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26 Dermatologic Surgery S K I N & A L L E R G Y N E W S • Ju ly 2 0 0 5

Help Lips Shape Up With Proper Use of Fillers B Y J A N E S A L O D O F M A C N E I L

Southwest Bureau

P H O E N I X , A R I Z . — The lip that is en-hanced with filler should meet definableproportions and yet retain its individuali-ty, Arnold W. Klein, M.D., said at a clini-cal dermatology conference sponsored byMedicis.

“Lips are about volume but more im-portantly shape. Any enhancement mustbe undetectable,” said Dr. Klein, who

holds a dermatology chair in his name atthe University of California, Los Angeles’David Geffen School of Medicine.

Lip augmentation requires fillers to in-crease facial volume in a subtle and aes-thetically pleasing manner, he said. It is notabout “simply eradicating lines.”

The lower third of the aging face, in-cluding the lip, is the area least amenableto plastic surgery. Along with the thinningof both lips, he cited prominent labialmandibular grooves, the ends of the upper

lips hanging down, loss of bone supportfrom dentition and from the mandible,and decreased vertical support, he said.

According to Dr. Klein’s formulation ofthe aesthetic lip: “The length of the closed,relaxed mouth should equal the distancebetween the medial aspect of the irises inthe well-proportioned face.” In addition,the ratio of the upper lip to the lower lipshould be 1:1.6.

When the head is photographed in apostural position with a relaxed mouth, an

interpupillary line drawn horizontallyacross the eyes should be parallel to a hor-izontal commissural line drawn where thelips meet.

Dr. Klein cited other characteristic faciallandmarks including curvature of the dor-sum and angulation of the nose. He saidthe base of the nose should be 18-20 mmabove the upper lip, whereas the recom-mended distance between the lower lipand the chin is 36 mm.

Looking at the postural head position in

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Ju ly 2 0 0 5 • w w w. s k i n a n d a l l e r g y n ew s . c o m Dermatologic Surgery 27

ics, Anika Inc., Medicis, SkinMedica, andOrthoNeutrogena.

“It is not what you use. It is how you useit,” he said, recommending physicians be-come really skilled in one or two productsrather than plow through what he de-scribed as a delicatessen menu of fillingagents on the market.

Except for correction of scars, Dr. Kleinopposes the use of permanent fillers. He

warned that these agents could become in-creasingly visible or create an unnaturalappearance as facial contours change overtime. “For aesthetic indications I believepermanent fillers are a formula for disas-ter,” he said. ■

profile, the physician should make sureboth lips touch the “Steiner line,” he said.

When seen in profile, the nasolabial an-gle should be about 84-105 degrees, he con-tinued: “You want a good nasolabial angle.”

To illustrate this, he showed a photo-graph in which one extended line con-nected the base of the nose to the tip of thenose. A second line from the base of thenose touched the “Glogau-Klein point” atthe center edge of the upper lip. The angleis formed where the two lines intersect.

The G-K point describes the “ski slope”shape of the lip in profile as you movefrom the skin above the lip down onto thepink vermillion. There is always a little up-

turn, a point of reflection, which becomeslost as one ages, Richard G. Glogau, M.D.,told SKIN & ALLERGY NEWS.

The cosmetic implication is that youhave to recreate this shape with fillersused in the border of the lip to make thelip young and attractive. Also, if you usetoo much Botox on the upper lip, the or-bicularis muscle flattens and makes anolder looking lip. Therefore, it is general-ly a good idea to combine fillers with theBotox if you are trying to reestablish ayouthful looking upper lip, said Dr. Glo-gau, who is a consultant to Allergan Inc.,Medicis, and Inamed Aesthetics.

Dr. Klein cited a study of 100 women

which showed that aging lips lose height(Dermatology 2004;208:307-13). He saidthe most important aspect of lip aug-mentation involves building buttresses torestore the lost height and the ends of thelips.

“You want flying buttresses to hold upthe lips because of the loss of dentition,”he said. “You want to restore the ends andbuild buttresses to support the lip. That’sreally important.”

The choice of filling agent is less im-portant than the physician’s skill in usingit, according to Dr. Klein, who disclosedties as a consultant and/or investigator forAllergan Inc., Genzyme, Inamed Aesthet-

Plasma Method

Irons Out Lines

And Acne ScarsL A K E B U E N A V I S TA , F L A . — Plas-ma skin resurfacing reduces acne scars andfine lines while minimizing downtime andadverse events, according to data present-ed at the annual meeting of the AmericanSociety for Laser Medicine and Surgery.

“Plasma skin regeneration provides aneffective long-term facial rejuvenation foracne scarring and fine lines,” said M. Pot-ter, M.D., of RAFT Institute of PlasticSurgery in London.

The plasma device works by passing ul-trahigh energy through nitrogen gas, gen-erating plasma used to treat scars andlines with short pulses.

In this study, Dr. Potter treated a total of11 patients (10 women)—3 for acne scars,7 for fine lines, and 1 patient for both. Thetreatment was performed under anesthe-sia. Energy varied between 1 and 4 J.

All patients were assessed at 10 days and3 and 6 months post treatment. “A precisemeasure of skin irregularity was recordedusing silicon molds. ...Wrinkle depth wasassessed using a light microscope tech-nique to give an accurate measurement,”Dr. Potter said.

In patients with fine lines, the mean pre-treatment wrinkle depth was 0.25 mm. At10 days, there was a mean improvementin wrinkle depth of 39%. At 6 months,mean improvement was 24%. “Acne is al-ways difficult to treat, but these patientshad an improvement of 35% at 10 daysand 23% at 6 months,” Dr. Potter said.

—Kerri Wachter

The Glogau-Klein point showsdimensions of the aesthetic lip.

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