Elements of Morphology: Human Malformation Terminology Human Malformation Terminology References Anatomy of the Lips, Mouth, and Oral Region The appearance of the lips varies with facial movement. Smiling and crying can alter dramatically the shape of the upper lip, as do pursing or pouting. Therefore, the lips must be assessed when the subject has a relaxed (neutral) face: the eyes are open, the lips make gentle contact, and the teeth are slightly separated. The neck, jaw, and facial muscles should not be stretched nor contracted, and the face should be positioned using the Frankfurt horizontal (a line joining the orbitale and the porion) [Farkas, [ 1981 ]]. Figure 1 Figure 2 Lips: The structures that surround the oral aperture (Fig. 1). In the central region their superior border corresponds to the inferior margin of the base of the nose. Laterally, their limits follow the alar sulci and the upper and lower lips join at the oral commissures. The inferior limit of the lips in the central region is the mentolabial sulcus. Anatomically, the philtrum and its pillars are a part of the upper lip.

The surface of the lip is comprised of four zones: hairy skin, vermilion border, vermilion and oral mucosa. The normal shape of the lips varies with age, and is influenced by ethnicity. Vermilion: The red part of the lips (Fig. 1). It is covered with a specialized stratified squamous epithelium, which is in continuity with the oral mucosa of the gingivolabial groove. Confusingly, the vermilion itself is also often referred to as the lips. Vermilion Border: The rim of paler skin that demarcates the vermilion from the surrounding skin. Cupid's Bow: The contour of the line formed by the vermilion border of the upper lip. In a frontal view, this line resembles an archer's bow, which curves medially and superiorly from the commissures to the paramedian peaks located at the bases of the pillars of the philtrum (crista philtrae) with an inferior convexity lying between those peaks. The philtrum is the vertical groove in the midline of the upper lip bordered by these lateral pillars (ridges) [Hennekam et al., [ 2009 ]].

Oral Mucosa: Stratified squamous non-keratinized epithelium covering of the inner aspect of the oral cavity [Standing, [ 2005 ]]. Mouth: The oral aperture that opens into the oral cavity proper [Standing, [ 2005 ]]. The opening is bounded by the upper and lower vermilion. The cavity comprises the alveolar arches with gums and teeth, the hard and soft palate, and the tongue, anchored to the floor of the mouth (Fig. 2). The oral cavity leads into the oropharynx, bounded by the tonsillar pillars. Standards exist for measuring the length and height of the oral aperture [Farkas, [ 1981 ]]. Oral Commissure: The place where the lateral aspects of the vermilion of the upper and lower lips join. The cheilion is the anthropological landmark located at this site (see Fig. 1). Labial Fissure: Slit-like space between the lips; the oral vestibule.

Oral Cavity: The space bounded superiorly by the hard and soft palates, laterally by the alveolar processes of the maxillary bone, and inferiorly by the tongue (see Fig. 2). Alveolar Ridge: The U-shaped bony crests of the upper and lower jaw in which the teeth are situated. Hard Palate: Bony anterior two-thirds of the roof of the mouth separating the nasal cavity from the oral cavity. The boundary of the hard and soft palates can be determined by palpation. Soft Palate (velum palatinum): Posterior one third of the palate comprised of a fibromuscular fold of soft tissue suspended from the hard palate and separating the nasal and oral cavities. Uvula: A conical projection of soft tissue extending inferiorly from the posterior edge of the middle of the soft palate (see Fig. 2). Gingiva (gums): Dense fibrous tissue covered by mucous membrane overlying the alveolar ridge in which the teeth are situated. Buccal Frenulum: A thin fold of soft tissue extending from the gingiva of the mid-anterior alveolar ridge to the inner surface of the medial part of the upper or lower lip (see Fig.

2). Lingual Frenulum: A thin fold of soft tissue extending from the floor of the mouth to the base of the tongue. Tongue: Muscular organ of deglutition, speech and taste covered with epithelium and bound to the floor of the mouth. Teeth: Hard dental structures located on the alveolar ridges and situated in the gingiva. In humans, teeth have two stages, the primary (deciduous) and the secondary (permanent, adult). Explore Plastic Surgery – Dr. Barry Eppleylip lifts Archives - Explore Plastic Surgery - Dr. Barry Eppley Double Duck Lip Lift Saturday, August 27th, 2016 As the face ages many changes occur around the mouth which are well known. Such structural changes include lengthening of the upper lip, loss of vermilion height and tissue thinning and a decrease of the nasolabial angle in some people. (due to dropping of the nasal tip) The combination of tissue lengthening and volume loss with some resorption of the underlying bony pyriform aperture is the culprit. Many contemporary treatment strategies exist from injectable fillers, neuromuscular modulators to surgical lip lifts.

The subnasal lip lift is often viewed as a last resort treatment approach but for some patients it should clearly be the first. There is no more effective method for shortening the long upper lip than the excision of skin. The subnasal technique in lip lifting is often chosen because of its more hidden scar even though its effects is limited to the central part of the upper lip. In an effort to manage the change in the nasolabial angle during a lip lift, the technique of moving part of the de-epithelized skin into the base of the columella has been previously described. This creates an opening in the nasolabial angle as well as increases columellar length. In the 2011 Brazilian Plastic Surgery Journal (volume 26), a paper was published entitled ‘Double Duck Nasolabial Lifting’. In this paper the authors describe a procedure designed to both shorten/lift the upper lip as well as change the nasolabial angle.

The technique includes a transverse incision of nasal floor and alar margin skin, separation of the upper lip skin from the underlying orbicularis muscle down to the vermilion-cutaneous junction, the placement of a permanent transcolumellar suture between the nostrils, resection of upper lip skin using a trapezoid resection at the nasal floor and an elliptical pattern at the alar margins and final skin closure. The authors report satisfactory results in 90% of the patients characterized by shortening of the upper lip, increased vermilion exposure (centrally) and opening of the nasolabial angle. They conclude that the “double duck” lip lift technique was effective with good concealment of the scars. The term double duck lip lift comes from the pattern of the incisions used in the technique. While the pattern of the incisions is not necessarily novel, what is done with the mobilized skin is. Rather than resecting skin across the base of the columella as in the traditional subnasal lip lift, the skin is spared and moved up into the the base of the columella. (after columellar skin mobilization) This is what also creates the central lip shortening as well as the increase in nasal tip projection.

The double duck lip lift isn’t for every patient that wants/needs a subnasal form of lip lifting. But for the properly selected patient it can be an effective technique. Dr. Barry Eppley Saturday, January 23rd, 2016 Background: Rejuvenation of a long upper lip can only be reliably done by removing skin somewhere between the nose and the upper lip. The most common procedure to do so is known as the subnasal lip lift. It is more popular and commonly done than its cousin the upper lip advancement due to the less risky scar location along the base of the nose. But the subnasal lip lift is often misunderstood at to its effect on the upper lip. It is important to realize that this is a central lip enhancement procedure. It will have no effect on the size or shape of the upper lip outside of the cupid’s bow region. This is understandable as the horizontal length of the skin excision at the base of the nose is no wider than the width of the nostrils. This limited subnasal lip lift effect must be appreciated before surgery to prevent a vermilion fullness imbalance developing across the upper lip.

While the height of the vermilion at the cupid’s bow region is always higher than that at the sides, thin lateral upper lips may look even thinner when the central upper lip vermilion becomes fuller. Case Study: This 44 year-old female wanted to shorten her long upper lip, give the cupid’s bow more of a pout and show a little more upper teeth. But in demonstrating the effect of the upper lip lift, it was a revelation to her that the sides of the upper lips did not change. A concurrent strategy of increasing the height of the vermilion directly at the sides of the upper lip with the lip lift was planned. Her upper lip enhancement procedure was done under infraorbital nerve blocks with direct local anesthesia infiltration into the base of the nose and the sides of the lips. A subnasal lip lift was done that reduced the skin distance of the upper lip from 18mm to 13mm along the length of the philtral columns. This was combined with a 4mm lateral vermilion advancements from the corner of the mouth to almost the cupid’s bow.

Her immediate result showed a total lip enhancement effect of shortening her long upper lip and increasing the vermilion show at the sides of the lip A subnasal lip lift can not change the sides of the upper lip no matter how it is designed. A simple but often overlooked strategy for a more complete upper lip effect when doing a subnasal lip lift is the lateral vermilion advancement. This avoids a scar along the vermilion-cutaneous junction across the cupid’s bow area where it can be potentially more noticeable. Highlights: A subnasal lip lift shortens the vertical distance between the base of the nose and the central upper lip only. A subnasal lip lift does not increase the height of the vermilion at the sides of the lip. 3. Lateral vermilion advancements are needed with a super lip lift to create a total lip enhancement effect. Dr. Barry Eppley Saturday, December 12th, 2015 Background: A full upper lip and a broad smile are several mouth features that are associated with youth and attractiveness. While there are a variety of lip enhancement procedures, the lip lift represents just a minority of the cosmetic lip procedures done.

Its largely hidden subnasal scar location and the visible upper lip shortening effect give it a limited but defined role in lip enhancement options. Less has been described about how to manage a ‘small mouth’. A short horizontal distance between the corners of the mouth is often perceived as the width of the mouth that lies within vertical lines dropped down from the pupils of the eyes. Many have asked about how to widen their mouth but have been discouraged from doing so because of concerns about adverse scarring. But cosmetic mouth widening surgery should not be confused with the corner of mouth reconstruction that is done in cases of congenital or traumatic microstomia. Case Study: This 22 year female wanted to shorten her long upper lip and get more of a prominent cupid’s bow appearance. (the philtral distance was 18mms in length) In addition she wanted to have more upper tooth show at the bottom of the upper lip smile line. She also felt that the width of her mouth from corner to corner was too small and wanted it widened. Under local anesthesia in the office, a bullhorn pattern skin excision was marked out under the base of the nose and removed.

An excisional skin width of 5.5mms was made along the philtral columns, making it almost one-third of the upper lip length removed. At the same time an arrow-shaped segment of skin was removed from outside the corners of the mouth. (horizontal length of 5mms removed on each side) The mucosa at the corners of the mouth was mobilized and brought out to a new corner of mouth position. This created a 1 cm increase in horizontal mouth length. A subnasal lip lift creates a shorter upper lip which is often associated with a younger appearing upper mouth area. Short mouth widths can be increased by moving the location of the outer corner of the mouth mucosa. (mouth widening procedure) A subnasal lip lift and lateral commissuroplasties can be done at the same time. Highlights: The subnasal lip lift accentuates the central part of the upper lip vermilion (cupid’s bow) by shortening the vertical distance of the skin below the nose. A short horizontal mouth distance can be increased by a lateral commissuroplasty procedure which opens up the corners of the mouth.

3) A subnasal lip lift and mouth widening surgery can be done together for a more complete perioral change. Dr. Barry Eppley Tuesday, December 8th, 2015 Background: There are a variety of upper lip enhancement procedures from injectable fillers to lifts. By far lip lifts represent just a minority of cosmetic lip procedures done and, as a result, is a frequently misunderstood operation. A subnasal lip lift can be confused with a lower lip advancement because they are both excisional procedures. But a lip lift truly does lift the lip up while a lip advancement pushed up the vermilion from below. The appeal of a subnasal lip lift is that the scar rests in a relatively concealed area along the base of the nose. When performing the procedure it is important to recognize that the interface between the base of the nose and the lip is not a straight line. It is a multiply curved interface hence the urban name for a subnasal lip lift…the bullhorn lip lift. But despite the appeal of the scar location, a lip lift has its limitations and it is important that patients understand what they are before undergoing to the operation.

By removing skin from under the nose, the vertical distance of the upper lip is effectively shortened. That is its primary effect and by so doing there will be an increase in the fullness of the cupid’s bow vermilion. But beyond the centrally located cupid’s bow the vermilion along the sides of the lip will not change. Draw a vertical line down from the sides of the nostrils and any part of the lip lateral to it will be unaffected by a lip lift. Also, contrary to popular perception, a lip lift will not increase upper tooth show. That area is simply too far away from the point of pull to be affected. To improve tooth show at the time of a subnasal lip lift, a lower horizontal vermilion excision is needed at the same time. Case Study: This 44 year female felt she had a long upper lip and wanted it shortened. She also wanted the lip lift to look natural and not be overdone. The length of the upper lip along the philtral columns was 18mms. Under local anesthesia, a bullhorn pattern of skin excision was marked under the base of the nose and removed.

An excisional width of 4.5mms was made along the philtral columns, making it 25% of the total upper lip length. At three months after the procedure the subnasal scar redness is fading nicely and the stability of the lip lift maintained at 14mms of philtral column length. A subnasal lip lift has a central upper lip effect that is limited to the skin component area of the prolabium. The skin distance of the upper lip is reduced and the cupid’s bow is more pronounced. But the sides and bottom area of the central upper lip remained unchanged. Highlights: A lip lift is a lip shortening procedure that affects the central part of the upper lip only. A well placed subnasal lip lift scar curves in and around the nostrils and columella and is not a straight line. 3) A subnasal lip lift will usually not increase upper tooth show and will not increase the fullness of the sides of the lip. Dr.

Barry Eppley Tuesday, June 30th, 2015 Background: Lip augmentation is one of the most popular non-surgical cosmetic facial procedures and is one of the most common sites for the placement of injectable fillers. But injectable fillers only add volume and in the vermilion deficient lip may create a very pouty lip or ‘fish’ lips. Without adequate vermilion height the filler merely pushes the lip forward and not up as well. For the vermilion deficient upper lip, there are several surgical procedures to change the location of the vermilion-cutaneous junction. Such change is instrumental in getting a good and natural lip augmentation effect. These two well known procedures are the lip lift and the vermilion advancement. The subnasal lip lift is, literally, a lifting procedure of the lip by removing a segment of skin from right under the nose. It achieves two important effects, shortening the lip-nose distance and creating more of a central lip pout. In some patients and with enough tissue removed more tooth show may also result.

(but the risk of excessive tissue removal and a ‘chipmunk look’ can be created with too much of a lip lift) It is equally important to appreciate that it is does not create a corner to corner lip change and only augments the portion of the nose that lies between vertical lines drawn from the sides of the nostrils. There are several criticisms/concerns about the subnasal lip lift. Some feel that if only skin is removed there will be significant relapse.(recurrent lengthening) This has led to lip lift techniques that remove or tighten the orbicularis muscle which can lead to its own set of problems. (lip tightness, smile deformity) There is always the concern about the appearance of the scar right under the nose and whether it will deform the nostrils or the base of the columella. Case Study: This 26 year-old female wanted a lip lift to shorten her lip to nose junction and provide some some additional central lip pout. She already had reasonably good vermilion fullness and did not need/want any direct vermilion augmentation. Given her greater skin pigment there was good presurgical discussion about the resultant scar.

