Background: The purpose of this study was to examine the anatomical principles of lip structure as they relate to individualized lip enhancement procedures and to describe a technique that does not violate lip mucosa during injection.
Methods: A retrospective analysis of patients undergoing lip enhancement procedures between 2001 and 2014 was performed. Preprocedural and postprocedural photographs were analyzed for lip subunit changes. A stepwise treatment algorithm targeting specific anatomical subunits of lip is described.
Results: Four hundred ten patients were treated with a "no-touch" technique for lip enhancement. Lip profile is determined by the position of the white roll. The white roll is accessed by a 30-gauge needle at a point 5 mm lateral to the oral commissure and at the base of the philtral columns. Lip projection is established by vermilion formation contributing to the arc of the Cupid's bow. To improve projection, the labial commissure is entered with a 25-gauge cannula and tunneled into the submucosal space between the white and red rolls. Lip augmentation is a direct reflection of the prominence of the red line and can be approached in a perpendicular fashion with a needle or cannula descending to the level of the wet-dry junction.
Conclusions: Accurate assessment of the white and red rolls, arc of Cupid's bow, philtrum, and gingival show can guide the injector on the proper enhancement that individual patients require. The no-touch technique minimizes mucosal trauma. Tailoring treatment toward lip profile, projection, and/or augmentation can yield predictable and reproducible outcomes in this commonly performed cosmetic procedure.