A. The lips

Proportions and ratios in the face can vary with different races. Beauty is a fluid concept and fluctuates from one civilization to the next. Some people will regard the beauty criteria of others as handicaps, and even as monstrosities. Our collective subconscious has always been influenced by the sculptural Greco-Roman statuesqueness and by the daily peltering, by the fashion industry, of ideas on what beauty should be. Therefore, in our own perception of beauty, the upper lip should jut out further than the lower one. At the same time, we prefer both lips to be more or less curved, especially the upper one.

If then, according to what we have just said, the features of a face are in a reversed position, maxillo-facial surgery can be performed in order to either move the upper jaw forward or the lower jaw backward.
Another way to achieve equilibrium or dental re-alignment is by orthodontics. Once these osteodental considerations have been satisfied, we can now proceed with the modification of the soft tissue.

1) Thin lips

Be it the upper or lower lip, either one can be thickened by the inclusion of various products such as:

a) Silicone
It's utilization is banned in most countries. It offers an enticing solution but surgeons who utilize it do not, unfortunately, forsee the problems they will be faced with in the long run, be it inflammation, redness, swelling, ulcerations or allergic reactions which may manifest themselves as far in time as twenty or thirty years later. It, therefore, is a solution which I personally reject.

 b) Collagen
A beef product, collagen is injected after an intradermal test has been done to rule out an allergy to it. In my opinion, its high cost as well as its short term effect (three to six months) makes it less than ideal for lip thickening.

c) Goretex
A strip of this solid product mounted on a needle is inserted into the lip. The result is interesting but it can sometimes be felt through the skin or become visible in the form of an ulceration on some part of the lip.

d) Mixture of collagen and ceramic sand
Two thirds of this mixture disappear and the remaining material is the ceramic sand. The high cost of this product is its main problem.

e) Fat
Lipografting is a technique which satisfies me. It is safe and stable on the condition that it be practiced three times. Being an autograft, the fat is removed from the same person from an area where it sometimes is overabundant i.e. from the abdomen, the hips, the saddlebags, the internal faces of the knees, etc.

To avoid being resorbed, the fat must be injected into the muscles. If injected into the subcutaneous area, the fat would encyst and form perceptible small beads under the skin, thus not serve its purpose.

There is, however, an important resorption of fat after the first injection, and the quantity remaining is estimated to equal 20% of the originally injected amount.

A second injection has to be contemplated three to six months later when 50% of the fat injected this time will remain; resorption will only equal 50%.

A third injection performed again three to six months later would remain almost 100% in the muscles, there being practically no resorption following this third lipograft.

 Lipografting is mostly indicated for facial features: the temples, the cheek bones, the upper and lower lips, the upper oral (buccal) triangle, the chin, etc. I, personally, have applied the lipograft technique to some extrafacial parts of the body among which; the thigh adductor muscles so as to fill in the concavity of a hollow thigh, or even the upper and internal part of the internal gastrocnemius muscle to correct a knee which curves inward too much (genu varum).

2) Too thick lips
We are rarely called upon to reduce the size of the lips except in the presence of a particular pathology called minor salivary glands hyperplasia which affects people of the white race. On the other hand, black people may ask us to reduce the size of their lips. This is done simply by horizontally and elliptically excising part of the labial mucous membrane with the underlying glandular tissue.

 3) Too straight lips
Too stiff or straight lips which present no curved rim or eversion of their mucous part, especially the upper lip, give the impression of an austere, severe and even angry person. Its eversion can be done in two different ways:
a) by a lipograft (see Lipograft)
b) by a VY surgical procedure

When well performed, this technique allows us to raise the vermillion, especially its central part topped by the phyltrum. The results are excellent and it is a simple procedure which can be done in very little time.

4) Reversed proportions

We mentioned earlier the generally accepted fact that the upper lip should jut out further than the lower one. We also said that, if this is not the case, this malposition can be corrected by osteosurgery but, if this solution is rejected by the patient, there exists a much less drastic
and painful compromise solution to osteotomy. It is the moving forward of the entire buccal triangle adding to its volume with lipografts. This triangle comprises the entire area between the nasal base, the upper lip vermillion and the two nasogenial furrows. Since this lipografting procedure gives excellent results, it is the one I prefer.

B) The temples

In certain types of ageing faces, a loss of fat occurs in the temple area accompanied by a more or less pronounced concavity which emphasizes the contour of the zygomatic bone and makes it look more angular, thus more obvious. A lipograft in the temporal muscle will eliminate this depression and give back youthful traits to this particular area of the face.

C) The cheek bones

High contoured cheek bones are a sign of youthfulness, especially in the absence of jowls. The restoration of cheek bones can create a spectacular and dazzling transformation. The lipograft is performed in the muscular mass of the cheek bones - the infiltration of fat in the Bichat's fat pads gives a less satisfying effect and sometimes emphasizes the impression of the presence of jowls.