Under local anesthesia, a subnasal lip lift was performed removing 25% of the distance of the philtral column. (4mms) Only skin was removed without any muscle manipulations. Only small resorbable sutures were used on the skin as she lived far out of town. When seen one year later, the subnasal scar was barely detectable and there was no nostril/nose deformity. Comparing her immediate and one year pictures, the subnasal lip lift result has remained stable. (no change in the lip-nose distance or the amount of central lip pout) The subnasal lip lift can be an effective procedure that has minimal risks if it is not overdone or involves muscle manipulation. It must be meticulously measured and executed to be both symmetric with a good scar outcome. Highlights: 1) The subnasal lip lift is a surgical procedure for enhancing the central part of the upper lip and shortening the nose-lip distance. 2) The amount of relapse or recurrent skin stretching is 10% or less and is not that noticeable. 3) A skin excision (muscle sparing) subnasal lip lift is both safe and effective and has a very low risk profile. Dr.

Barry Eppley Monday, August 18th, 2014 Background: Lip rejuvenation is most commonly done by injectable fillers. By adding internal volume the lip gets bigger and, most of the time, looks more aesthetically appealing. But injectable fillers will not work for all aesthetic lip concerns. It can not reduce the amount of skin in the upper lip nor can it increase the amount of tooth show. Should these features of the upper lip need to be improved, an excisional approach is needed. Excisional lip procedures involve the removal of skin to create their effects. This can be done either under the nose (lip lift) or from just above the upper lip line. (lip advancement) There are specific indications for either excisional lip procedure and they are often confused. Fundamentally, a lip lift only changes the central portion of the upper lip while a lip advancement changes the entire vermilion appearance of the whole lip form corner to corner. Both shorten the vertical length of skin of the upper lip and may improve tooth show. A lip lift accentuates the current shape of the cupid’s bow while a lip advancement can dramatically change the shape of it.

The different location of the resultant lip scars are also obviously different. Case Study: This 26 year-old Hispanic felt that her upper lip was too long and she did not have enough tooth show. She has very reasonable vermilion shape and fullness but she was not opposed to a more pronounced cupid’s bow appearance. She had tried injectable fillers but this did not give her the upper lip look she was seeking. An irregular wavy line excision pattern was marked out under the nose in what is often called a ‘bullhorn’ shape. The maximal width of the excision was marked out along the philtral columns based on a preoperative measurement of 15.5mm length with a 5mm skin excision along these lines) The marked excision pattern tapered into the crease at the sides of the nostrils. Under local anesthesia (infraorbital nerve blocks with direct infiltration), the intervening skin segments were excised in two pieces exposing the orbicularis muscle. The lip segments was lifted and sewn in a two-layer closure with resorbable sutures. Antibiotic ointment was applied as the only dressing. The results from a subnasal lip lift are immediate as one would expect from the vertical skin shortening.

While the upper lip is moved upward to be closed under the nose. There can be a slight pulling down of the base of the nose in some cases. This has led to some surgeons doing deep sutures, sewing either the muscle or the dermis of the advanced upper lip skin flap to the anterior nasal spine. This well-intentioned suture manuever is ill-advised as it can affect how the upper lip moves or cause other distortions. As long as not too much skin is removed from the upper lip (never more than 1/3), this slight pulling down effect is temporary and is not of an aesthetic concern. All subnasal lip lifts will eventually suffer some relapse of up to 20% of the skin removed, that is a far easier problem to correct if desired than any type of lip distortion caused by muscle manipulation or deep suturing manuvers. Case Highlights: 1) A subnasal lip lift is an effective lip enhancement procedure whose effects are limited to the central portion of the upper lip. (cupid’s bow) 2) A subnasal lip lift will shorten the upper lip with a minimal effect on increasing upper tooth show.

3) A subnasal lip lift should not remove than one-third of the vertical skin distance between the nose and the lip and should never remove or plicate the orbicularis muscle. Dr. Barry Eppley Sunday, March 17th, 2013 A lot of attention has been paid to how to create more attractive and sensuous lips. From injectable fillers to lipsticks and lip plumpers, enhancing the lips has much to do with altering the appearance of the pink portion of the lip. (vermilion) But an often overlooked area of the lip is what lies above it…the amount of skin between the nose and the upper lip. If this distance is too long, which often happens with aging, the lip looks smaller and less perky. While there are some dental strategies to help the lip look fuller (tooth lengthening), this produces at best a minimal improvement. The most aesthetic skin distance along the philtral columns of the upper lip (Upper Lip Length, ULL) is anywhere between 11 to 13mms for most women.

(for men it can be a few millimiters longer) If you do not have an aesthetic ULL, it can be made by a procedure known as a subnasal lip which actually removes a strip of skin right underneath the nose. Shortening this distance also lifts up and makes the cupid bow’s area more full. Case Study: The BullHorn Lip Lift in Men Tuesday, February 19th, 2013 Background: While lip enhancement has long been desired by women, it is not an exclusive female procedure. While men make up a relatively small minority of patients who undergo cosmetic lip procedures, it is not as rare in men as it once was. I see an increasing number of men who recognize that a thin upper lip is not attractive for them and desire a more appealing size. While the procedures available for lip enhancement in men are no different than in women, there are several subtle differences. Injectable fillers are the most common form of lip augmentation and are highly successful, but it remains of little appeal to many men. Most men do not find the use of needles on a recurrent basis as very motivating. Men are often more interested in a one-time ‘fix’ to their concerns than the need for a recurring treatment.

In addition because men do not wear lipstick, the use of the vermilion advancement procedure (even though it is very effective and affects the lip from one corner to the other) may be approached with extreme caution in them. This leaves the subnasal or bullhorn lip lift as the only surgical option for lip enhancement in men. Putting the scar along the nasal-lip groove at the base of the nose places it in a relatively inconspicuous location in a natural skin crease. As the thin upper lip is almost always associated with vertical skin excess, some reduction in the upper lip skin length is also a benefit. Case Study: This 50 year-old male wanted to improve his ‘weak’ upper lip. He felt his lip was very thin and it gave him a more aged appearance. Since he was undergoing numerous other facial procedures, he felt this was an opportune time to address his lip concerns as well. Prior to surgery, subnasal markings for the lip lift were made with a calipers and a fine marking pen. Initially the vertical philtral columns were marked from the nose to the height of the cupid’s bow and measured. (18mms in length).

A wavy incision in the subnasal crease was then made from one nostril to the other across the columella in the midline. At 5mms down from the crease along the philtral lines, the lowest extent of the planned excision was marked. The lower skin lip excision line was then marked paralleling the wavy line in the subnasal crease but in a feathering fashion as it came to join the upper incision at the sides of the nostrils. At the completion of his other facial procedures under general anesthesia, the subnasal skin segment was excised sparing the underlying orbicularis muscle. The upper lip was then lifted and closed, creating an immediate cupid’s bow enhancement effect. His postoperative course was typical for a subnasal lip lift procedure with minimal swelling and no bruising for the first week after surgery. Sutures were removed at one week after. By three weeks after surgery (as seen here) he looked non-surgical even though the scar was very slightly red. While somewhat visible in a picture taken with a flash, it was not visible in normal room lights or at a speaking distance. Full scar maturation takes months to completely fade.

