The Science of the Pout: Enhancing the Lips

Each part of the face projects subtle indications of its owner’s age, health, and weight. When you meet someone for the first time, you unconsciously examine their features and draw conclusions. Plastic surgeons like myself examine these signals on a daily basis and can generally determine a person’s age within a relatively small range. Whether we agree or not with these societal judgments of youth and beauty, we all participate in them, especially in the age of social media. For example, that slight pout in an Instagram selfie has a scientific basis for its appeal, and when performing lip augmentation, I evaluate and offset a patient’s own aging patterns and aesthetic deficits. Lip augmentation with dermal fillers treatments performed nationally have also become staggeringly popular with over 1,000% growth between 2000-2015, according to the American Society of Plastic Surgeons. Below, I examine the aesthetic “ideals” of the lips, where those ideals originate, and how non-surgical lip augmentation can mimic them. (Note that the “ideal” is simply what is in traditional aesthetic medical literature and may not be the best fit for any particular gender or patient.)

The Lips as an Indicator of Beauty and Youth

• Overall Lip Fullness: As we age, we lose volume due to the atrophy of youthful fat in several areas of the face, especially the lips. The lips are a very mobile area of the face and are involved in speech and in most facial expressions. Over time and repeated animation, that fat unfortunately is lost.  As a result, thin lips are to some degree less aesthetically ideal, because they subconsciously are associated with age. For a similar reason, thinning of the lips laterally is also not perceived as aesthetically ideal and is a common area I correct in my non-surgical lip augmentations. As a side note, even though the trend toward fuller lips is a recent phenomenon, lip fullness being correlated to youth is an old (ancient), very fundamental pillar of our perceptions of facial beauty. However, until the approval by the FDA of hyaluronic acid dermal fillers like Juvederm or Restylane beginning just over a decade ago, there were few effective, affordable options for lip augmentation.
• Ratio of Upper to Lower lip: In plastic surgery literature, the “ideal” lower to upper lip ratio is most often referenced as 1.6:1, where the lower lip is larger than the upper. Hence, this means that a natural “pout”, where the lower lip is more prominent, is the most aesthetically pleasing. Why is that? The answer is somewhat unclear. Possibly, it is due to the fact

  that Caucasian women’s lips tend to follow this trend, and unfortunately, there is a somewhat racial component to our perceptions of beauty in the lips and in other areas of the face and body. (There are signs, though, that that may be changing.) My own personal theory, for which I have limited and solely anecdotal evidence, is that a protruding lower lip, and central lip fullness in general, is reminiscent of an infant’s facial structure. So again, this aesthetic ideal is possibly due to our perceptions of youth, but is a not a static measure. Societal preferences do change over time, and a recent medical research study in the journal JAMA Facial Plastic Surgery asked participants to identify the most aesthetically pleasing lip ratio, and participants chose the far left image in the gallery above with a ratio of 2:1 (Notation is 1:2 in the image below). Today, most of my patients actually request overall greater fullness in both lips than that far left image, reflecting further changes in aesthetic trends.

• Lip Symmetry: In several aspects of the face and body, research studies have demonstrated that symmetry is prized, and the lips are no exception. In fact, there was a seminal study demonstrating that symmetry is the most important factor in our perception of beauty. It is thought that this preference may have an evolutionary basis: we perceive a potential mate as being healthy when there is symmetry. As a very big picture example, imagine if someone were missing an eye or a limb. These disabilities would seriously impact their survival probability in all but the most recent eras.
• The Celebrity Effect: In another study in JAMA Facial Plastic Surgery, researchers analyzed the photos of 353 fashion models from the magazine Vogue from years 1960-2011 and found that there was no increase in the average lip size of a model over that time. This was an unexpected finding, so the researchers posited that celebrities, rather than fashion models, may be driving these trends. Given the frequency with which one of my patients mentions “Kylie’s lips”, of the Kardashian/Jenner clan, in the context of her lip augmentation treatment, I tend to think that celebrities of film and social media are becoming more dominant in determining our perceptions of facial beauty. In addition, there have been behavioral studies indicating that social media very much influences one’s self-perception and ideals.

Why You Do a “Selfie Pout”

We’ve all seen it: the slight puckering of the lips that you, or that friend, make when the phone camera comes out. The question is why? There are actually objective reasons why the “selfie pout” is aesthetically appealing. As above, we perceive fuller lips as beautiful and youthful, and a slight pucker increases the perceived volume in the central portion of the lips without distorting your facial expression too much. For many people, it also exaggerates your pout causing the lower lip to protrude slightly, bringing your face closer to the “ideal” lower to upper lip ratio. In addition, this facial expression slightly narrows the lower half of the face and tugs upward on the jawline. We perceive a square, wide jaw as a masculine feature, therefore not an ideal feature for a woman, and fullness in the lower cheeks and along the jawline is associated with weight gain and aging. The aesthetic feminine “ideal” is a linear jawline with little to no submental, or under the chin, fat, the presence of which you also camouflage by intentionally the lower face just that little bit. In fact, the makers of Botox introduced a non-surgical treatment called Kybella to eliminate submental (double chin) fat permanently, and it has become extremely popular nationwide.

Enhance Your Natural Anatomy

Lip augmentation is such a quick, almost painless procedure in the right hands and provides an immediately visible enhancement to the lips. I can correct several aesthetic issues with lip augmentation:

• Enhance overall lip size
• Bring the lower to upper lip ratio closer to the “ideal” ratio
• Correct any deficit in lateral lip fullness
• Correct any existing left to right lip asymmetry

Finally, I demonstrate two of my personal lip augmentation techniques in the video below and show one of my patient’s before and after results. I first accentuate the points of the Cupid’s bow at the top of the lips and then inject the philtral columns, the vertical structures between the lips and nose. Together, these techniques enhance your pout by slightly lifting, or everting, the upper lip.

Why Visit a Plastic Surgeon for Lip Augmentation?

Lip augmentation is an overwhelmingly safe, easy procedure when performed by a board-certified plastic surgeon like myself, but due to its popularity, there are many practitioners who are not board-certified physicians. We’ve all seen “duck” lips or “earthworm” lips, where too much dermal filler has been injected. It is also possible to generate excess bruising or a”hanging lip” if the injector is less familiar with the delicate lip anatomy and injects in the wrong plane of tissue. If not in a sterile medical environment, injections can lead to infection, although this is extraordinarily rare when performed by a physician. In addition, a plastic surgeon will always carry hyaluronidase, the enzyme that will quickly dissolve the hyaluronic acid in the filler, in the case that you do not like the treatment result or if you experience a rare allergic reaction. If you’re interested in further information, this recent popular media article outlines some of the unfortunate side effects patients experienced in the United Kingdom after they visited untrained practitioners. With me, you need not worry about such complications, because I have hundreds of hours of experience performing lip augmentation and am well aware of all anatomical concerns in this cosmetically sensitive area of the face. At Zuckerman Plastic Surgery, you can also choose from several different dermal fillers including Juvederm, Volbella, and the Restylane family of products. Volbella is Allergan’s newest hyaluronic acid filler and is meant for lips and fine lines around the lips. It is great for those desiring a subtle lip augmentation, because it is less viscous and has less structure due to its lower concentration of hyaluronic acid particles. This means I can achieve subtle plumping effects without the slightest worry of duck lips.