality. By contrast, when thin and asymmetric, they may contribute to an appearance of sternness, meanness or even untrustworthiness. The literary expression "pursed lips" speaks to a close association between our mouths, our emotions and how others may perceive us.

The loss of lip mass with age may also give rise to several other esthetic problems. Thinning lips can create the illusion that the upper lip, or actually the space between the upper lip and the base of the nose, is elongated. In addition, the volume loss can accentuate the vertical, so-called "lipstick bleeding" lines above and below the mouth. These wrinkles are sometimes referred to as "smoker's lines," although they are quite common in non-smokers. Taken together, the changes can impart an aged, withered and stern appearance to the lower face.

SKN: Besides a fuller pout, what other traits characterize the "ideal" mouth?

Dr. Novick: To conform to the "ideals" of beauty in Western culture, your lips must be of a certain size, shape and proportion to one another. Lips like those of Angelina Jolie may not be quite your thing, but in general when it comes to the lips, size does matter. The width of the mouth should be no wider than the distance between the inner colored portions of your eyes. And the upper lip must be no more than three-quarters the fullness of the lower lips in order to assure that a protruding pout is maintained regardless of just how plump or full each of the lips individually is.

Finally, in profile, there should be a gentle S-shaped curve between the bottom of the lower lip and the chin with an approximately one-fifth of an inch rounded depression between the base of the lower lip and the chin. If these measurements aren't respected, the mouth may not only look out of proportion, but downright odd-looking.

SKN: What traditional procedures have been used to achieve the ideal pout?

Dr. Novick: A number of surgical methods for lip augmentation have been devised to address the above problems. In general, they rely upon the insertion of synthetic implants, such as Gore-Tex or Softform. These products are non-dissolving, non-organic substances that are manufactured from the same material from which some forms of permanent surgical sutures are currently made.

Alternatively, implantable tissue for the lips may be harvested from elsewhere in the person's own body. This is known as an autologous graft and may be obtained from tissue removed when the individual undergoes another surgical procedure, such as a tummy tuck or breast reduction. If this isn't available, a small piece of the patient's dermis (skin stripped of the epidermis) or fascia (the tissue layer covering muscles, usually the temple muscle) is surgically retrieved for grafting. Dermis derived from donor tissue (Alloderm) has also been implanted. But whatever the material chosen, it must be shaped and then surgically threaded through the lip from one side to the other. To reach the desired plumpness, several strips of material often must be inserted into each lip.

SKN: What's the role of non-surgical procedures?

Dr. Novick: Non-surgical lip enhancement addresses the problems of aging lips without the need for any cutting. Lip enhancement isn't restricted to replenishing volume loss within the red portions of the lips, (what doctors call the vermilion, or the outermost region of the red region, the white hair-free line that outlines the lips). It can also be used to restore the integrity of the lip boundaries.

A variety of volumizing injectables have been tried for the lips, including collagen. However, the hyaluronic acid fillers have proven to impart a smooth effect with little chance of any lumpiness. Restylane is my personal favorite for the vermilion and vermilion border. Restylane is one of several filling agents containing hyaluronic acid, a major component of the dermal layer of the skin. Hyaluronic acid is largely responsible for holding on to moisture within the skin that contributes to its plumpness and smoothness.

SKN: When a patient walks in for a non-surgical lip enhancement, what can she expect?

Dr. Novick: The procedure is quick and simple. The lips, being especially sensitive, are first sprayed with a topical numbing agent, such as Cetacaine that dentists use before injecting gums. Afterward, they're anesthetized locally with lidocaine. Following this, the borders of the lips are filled along most of their length. Doing this simultaneously softens the appearance of any vertical lip lines, reducing the need to outline the borders of the lips with lip lining pencils.

Next the body of the lips themselves is plumped to the desired shape and configuration, keeping the proportions mentioned above in mind. If desired, the lines of the Cupid's bow can also be accentuated with filler, creating the so-called "Paris Lip" that was all the rave about a decade ago.

If the vertical lipstick lines are especially long and numerous, each may be filled with a tiny amount of Restylane or another hyaluronic acid filler, such as Juvederm Ultra. Then two microdroplets of Botox Cosmetic can be instilled on each side of the upper and lower lips to complement and prolong the effects of the filler.

The entire procedure generally takes no more than about 10 minutes. Slight swelling and bruising are common afterward, but these usually disappear within a few days. Lipstick can be applied immediately afterward.

SKN: How long do results last?

Dr. Novick: Results usually last about four to six months.

SKN: What's the cost for this sort of procedure?

Dr. Novick: The cost may range from $750 to $1500, depending upon the kinds and amounts of materials used.

Got a question for Dr. Novick? Send him an email here info@skincare-news.com! Your question might be featured in an upcoming article.

Skincare-News.com thanks Dr. Novick for his fourth interview on non-surgical procedures for the ideal, healthy, vibrant pout. Be sure to check back with us for the rest of the interviews in our seven-part series on non-surgical rejuvenation procedures.

The Non-Surgical Rejuvenation Series:

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Facelifts (Part 1)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Nose Jobs (Part 2)

Non-Surgical Rejuvenation: Dr. Novick on Non-Surgical Eye and Brow Lifts (Part 3)

Talking Non-Surgical Neck Lifts (Part 5)

On Non-Surgical Chest Enhancement & Breastlifting (Part 6)

Chatting About Non-Surgical Hand Rejuvenation (Part 7)

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In addition to Dr. Novick's role as bestselling author, clinical professor of dermatology at The Mount Sinai School of Medicine in New York City and attending physician, he is also a fellow of the American Academy of Cosmetic Surgery (FAACS) and maintains a private practice in Cosmetic Dermatology and Cosmetic Dermasurgery on Manhattan's Upper East Side. He has been featured on many popular television and radio shows and lends his expertise to scores of major publications.