Subnasal lip lifts can be done successfully in men without creating an abnormal appearance. The key to a natural looking result is to not remove too much upper lip skin. A safe amount of skin to remove in men is either 1/4 to 1/3 of the vertical philtral length presurgical measurement. It is always better to be conservative (1/4) as men have little tolerance for even a small amount of excessive central lip show even if it will settle down 4 to 6 weeks later. While no one wants to have revisional surgery, it is always better to have to do a second stage for further improvement than to remove too much skin which is an irreversible problem. It canc be striking how much difference 1 or 2mms can make in a lip lift. Case Highlights: 1) The thin upper lip in the male has limited enhancement options, either injectable fillers or a subnasal lip lift. 2) The subnasal lip lift enhances the prominence of the cupid’s bow and shortens the skin distance between the nose and the lip. 3) A key to a subnasal lip lift , particularly in a man, is to not remove too much skin and avoid the’ chipmunk look’.

Dr. Barry Eppley Sunday, January 27th, 2013 Surgical lip enhancements involve removing select areas of skin to increase the vermilion show of the lips or change the angle of the corner of the mouth. These are precise and measured amounts of skin removal that result in fine line scars either under the nose, along the lip edges or extending out from the corner of the mouth slightly. The following postoperative instructions for excisional lip enhancement surgery are as follows: 1. Lip lifts/advancements and corner of the mouth lifts have a minimal amount of postoperative discomfort. Few patients ever require pain medication and a few Tylenol or Alleve are all that most patients need for a few days after surgery. 2. There are no dressings applied after lip and corner of mouth surgery. Only antibiotic ointment is used to keep the suture lines soft and supple, whose primary intent is to make suture removal eventually easier. 3. Be aware that your lips will get increasingly swollen over the next few days after surgery. This is normal and not a cause for concern. Lip swelling does not start to go down until three days after surgery and will take a week or two to go away completely.

The use of ice packs on the lips is very useful the first day after surgery to control swelling and improve comfort. You may use them as long as you like. Corner of the mouth lifts have little to none of this after surgery issues. 4. The lips and corner of the mouth suture lines may get wet without any danger of increasing the risk of infection. So feel free to wash your face and shave (men) as needed. 5. The incision lines at the base of the nose (subnasal lip lift), lip lines (lip advancement) or corner of the mouth lift will have sutures that need to be removed in a week after surgery. (unless you are an out of town patient). Apply antibiotic ointment to them three times a day to keep them slightly moist. If any blood has accumulated on the suture lines during the first day after surgery, clean it off with a little water or hydrogen peroxide on Q-tips. There is no need, however, to use hydrogen peroxide on clean suture lines. Just apply the antibiotic ointment. 6. Your lips will feel a little tight when you open your mouth widely. That will take several weeks to a month to return to normal.

You may stretch open your mouth and lips as much as feels comfortable. You may eat whatever you like. Focus on liquids and soft foods for the first few days after surgery. 7. After sutures are removed and the incision lines healed (several weeks), massaging the lips and stretching them gently will help make them feel softer sooner and regain their normal suppleness again. 8. You may return to any physical activity and work as soon as you would like based on your comfort level with pain and your facial appearance 9. You may drive when you feel comfortable and can react normally and are off pain medication. 10. If any lip redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready. Sunday, January 27th, 2013 Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various lip enhancement procedures. The following is what Dr. Eppley discusses with his patients for these procedures.

This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have. ALTERNATIVES Enhancements of the lips can be done by a variety of synthetic or fat injectable fillers to increase the size of the pink part of the lip. (vermilion) Whether the results achieved by injection techniques is comparable to that of tissue excision and lifting should be thoroughly understood before surgery. GOALS The goal of lift lifts and advancements is to shorten the distance between the base of the noses and the upper lip and increase the amount of vermilion show. A lip lift will increase the central lip pout and vermilion show. A lip advancement will increase vermilion throughout the whole lip from one mouth corner to the other. The goal of a corner of the mouth lift is to lift up the sagging mouth corners and create a more horizontal smile or lip line. LIMITATIONS There are limits as to how much the lip can be lifted or advanced and how much the corners of the mouth can be changed. The limits to these changes are based on trying to keep the lips looking natural and not overdone and to not making excessive visible scarring.

EXPECTED OUTCOME Expected outcomes include the following: temporary bruising and swelling around the lips and the corner of the mouth, temporary lip numbness, permanent scars at the junction of vermilion-skin junction (lip lifts and advancements) and away from the corner of the mouth. (corner of mouth lift) All excisional lip procedures may create some temporary stiffness on movement and mouth opening. Healing of the scars and settling any scar irregularities is a process that takes months (6 to 12) to see the final result in many cases. RISKS Significant complications from lip surgery are very rare but could include infection. More likely complications could include aesthetic deformities such as asymmetry and irregularities of the vermilion-skin junction (lip lines) asymmetry of lip (vermilion)sizes or mouth corners, suture reactions along the incision lines, and under vs. overcorrection of the desired lip sizes or corner of the mouth changes. Any of these risks may require revisional surgery for improvement. ADDITIONAL SURGERY Should additional surgery be required to adjust the shape of the lips or corner of the mouth, this will generate additional costs.

Lip piercing: Positions, Sites & Aftercare You are here: Home / Makeup & Beauty / Skin & Body / Lip piercing: Positions, Sites & Aftercare Lip piercing: Positions, Sites & Aftercare by sarita What is Lip Piercing? Lip piercing is getting very popular these days. Young boys and girls are getting their lips pierced in different ways to look more attractive and sexy. Lip piercing is a type of facial piercing that penetrates the lips from one side to the other. Lip piercing also involves piercing the area surrounding the lips in different ways. Lip piercing different styles and positions: Lip piercing can be done anywhere around the mouth. Piercing done at specific positions around the mouth has certain names. Monroe piercing: Piercing done above the upper lip, placed slightly off- center is called Monroe piercing. This position is often called the beauty spot on a face. This kind of lip piercing is more popular among men then women. Many celebrities have gone for this piercing. Other names: A labret stud 14, 16 or 18 gauge is used for this kind of piercing. Advantage: Less painful since the area is soft and contains few nerves. It heals faster than any other body piercing.

Healing duration: 6-12 weeks. Risks: It can cause long-term damage to the teeth and gums as the back-disk of the jewelry continually rubs against the teeth and gums. Lack of proper oral hygiene invites infection. Medusa piercing: Medusa piercing is often referred as the upper-lip piercing. The medusa piercing is placed in the philtrum (vertical groove in the upper lip), below the septum of the nose. Jewelry: A labret stud is the most preferred one. Captive bead rings can also be used. Healing duration: 6-12 weeks. Risks: It can cause long-term damage to the teeth and gums as the back-disk of the jewelry continually rubs against the teeth and gums. Lack of proper oral hygiene invites infection. Labret piercing: Also known as lower-lip piercing or bottom lip piercing .The labret piercing is placed at the labrum (below bottom lip, above chin). Popular among men and women, this style looks super cool and trendy. Jewelry: A labret stud is the most preferred one. Captive bead rings can also be used. Healing duration: 4 -12 weeks.

Risks: It can cause long-term damage to the teeth and gums as the back-disk of the jewelry continually rubs against the teeth and gums. Lack of proper oral hygiene invites infection. Vertical lip / labret piercing: The piercing is done through the center of the bottom lip, parallel to the tissue, reaching the bottom. The jewelry is pulled through and is visible on both sides of the lip, top and bottom. Jewelry: A barbell is the most preferred one. Captive bead rings can also be used. Healing duration: 4 -12 weeks. Bites: in lip piercing “Bites” is a term used for piercing done in sets around the lips in different styles. 1) Angelbites : A double-version of Monroe piercing with piercings worn on both sides of the upper lip. Jewelry: A mirror-image of angelbites with two piercings, placed on each side of the lower lip. Jewelry: A labret stud as well as Captive bead rings, both can also be used. 4) Spiderbites: Two piercing placed together on one side of the lower lip, left or right. Jewelry used in this case is captive bead rings.

