ORLANDO — "There is no perfect lip," according to Dr. Deborah Sarnoff. Instead, the perfect lip is a lip that is aesthetically pleasing to each patient.
She advised dermatologists to keep Leonardo da Vinci's classic proportions in mind when evaluating a patient for perioral rejuvenation. Leonardo's proportions translate approximately to dividing the face into thirds. Consider the area from the base of the nose to the tip of the chin as the lower third of the face, Dr. Sarnoff said at the Orlando Dermatology Aesthetic and Clinical Conference.
Although everyone is different, and cosmetic trends (including lip size) come and go, "we can agree that certain things are more aesthetic," said Dr. Sarnoff, a dermatologic surgeon in Greenvale, N.Y., and clinical professor of dermatology at New York University.
Many younger women are focused on fuller lips, while older women are usually more concerned about fine lines around the lips. Listen to what the patient wants, but "when you analyze someone, think beyond what they are asking for," Dr. Sarnoff said.
Be mindful of trends, and use Leonardo's classic proportions as a guide.
Theoretically, the ratio of the vertical height of the lower lip to the vertical height of the upper lip should be 1.4:1. "Analyze the person's face and see what they want to achieve, and give it the best aesthetic sense you can," she said.
To create the best lip for each patient, start by identifying the cause of the patient's concerns, Dr. Sarnoff said.
She described three factors to consider in perioral aging to help dermatologists and patients decide which treatment or combination of treatments will yield the most aesthetic result:
- Photodamage. If photodamage is the primary problem in the perioral area, consider using dermabrasion, a chemical peel, or a nonablative, erbium, or CO2 laser (standard and fractional).
- Muscle loss. If muscle is the problem, botulinum toxin remains the treatment of choice for dynamic rhytids, including "lipstick bleed lines" and lines that turn down at the corners of the mouth, she said.
- Fat loss. If volume loss due to loss of fat is the problem, choose fillers. Replacement fillers, including hyaluronic acid and collagen, can be injected in the perioral area to add volume to the face, or into the lips themselves.
"Think about what would be the ideal program to rejuvenate around the mouth," Dr. Sarnoff said. It may be that a combination strategy using fillers, laser treatment, and an injection of neurotoxin as a final step to prevent migration of the filler may be the blueprint for the perfect lip for some patients, rather than a single procedure.
During a live demonstration, Dr. Sarnoff shared some additional tips for injecting fillers in the perioral area. The filler should be injected as the needle is pulled out, she suggested, and the injected area should be molded. Physicians should not feel like they have to use the whole syringe in one area—consider adding a bit at the nasolabial fold.
When performing some perioral rejuvenation procedures, she prefers to stand behind the patient's head, instead of standing beside the patient.
Dr. Sarnoff has served as an investigator for Cynosure and DEKA/Eclipse Med. She also has served as a consultant to Allergan, Bioform Medical, Beiersdorf, Home Skinovations, and Abbe Laboratories.
Watch a video interview with Dr. Sarnoff discussing the three keys to lip rejuvenation.