As the source of sound and communication, the lips have always had a central role in the face: they smile, they kiss, they smirk, or turn downwards. Away from the ham-fisted trout pout interventions of the 1990s and 2000s, the latest techniques in lip rejuvenation are able to plump and rejuvenate your lips without the tell-tale signs. Innovation in the filler and cosmetic surgery industry is bringing a new arsenal of weapons to return fullness, symmetry, definition and youthfulness to the mouth.

The lips are one of the most vulnerable areas for ageing. The skin of the lip, with three to five cellular layers, is very thin compared with other facial skin, which has up to 16 layers. This means that lip tissue ages faster than the rest of the skin.

The lack of sebaceous glands means the lips are less protected and more prone to dehydration, and reduced melanocyte content means a greater chance of hyperpigmentation and skin cancers. As verbal animals, the lips are also exposed to a lot of mechanical stress when talking, as well as strenuous muscle activity when smiling or frowning, and therefore are under greater pressure from the surrounding environment.

The lip is more than just the vermilion, the fleshy red part. The lips are defined by a white patch of skin around the lips, the peri-oral area, the importance of which is gaining traction in lip rejuvenation.

Lips or smile: what are we correcting?

Physicians like Koenraad De Boulle, with more than 30 years of experience in his practice, believe that in 75% of cases he corrects the aesthetic of the lips, leaving only 25% of cases in which a smile is corrected. The smile, he explains, is active and dynamic, while the lips are static.

Soft tissue filler manufacturers have been communicating on the smile when promoting their products, such as Allergan’s market research for ‘Signature Smiles’1.

What do women want to change about their lips?

Women of all age groups complain about their lips. The average age for women to consult for lip correction is around 25 years of age. However, they tend to notice their lip ageing faster much later in life, at around 40–45 years — usually when lipstick stops doing its job to camouflage the lips and feathers into the surrounding lines. Women report greater worry with regard to deep wrinkles, such as the nasolabial folds and barcode lines around the lips, rather than the ageing vermilion itself. When it concerns the vermilion, women typically complain about a lack of fullness and symmetry, as well as lipstick feathering in the lines.

After the full lips paraded by celebrities like Angelina Jolie, a 2013 online survey by Allergan of 3000 female respondents aged 20–60 years from the UK, France, Germany, Italy, Spain and Switzerland, found that women now want natural‑looking lips. The perceptions and aspirations with regard to the lips are age‑related. Younger women like the sensual, fuller-lipped look of celebrities like Angelina and Jessica Alba, while older women go for more ‘classic’ Hollywood icons like Julia Roberts and Marilyn Monroe. The survey also found that one quarter of the women were unhappy with their lips or smile. More than half of the women surveyed would choose to alter their lip shape if they could, with the vast majority doing this for emotional reasons (e.g. to feel more confident, rather than to look younger). Women in the UK feel the most negative about their smile, with over one third expressing unhappiness about their lips or smile, which is 12% higher than the EU average. Make-up is mostly used to enhance lip shade, but there is generally a low level of satisfaction with make-up and anti-ageing creams.