Jewelry: A labret stud as well as Captive bead rings, both can also be used. 5) Viperbites: A variation of spiderbites with two piercing placed together at some distance (more than in spiderbite) on one side of the lower lip. Jewelry: A labret stud as well as Captive bead rings, both can also be used. 6)Caninebites: A labret stud as well as Captive bead rings, both can also be used. How is lip piercing done? Depending on the position where the piercing is desired around the mouth, the piercing process varies slightly. We will take an example of Labret piercing and tell you how a labret piercing is done. The piercer needs to wear gloves before he starts the piercing process. The area inside the mouth, between the lower jaw and the lower lip is cleaned and whipped with tissue paper. The piercer will then make a small mark on both, out and in sides of the lip, to place the jewelry in the right spot. The inside and outside markings should match exactly. He then measures the lip thickness using a little tool. The measurement helps in choosing the jewelry of right length, which can help accommodate the initial swelling.

The piercer pulls your lip from your face without it slipping accidentally and holds it tightly with the help of forceps and clamp. It helps in aligning the needle properly on the mark. The piercer lines up the needle in the right angle and pushes the needle through. The piercer will put the jewelry by the help of the cannula attached to the needle which is also pulled through the piercing. You are done with the piercing. Lip piercing aftercare: A lip piercing may sound very fascinating. Bu just getting one done is not enough. Neglecting proper oral hygiene can invite a number of infections. Most lip piercing are reported to cause damage to both teeth and gums. It is therefore very important to follow some basic instructions to maintain a healthy piercing. Avoid eating or drinking and smoking for the first 3 hours of your lip piercing. You may observe some redness, pain and swelling around the lip area, that is absolutely natural as the body is healing the wound. Therefore, you don’t need to panic. Clean the piercing with a saline solution at-least 4-6 times a day. Use soft cotton ball or a tissue to remove any crusting that has formed around the jewelry.

Normally, orals piercings heal faster than any other body piercing since mouth has the natural ability to fight bacteria. You can eat ice-cream, drink cold juice etc to reduce the swelling. Keep the jewelry clean: It is very important to keep the jewelry clean as it can cause the food particles settle on it causing plaque. Brush your teeth 2-3 times a day. Use a moth wash to gargle every time you eat something. Looking stylish at the cost of health is a bad idea. Whichever piercing you choose to go with, ensure that you have made yourself fully aware of its side effects. Evaluate the risks associated with it and then take a decision, so that you don’t regret it later. Lip piercing isn’t and usually infection accompanies it. During the healing period that pierced part needs attention and care. Check out for some lip piercing pictures below: SHARE ON Lip Anatomy | LipAugmentation.com Lip Anatomy Lips – we're mesmerized by their scarlet hue and caressed by their silky softness.

The eyes may be the windows to the soul, but beautiful lips are definitely the gateway to sensuality, as Shakespeare's Romeo attests during his first encounter with Juliet: "My lips, two blushing pilgrims, ready stand to smooth that rough touch with a tender kiss." Perhaps the fair Juliet's focus was on her suitor's lips, fascinated by their infinite movements as they performed a vocal dance of courtship. Even a girl as young as she would have noticed (or at least imagined) their sensual qualities long before they met hers. But we digress . . . Anatomy of the Lips Lips are one of the most visible of all human organs and perhaps the most emotionally expressive part of the human body, so it's hardly surprising that lip enhancement has become so popular. Soft, protruding, and pliable, they are also multi-functional, providing an opening for food and beverage consumption, an instrument of both verbal and non-verbal communication, a tactile sensory organ and an erogenous zone. Three aspects of the lips vary in men and women and by geographic population: size (full or thin), curvature (sinuous or straight) and eversion (turning out or in). All three can be modified through lip enhancement surgery.

Lips are composed of skin, muscle and mucosa – no bones and no infrastructure, making them unique pliable. The upper lip (Labium superioris) is superior in name only since it is actually somewhat smaller than its partner, the lower lip (Labium inferioris). The most cosmetically apparent portion of the lip is the vermilion border, or simply vermilion. This colored border between the lips and the surrounding skin exists only in humans. Rounding out the lip glossary are the philtrum (the vertical groove on the upper lip that forms the so-called “Cupid's bow” and gives the lip its characteristic appearance) and the ergotrid (the stretch of skin between the upper lip and the nose). Two lip surfaces can be differentiated: the skin and the mucous membrane, or lining. The red line formed where the upper and lower lips meet marks the transition between the vermilion lip and the mucosal lip. The skin of the lips is categorized as stratified squamous epithelium, or flattened tissue cells arranged in layers. In actuality, the phrase “thin-lipped” applies to all of us (although it may not be considered a compliment by most).

The skin of the lip is made up of 3 to 5 cellular layers and is very thin compared to the skin on the rest of the face, which typically runs up to 16 layers deep. The mucous membrane of the lip is full of capillaries (tiny blood vessels) that are close to the translucent surface, giving it a reddish color. The lips are also somewhat fragile when compared to other areas of skin on the body. With no hair, sweat glands or sebaceous glands of their own, they lack the usual protective layer of sweat and body oils that keeps skin smooth, kills pathogens and regulates warmth. That's why lips tend to dry out faster and become chapped more easily. Lips are controlled by their own muscles, which are considered part of the muscles of facial expression.

The specific muscles acting on the lips are the sphincters of the oral orifice (orbicularis oris and buccinator), modiolus (anchor point for several muscles), muscles that raise the lips (levator labii superioris, levator labii superioris, alaeque nasi, levator anguli oris, zygomaticus minor and zygomaticus major) and muscles that lower the lips (risorius, depressor anguli oris, depressor labii inferioris and mentalis). The principal lip muscle is the orbicularis oris, a concentric band of muscle that is suspended from the aforementioned surrounding muscles. This sphincter is made up of the pars marginalis (beneath the margin of the lips themselves, and uniquely developed in humans for speech) and pars peripheralis (around the lips' periphery from the nostril bulbs to the chin.) Lip movement is directed by the orbicularis oris and by the muscles in the upper and lower lips, making them extremely expressive of as well as multi-functional. For example, in addition to their gustatory function, lips can close the mouth airtight, keeping out unwanted objects.

When narrowed into round shape like a funnel, suction can be applied – the basic function that allows babies to breastfeed or suck from a bottle. Infants also use their lips extensively to explore their world, mouthing objects and making sounds that mimic speech. As we mature, lips telegraph our changing range of emotions like no other body part can, from anger to joy, laughter to grief, and disappointment to exhilaration. The lips' ability to carry out many functions may be attributable to the fact that the human brain devotes an unusually large part of its surface area to lips. It adds precision to lip movements through nerve fibers linked to the primary motor neocortex, the area of the brain that handles the higher functions of sensory perception, generating motor commands, spatial reasoning, conscious thought and language. Sensation in the upper lip is courtesy of the infraorbital nerve and branches of the trigeminal nerve, the largest of the cranial nerves. It is responsible for sensation in the face as well as motor functions, including biting, chewing and swallowing. The lower lip is served from the mental nerve and the perioral muscles are innervated by the facial nerve.

