The Buffalo Horn Lip Lift is a lift that entails incising under the nose with corresponding excision of skin and possibly muscle to reduce the distance from the bottom of the nose to the upper lip.  Other names for this lip lift are Gull Wing Lip Lift or Under the Nose Lip Lift.  The question is when do we need to do this as opposed to other procedures.  Other procedures you can do our corner of the lip lifts, fat injections in the lips, silicone implants to the lips (Permalip), V-Y mucosal advancements, Temporary fillers to the lips.  What is the ideal lip in terms of aesthetics is a great question to start answering this.  The upper lip from the front should be about half the height of the lower lip.  The puckering of the lower lip should exaggerate a highlight that is 3 iris widths wide or the same distance of the width of the eyes to emphasize the association with the eyes.  I discussses facial aesthetics in my award winning facial beauty theory here: http://www.drphilipyoung.com/pdf/circles_of_prominence.pdf on my harmony of beauty page: http://www.drphilipyoung.com/harmony.html. The puckering of the upper lip should be centered in the middle and should be one iris widths wide and 1/2 an iris width high.  The height of the lower lip should be one iris width in height.  The distance from the bottom of the nose to the upper lip border should be one iris width.   Other points of beauty should be that the teeth with the lip resting open should show at least 3mm of upper teeth and the lower teeth should not be visible much at all.  The upper lip should also protrude anteriorly beyond the lower lip by 1-2 mm.  When you look at beautiful models you will see something interesting.  All of the light that hits the lips is mostly concentrated on the lower lip.  The lower lip is the center of attention when you look at someone and not the upper lips. So you never want to make the upper lip the same size as the lower lip or this balance will be disrupted.    Based on these fundamentals of how the lip should look you can do one or a combination of the above procedures to achieve these ideals.  If the distance from the nose to the lip is greater than an iris width you can do a buffalo horn lip lift to shorten the distance.  A picture below shows in blue where the excision of skin takes place to shorten this distance.  The result of this will cause the upper lip to rise and also will tend to cause the upper lip to show more of the red portion which may or may not be beneficial.  If the lips are thin, that is less than 1/2 iris width for the upper and one iris width for the bottom and less than one iris width in puckering in the upper lip and less than 3 iris widths for the highlight puckering in the lower lip you could volumize the lips with fat injections, temporary fillers, or permalip or other silicone permanent lip implant.  You can also fill the lips with natural tissue implants from the temple or within the face (during a facelift for example) that can act just like the silicone lip implant.  Filling can be done to cause more of the red lip to show.  If there still requires more of the lip to show, you can do V-Y advancements to evert the lips more.  This is done be advancing the mucose or the lining inside the lips in a way that causes the lip to evert more.  You can read about these more here http://www.ayoungyou.com/?cat=15.  Corner of the lip lifts do just that and raise the corners.  The drawbacks with that are that you need an external incision to lift the corners.  If you can accept an external scar this could be a good option.  We have other blogs that discuss that too.  Fat injections can fill the lips, evert the lips and volumize the whole mouth area to rejuvenate the whole mouth or perioral area.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Permalip implants (Philip Young MD Bellevue Washington) are silicone implants that are placed in the lips from the corners of your mouth.  The procedure can take as little as 15 minutes.  It can be done under local anesthesia and the recovery is very fast.  Below are some before and after pictures. The after pictures are taken only 2 weeks after the procedure.  These silicone implants will not dissapear like restylane and juvederm injections.  They are there permanently.

I hope that was interesting for you!

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

Permalip (Dr Young uses this Lip Implant at his office in Bellevue Washington) is a relative new silicone lip implant that can permanently augment the lips.  There are 3 sizes for the permalip (silicone lip implant, silicone lip enhancement, silicone lip augmentation, silicone lip enhancement) small, medium and large and which very in width from 3, 4, and 5mm.  They are used to essentially give the lip more volume.  They are placed in incision in the red part of your lip and these can be varied and discussed with Dr Young during a consultation.  The great thing about these implants is that they last essentially permanently.  Silicone is very capatible with our tissues.  Silicone is located just under carbon on the atomic chart of all the atoms on earth.  So its elemental structure is very similar to carbon which is what humans are predominately made of.  Of all implants it is the most compatible.  Hundreds of thousands of people have had silicone implants and it is proven to be very safe, non carcinogenic, non toxic, etc meeting many of the characteristics of an ideal implant.  Bottom line is that there is no ideal implant but silicone possesses many of those characteristics.  If silicone implants are not something that you are totally comfortable with, other tissue can be substituted including different areas of your body like muscle covering, SMAS, and free fat grafts.  Other options include micro fat injections to the lip, VY advancements, and other lip lifts.  More temporary lip implants include restylane, juvederm, perlane, and the new juvederm xc which has lidocaine and has received some recent attention.

Here is a video showing a live demonstration of a Permalip Lip Augmentation Procedure.

Thanks for reading, Dr Young

Dr Young specializes in Facial Cosmetic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

There are other options for the corner of the lip lifts (Lip Augmentation, Dr Young Seattle).  The two major designs are shown below in the diagram that is included.  The original one is on the left and a modified one is on the right.  These lifts can elevate the corners of the mouth significantly but do not address the marionette lines and extra fold inferior to the corner of the lips.  In my experience, and in the hands of others, there can be a tendency with these more traditional corner of the lip lifts to elevate the corners too much.  That is why other’s have adopted excisions more like the ones drawn in my other blog and shown in the cartoon picture that I included as well.  All options can be used to improve the downturned mouth like many women and men wish to improve. Notice how the older lip lifts are bowl and heart shaped and the newer designs in the cartoon drawing are reversed bowl shaped which seem to avoid excessive elevation.  The other shapes in the cartoon are for direct excision of the nasolabial folds and an extension of the corner of the lip lift that includes the marionette folds, or puppet mouth line folds.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington