Lip enhancement is a commonly performed aesthetic procedure in the United States. However, in the literature, anthropometric measurements defining the ideal lip proportions are computed and reported based on the white face. These proportions do not reflect the ethnic variations in Hispanic, Asian, and black lip dimensions.
In a study in the Journal of Plastic Reconstructive Aesthetic Surgery, Wong et al. evaluated three-dimensional models of male and female white, Chinese, and Korean subjects using surface-imaging technology (2010;63:2032-9). In both the Chinese and Korean patient groups, there were significant differences in lip parameters and lip-projection volumes, compared with whites, thus revealing measurable differences in the Asian lip morphology. Similarly, Hispanics and blacks do not exhibit the common 2/3 to 1/3 lip height proportions that are commonly used to define the "ideal" lip proportions in whites.
Skin of color patients often have full upper and lower lips, often with a 1/2 to 1/2 height ratio. In addition, photodamage and fine rhytids are not as common in these patients. Mandibular retraction in the lower face leads to perioral volume loss and ptosis of the lateral oral commissures, the development of the prejowl sulcus, and loss of lip volume.
Rejuvenation of the lip and perioral area in skin of color patients should involve the symmetry, shape, and projection of the lips in the context of their ethnicity and the structural differences in their faces. The extent and pattern of volume loss in the perioral region and the lower face should also be evaluated and treated. Revolumizing the lower face in conjunction with revolumizing the lips can produce perioral lifting and global lifting of the mouth and lower face.
Lip enhancement in skin of color patients should involve an understanding of both the inherent differences in the perception of beauty in skin of color patients and the differences in the mechanism of aging. Volumizing and recontouring of the perioral region is best approached in the context of what is thought to be aesthetically pleasing based on patient’s culture, ethnicity, and facial structure.