The latter supplies the muscles of facial expression, including specific muscle fibers of the lips that control the pouting, curling and tightening movements that often unintentionally reveal our moods. It has been noted that our ability to whistle a tune is testament to our lips' “high IQ as neurological smart parts.” The blood supply for the lips comes from the superior and inferior labial branches of the facial artery, one of the six non-terminal branches of the external carotid artery. More than just supplying nutrients to lip tissue, blood also figures prominently in lip color. Light-colored skin contains no melanocyte (pigment cells) and consequently the underlying blood vessels appear through the skin on the lips. The effect is less prominent in the case of darker skin, which contains more melanin and is visually thicker. Lips are packed with nerve endings, making them a highly erogenous zone (ergo the popularity of kissing). The concept of lips as sex object is based as much on their visual allure as it is on their sensitivity to touch. Scientists in Scotland have given credence to the long-held belief that a woman's lips are a highly visible expression of her fertility and sexuality.

The sexual psychologists tested dozens of women to determine their estrogen levels and found that those with higher levels of the sex hormone linked to fertility also had more feminine features, including fuller lips. The researchers then showed the pictures of the women to a group of men who rated the women for health, femininity and attractiveness. It turned out that the men gave the highest marks to the women who tested highest for estrogen. “In our evolutionary past, men who favored women with feminine features would be choosing the more fertile female, and thus would have had more babies and be passing on more of their genes,” explains Miriam Law Smith, who helped conduct the study. She also postulates that women wear makeup (or employ other means of enhancement, including lip surgery to highlight the facial features most closely associated with heightened fertility and sexuality – and beautiful lips rank near the top of that list. Dry, Chapped and Flaky Lips: The Perfect Way To Ruin A Perfect Pout As already noted, our lips are very different from the skin on our bodies and faces, which have many more layers, glands, pores, follicles and melanin, which allows us to tan as a natural reaction to sun exposure.

This melanin screens the harmful UVA/UVB rays, meaning that people with higher melanin (darker skin) are less likely to develop a sunburn than their fair-skinned counterparts. Lips do not produce much melanin, making it important to always use a moisturizing product with an SPF (sun protection factor) of at least 15, although I recommend much higher than that. Since our lips have fewer skin layers than other parts of our bodies, there's not much of a barrier to hold in vital moisture. Chapped lips can happen anytime of the year, but occur most often during the winter when the air outside is drier and colder and our homes are heated with circulating dry, hot air. So we must carry around our pots, sticks and tubes of lip products to maintain our lips' usual softness. Many of you may notice that your lips become dry when you are in bed with the flu or have allergy problems. Oftentimes this is due to fever, dehydration and mouth-breathing. Just be sure to coat your lips often with a good lip product and drink plenty of fluids, which you should be doing anyway.

If you are looking for ways to maintain your smackers at their peak, visit our Lip Maintenance page for some pointers. This section contains lip enhancement tips on how to keep your lips smooth, flake-free and soft, as well as moisturized and protected. If you have any lip care or product recommendations, we'd love to hear from you, so drop us a line ! Best treatment for horizontal line above lip (no Botox)? Best treatment for horizontal line above lip (no Botox)? Posts: 198 Sat Jan 11, 2014 8:36 am Help! Just noticed the other day when looking in the mirror, a horizontal crease appears above my upper lip when I smile. It's almost like a smile above my smile. Where did that come from? And how do I get rid of it w/out using Botox or plastic surgery? Immacolata Posts: 730 Sat Jan 11, 2014 8:58 am Is it right below your nose?

I noticed the same thing recently but it's not unattractive, I don't think...More like a depression/shallow crease than a line so I don't worry about it. _________________ Derminator, phytoceramides, Retin-A, DIY Vitamin C serum, Ageless if You Dare and Pilates! Nonie aka AD Sat Jan 11, 2014 9:54 am Ollie wrote: Help! Just noticed the other day when looking in the mirror, a horizontal crease appears above my upper lip when I smile. It's almost like a smile above my smile. Where did that come from? And how do I get rid of it w/out using Botox or plastic surgery? Image from RealSelf link below. According to plastic surgeons, it is caused by contraction of the muscle between the lip and nose. So maybe face exercise gurus can advise you on how to relax the muscle or maybe microcurrent's "re-education of muscles" can relax the contraction for you. Perhaps Aprile, Sister Sweets, Kassy_A, Christine, et al may have suggestions on how microcurrent can help. It may also not hurt to ask facialdetox if massage can help.

Posts: 868 Sat Jan 11, 2014 1:53 pm I just got thinking. If this line developed out of nowhere and you were not doing anything that may have caused it, and doctors believe it is caused by the contraction of a muscle in that area, couldn't it also be due to the slacking of muscles around it? Which probably means a full workout toning all muscles to get them back to how they were (something microcurrent claims to do--ie, return muscles to their norm) may also help. So I did a search using the keyword "horizontal" to see if anyone with this problem might have solved it with just face exercises. And it seems this reviewer below did! The cross she is referring to seems to me like the image one would see if you looked at a horizontal line going across the philtrum: Another thing I thought of, if the contraction is caused by a repeated expression, kinda like smile lines, then "rubbing out the wrinkles" may help "de-tack" it so the fold isn't "glued" into the muscle. That along with toning of all related muscles seems to me to be one way to fix this.

See more about "de-tacking" in this article: I don't know if you read the thread Christine started about her 12 Day Microcurrent Challenge. In it she mentioned how a stretch of sorts could have fixed a dent seen on one side of her mom's face. I take it that a similar maneuver may be helpful in fixing this line if combined with toning of the areas around it, but don't take my word for it. Check with the microcurrent pros to see if that is the case. Good luck! Posts: 198 Sat Jan 11, 2014 6:10 pm Immacolota, it's not the depression thing we all have above the middle of our lip that connects our nose. It looks exactly like the woman in the picture that Nonie aka AD posted. Thank you for your research on the subject Nonie aka AD! I've heard of facial exercises but I'm too afraid to try them. For fear of skin wrinkles. Although, I have read some positive stories on here. I'd also like to stay away from plastic surgery procedures like micro current. I'm not sure how long it's been there. Maybe it's been a while and I never noticed it before.

I haven't paid attention I guess. I read somewhere this is considered a dynamic wrinkle. One that comes out when using that muscle not when you're face is at rest. It's very noticeable when I smile really big. So, I'm surely hoping this line doesn't become permanent. Do either of you think it will? Nonie aka AD Sun Jan 12, 2014 6:06 am Ollie wrote: I'm not sure how long it's been there. Maybe it's been a while and I never noticed it before. I haven't paid attention I guess. I read somewhere this is considered a dynamic wrinkle. One that comes out when using that muscle not when you're face is at rest. It's very noticeable when I smile really big. So, I'm surely hoping this line doesn't become permanent. Do either of you think it will? Well, lines caused by expressions we make only continue to get deeper and thus permanent with time unless we do something to change that progression. This is where face exercise/massage, facial gadgets and cosmetic procedures come into play. Think about this: the line came to be from frequent use of that muscle.

You probably do it inadvertently so you probably cannot stop yourself from engaging it. It is this repeated action that took you from not having the line to now having it. Add to that gravity's effect on your face, normal aging (less skin renewal), and you can see that without doing anything to address these changes, then you will just get more of the same. If face exercises scare you, perhaps you can consider the stimulating gadgets many people on the forum use...or even just massage. I cannot recommend any because I do face exercises but there are several threads that discuss them and even demo videos by Christine that can show you how well they work. In any case, you will have to commit to whatever method you choose because the aging process does not stop. Collagen loss, bone loss, fat loss, muscle laxity thanks to gravity, skin elasticity loss, etc...just mean signs of aging get worse with passing time. So full commitment to an anti-aging regimen is necessary if you are to slow down the aging process. Add to this a healthy lifestyle and you can appear to reverse things. bethany Sun Jan 12, 2014 1:47 pm Ollie wrote: Thank you everyone for your helpful responses!

Bethany, I have never used any kind of fillers or had any kind of plastic surgery. I'd be afraid I'd come out looking like a duck! I read that women who get lip injections tend to have this line above their lip too. Autumn 1995 & Nonie aka AD, I don't think this line I have is unique whatsoever? Maybe, I'll give some mouth exercises a try along with Furlees and maybe some Retin-a. Who knows maybe one of those will help. Ollie I do not think spot training or mouth exercises are what will help. I also don't think you should try to guess what to do. I think you should probably talk to a facial exercise trainer to see whether their program can help. When I had N/L lines, working that area didn't fix it. When I had bags, working my lower eyelids alone didn't fix it. Spot training IMO is a recipe for looking worse. I think you should PM microcurrent folks and ask them to chime in here. I know if I were the one having this problem, I would contact every pro to see what they advise. I would not try to figure it out on my own.

JMHO bethany Sun Jan 12, 2014 5:12 pm Nonie aka AD wrote: So sister sweets you don't think applying microcurrent to the belly of the muscle causing the tight contraction that creates the line could relax it to where the line could be erased? In other words, can't "re-education" of the muscle work? Nonie I do think re-education can work. Absolutely. Here's where my thoughts come in... Being in the business I'm in. Lip musculature can be killer tight - so tight that when you try to work on someone you almost cannot move the lips appropriately without hurting your own hands. It's involuntary and relentless on the patients part. When I saw that picture that's what I thought of. And maybe... maybe for Ollie what she needs is to release the muscle to give it a chance to relax. Upon relaxation other methods can take hold and create a better environment for her mind to understand and her physical ability to take over. I am not saying it's the only way but I know how tight and unconvincing the musculature in that area can be.

For Ollie if it's a relatively new thing and it seems like it might be, she may be able to do this without the botox (that would be awesome)> Ollie - you will have to get to the work of it right away and see if change is occurring. And you need to be consistent with it and you will need to do more than a few things. I agree with Nonie hitting the area with microcurrent will help release. Ollie - for a less invasive start: I would get going with facial detox at the mouth/lip area tonight!!!! and use it two or three times a day. And get frownies or furlesse. _________________ Enjoying dermalogica with my ASG and Pico toner ** Disclosure: I was a participant without remuneration in promotional videos for Ageless Secret Gold and the Neurotris Pico Emmy event. Ollie Sun Jan 12, 2014 5:58 pm Ollie wrote: Sister sweets, Thank you for adding your two cents! Do you happen to be in the cosmetology or plastic surgery field? I'm not willing to get Botox, fillers or any other plastic surgery.

I've read too many horrific stories of experiences gone wrong! I was looking for a more natural approach. I don't think micocurrent is for me. I thought it was plastic surgery but I was wrong. I don't have a lot of money to spend and after doing some reading on here it looks as though it's pretty expensive. I would be willing to try some facial exercises or anything else cheap that either you, Bethany, Autumn 1995 or Nonie aka AD could recommend. One thing I should mention is that the last few nights I applied heavy lotion to my entire upper lip area. And the next morning the crease was lessened quite a bit. could it be that this spot is just dry and needs more moisturizing? Here is the cheap, quick version to get you started. The moisturizing is helping lesson the look but you need prevention girlfriend. Get yourself some cheap medical type tape and put it over your line at night. (this helps with forehead 11's also). It's firmer than scotch tape and it will keep the line down and inhibit further development. Start the facial detox - basically back of the hand going back and forth over the lips and sides of lip about 30 times at each area.

I swear it helps wipe out lines. Twice a day - more if you can. I'm also thinking maybe some pucker up exercises might help when you're thinking about it. (Head back - fish lips - kiss the ceiling). Don't give up - you'll lick this thing. _________________ Enjoying dermalogica with my ASG and Pico toner ** Disclosure: I was a participant without remuneration in promotional videos for Ageless Secret Gold and the Neurotris Pico Emmy event. Nonie aka AD Sun Jan 12, 2014 10:18 pm Nonie aka AD wrote: Thanks, sister sweets for your input. Y'all have me expecting microcurrent to perform miracles. Of course having never seen any IRL, I haven't the foggiest idea of how easy it is to target the muscle in question, whether it is easy to grip or whether that is what one does...so I am just fantacizing really. And then when I see results like those of the lady below who seems to have had a hint of that horizontal line before even when not smiling and then no longer has it after microcurrent treatment, I am convinced y'all are holding out secrets on us.

J/K Pics are from Nonie - That is a beautiful illustration of the effects of microcurrent lifting NL and lifting sides of the mouth. Lots of "UP" (and out)going on here. This situation appears (to me) to be a different situation than the other person/picture. The issues with NL lines (sag and facial movement related) can be helped with microcurrent. Her whole face is more lifted. The other picture looked like something unusual - a full-on issue across the upper lip (Created by a tight, constrictive muscle movement. I've been trying to recreate on my own upper lip how that came to be and it's difficult to do. I've honestly never seen such a thing. Without actually evaluating the person and the reason, it's difficult to say for sure. _________________ Enjoying dermalogica with my ASG and Pico toner ** Disclosure: I was a participant without remuneration in promotional videos for Ageless Secret Gold and the Neurotris Pico Emmy event. sylphee Nonie aka AD wrote: Thanks, sister sweets for your input. Y'all have me expecting microcurrent to perform miracles.

Of course having never seen any IRL, I haven't the foggiest idea of how easy it is to target the muscle in question, whether it is easy to grip or whether that is what one does...so I am just fantacizing really. And then when I see results like those of the lady below who seems to have had a hint of that horizontal line before even when not smiling and then no longer has it after microcurrent treatment, I am convinced y'all are holding out secrets on us. J/K Pics are from Nonie - That is a beautiful illustration of the effects of microcurrent lifting NL and lifting sides of the mouth. Lots of "UP" (and out)going on here. This situation appears (to me) to be a different situation than the other person/picture. The issues with NL lines (sag and facial movement related) can be helped with microcurrent. Her whole face is more lifted. The other picture looked like something unusual - a full-on issue across the upper lip (Created by a tight, constrictive muscle movement. I've been trying to recreate on my own upper lip how that came to be and it's difficult to do. I've honestly never seen such a thing.

Without actually evaluating the person and the reason, it's difficult to say for sure. Sis, you don't see a line right above her lip? IMO that is the same thing. Only difference is she isn't smiling, but I reckon if she was, it would be more pronounced. Ollie says her line is non-existent when not smiling, which makes me think this lady's case is far more advanced since I see the line even when not smiling. The fact that she has N/L lines as well only confirms to me what I suspected: that its appearance is not just from one muscle tightening up but also enhanced by others responding to the call of gravity and loosening up. So it would appear to me that, if microcurrent does what it claims to, namely tighten loose muscles and relaxed tight ones, then this tight muscle in the upper lip was relaxed while all others tightened to give the smooth contours in the "after" pic. Looking at her before picture, her top lip seems to bulge out creating a dip right above it as if the upper lip muscle is pulled in/pinched. I have not seen this in anyone who hasn't had filler in lips, which is why I understood where bethany was coming from.

Am I the only one seeing this? Here's an attempt at zooming in and focusing on just her mouth: Upthread I linked to a post by someone called Shanti who said she had a cross in her upper lip. I believe this was caused by a similar horizontal line and her philtrum. I assume she saw it when not smiling as that is when the philtrum stands out most. She didn't qualify her statement by saying it stands out when she smiles, which makes me think her case was similar to this lady's. Anyway, to me the line is as clear as day on this lady. So clear that my eyes were immediately drawn to it when I saw her face because it is the only thing in her face that I don't regularly see in aging faces. My attention was drawn to it kinda like how one can't help but notice dimples on a face because not everyone has them so when someone has them, they seem to demand attention. I find this to be the case even if a dimple is ever so slight. And I bet my bottom dollar this line on this woman became even more pronouced when she smiled. Ollie That line shows up when I do a big and strong smile but...

if I focus and concentrate to relax my upper lip I can release whatever muscle is pulling upward and the line won't show. It sucks to be self-conscious every time you smile now. I've been following this thread for tips on correction. Thank you for all the suggestions. Good luck, Ollie! I know what you're going through and I do not want Botox either. Ollie, Does yours look like this? I have pretty full lips and the line only shows up when I smile. I'm 49, btw. Here's my no-smile crooked face: This is the first time I'm posting photos so I hope this works - kind of embarrassing. Since this only happened recently after doing that facial exercise, I'm thinking that some vertical muscle got over-built and tight - like the quadratus labii superioris or the caninus? - and they pull up the lip when I smile. I'm going to try working with massage and microcurrent to release and relax the muscles. All this is guess work so I'm open to suggestions too.

<---smile but not too big because of the horizontal smile line Ollie Mon Jan 13, 2014 12:44 pm Ollie wrote: Thank you sylphee! I'truly hope this line doesn't start appearing when I don't smile when I'm older! Hi Nonie aka AD, I hope you dont't mind me saying so but I don't see the same line that I have or the girl has in the first picture above. It's only apparent when I smile -for now-. I've never had any fillers or Botox or any kind. I don't have full lips either. In fact they're pretty thin. I looked up some of the facial exercises you suggested. Thank you! It's so hard to decide which one to go with -overwhelming-. How can you tell one from another? Hi Ollie: I know you don't see the line when you don't smile. I said that when I said that I believe both Shanti and this lady had the advanced stage of what you have. Your line is newly formed and you are much younger than the lady in the image.

This is kinda like how at the end of 2005 my N/L lines would be so pronounced when I smiled. They did not show up when I didn't smile. Of course I know that N/L lines show up when we smile anyway but in July of that year, they were shallow and didn't look like a fold, but were youthful. The bad change later that year was the N/L lines looking older, deep and clearly were now a fold when I smiled, whereby the cheek skin which was previously lifted and toned was now lying over the skin below so I felt it. Compare that with an older person who does not do face exercises. N/L lines show all the time even when not smiling. So that IMO is what we have here. Repeated smiling with that line appearing as it does on you plus deteriorating collagen and skin elasticity as well as increased muscle laxity with age have all added up to that fold becoming ironed in in this lady so that it appeared even when she was not smiling, the same way all her other lines also did before microcurrent. IMO lines that form when we make expressions are just a glimpse of what could become permanent with age unless we do something to counter that.

Laugh lines in people start off as only showing up when they smile. But as people age, laugh lines become permanent. And the same goes for frown lines, 11's, crow's feet, etc. Earlier on, all the lines are temporary and only there during an expression. But repeating the same expressions over time and with aging always in progress, we gradually become a map/record of every expression we ever made: I listed as many face exercise programs as I could think of, not so that you necessarily pick one, but so you have a good pool to do your research from. Personally I would contact all and let that be how I start to decide on where to seek my solution. But I am a bit nutty: when something is bugging me, I don't settle for the first thing I see, but I research till I am sure no stone has been left unturned. So one way IMO to decide on a program would be to contact all and see what advice you get. I mean how long would it take to write one email addressed to all?

Probably just as long as it takes to post here...and you would hopefully get a response that is more than the guesswork or empathy you are getting here and thus be well on your way to solving your problem. System Piercing Healing Times - Tattoos Forever Tattoos Forever Piercing Healing Times Ear piercings: Earlobe piercing – in the center of the lobe. Healing time is 3-9 weeks. Pierced with wide variety of jewelry, bead ring, captive bead ring(cbr), or circular barbell. Tragus – piercing in the Tragus which is in front of the ear canal. Healing time 4-8 months. Pierced with 16 gauge Anti-tragus – piercing in the anti-tragus, which is through the cartilage above the ear lobe. Healing time 4-8 months. Usually pierced with a 16 gauge Helix – piercing through the helix, which is through the cartilage of the ear. Healing time is 6-10 months. Pierced with a 16 gauge Rook – piercing through the cartilage between the outer and inner concha. Healing time 6-10 months.

Pierced with a 16 gauge Daith – a piercing through the innermost ridge of cartilage, located just above the tragus. Healing time 6-10 months. Pierced with a 16 gauge. Snug – piercing through the cartilage on the outer most ridge of the ear. Healing time 8-12 months. Pierced with a 16 gauge barbell Conch – a piercing directly through the cartilage located just outside of the ear canal. Healing time 6-12 months. Pierced with a barbell, size depends on the persons ear anatomy. Industrial – two or more piercings fashioned by one piece of jewelry, usually a longer barbell connecting the helix piercings.healing time 6-12 months. Pierced with a 14 gauge. Orbital – two or more piercings fashioned by one piece of jewelry, a captive bead ring (cbr), connecting the inner and outer conch. Healing time 6-12 months. Pierced with 14 gauge. Facial piercings: Nostril – the nose, healing time 2 to 3 months.

Pierced with a cbr or a nostril screw Septum – a piercing through the middle of the nose, between the nostrils. Healing time 1-3 months, pierced with a 16 gauge horseshoe Tongue – a piercing through the center of the tongue. Healing time 4-6 weeks. Pierced with a 14 gauge. Lip/labret – a piercing through the lower lip, located on either side or centered. Healing time 10-14 weeks. Pierced with a 14/16 gauge, a cbr or post. Monroe – a piercing through the upper lip, located on one side to represent a beauty mark. Healing time 10-14 weeks. Pierced with a 16 gauge. Dahlia – is two separate piercings located on the corners of the mouth. Healing time is 10-14 weeks. Pierced with a 16 gauge. Medusa – a piercing in the vertical groove(philtrum) directly under the nose, above the upper lip. Healing time is 10-14 weeks. Pierced with 16 gauge post.

Surface piercings: Eyebrow – a surface piercing through the eyebrow. Healing time 2-4 months. Pierced with a curved barbell or ring. Nipple – a piercing through the nipple. Healing time for female 2-6 months. Healing time for males 2-4 months.pierced with 14 gauge barbells or cbr. Navel – a piercing on the top or bottom ridge of the navel. Healing time 8-12 months. Pierced with 14 gauge. Dermal anchors – a form of body modification where an implant is placed under the skin with one exit where the desired jewelry is giving the appearance of being mounted on the surface of the body. Healing time is 3 months. Contact Us I have read the FAQs Name

Question: What is the name of the vertical groove above the upper lip that connects the top lip to the bottom of the nose?
Answer: Philtrum