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Dermal fillers
Published in Michael Parker, Charlie James, Fundamentals for Cosmetic Practice, 2022
Once you have done this, do the same on the other side and check for symmetry. To augment the middle of the Cupid’s bow, follow the same principles but start with your needle within the lowermost point of the middle of the top lip with the tip yet again sited within the apex of the bow itself on that side. Always perform these injections via a linear retrograde technique, as boluses within the lip can not only cause unsightly lumps but also confer an increased risk of vascular occlusion and subsequent avascular necrosis.
Volumetric Approach to the Lips
Published in Neil S. Sadick, Illustrated Manual of Injectable Fillers, 2020
Within the mucosal lip there are important anatomic considerations. The wet–dry border is where the mucosa inside the mouth meets the externally visible pink lip (Figure 10.4). A naturally youthful lip has undulations and prominences called tubercles (Figure 10.5). Typically the upper lip has three: the center and two lateral. The lower lip has one on each side of the midline. This anatomy should be maintained to prevent the unattractive “sausage” lips (Figure 10.6). The upper cutaneous lip has two important structures that are important to evaluate and restore as the aging process effaces them. These are the philtral columns and the Cupid’s bow. The philtral columns are the raised ridges that extend through the upper cutaneous lip from the lateral side of the columella to the top of the Cupid’s bow. The Cupid’s bow is the area between these two peaks of the upper lip along the vermillion border.
Smith-Magenis Syndrome—A Developmental Disorder with Circadian Dysfunction
Published in Merlin G. Butler, F. John Meaney, Genetics of Developmental Disabilities, 2019
Ann C.M. Smith, Wallace C. Duncan
Craniofacial features in SMS are distinct across all ages (Fig. 2), but often subtle during infancy. The head is brachycephalic with a square-shaped face and prominent forehead. The eyes are close and deep set with upslanting palpebral fissures. Although the marked midface hypoplasia persists across all ages, it may not be fully appreciated in early infancy. In the infant/toddler stage, children with SMS have a smiling, almost angelic (cherubic) appearance, due to their rosy and pudgy cheeks, marked midface hypoplasia, and upslanting palpebral fissures. Their facial features have been described as reminiscent of the Hummel porcelain angel figurines. Eyebrows are usually heavy and dark with mild to complete synophrys that becomes more apparent with age. The nose is short (reduced nasal height) and broad with anteverted nares. The face may appear expressionless with an open mouth posture. The mouth is very distinct and characteristic of the syndrome, especially at younger ages. The upper lip is down-turned with a cupid’s bow or “tented” appearance. Micrognathia changing to relative prognathism occurs with age. In a few instances, the micrognathia may lead to a clinical diagnosis of Pierre Robin sequence with/ without associated cleft palate (2,26). The facial appearance is most distinctive by mid-childhood (school age) and appears to coarsen with age (Fig. 2). The midface hypoplasia persists into adulthood, and the lower jaw grows, becomes more angulated and exhibits relative prognathia (56).
Invited commentary on: comparative study between Fisher anatomical subunit approximation technique and Millard rotation-advancement technique in unilateral cleft lip repair
Published in Alexandria Journal of Medicine, 2021
To quote Thompson: “all cleft lip surgeons have their favorite surgical technique for repairing the unilateral cleft lip. It is usually a hybrid of training experience and imagination.” [1] Of the myriad of repair techniques that have been described, several techniques have gained popularity. Millard introduced his rotation-advancement repair in the 1960’s [2], and its simplicity and “cut as you go” approach saw it adopted by cleft surgeons worldwide. Despite this, the resulting line of repair is not an anatomical reflection of the non-cleft side philtral column, especially at the top of the lip where it deviates to the non-cleft side. The transverse alar incision can result in nostril stenosis. In cases where a large rotation of the medial lip element is required in order to level Cupid’s bow, the long medial incision necessitates a matching marginal lip incision of the lateral lip element. This may require the surgeon to violate Noordhoff’s point and subsequently sacrifice transverse lip length in order to achieve sufficient height.
Presurgical naso-alveolar molding paired with cheiloplasty to treat median cleft lip deformity in holoprosencephaly
Published in Case Reports in Plastic Surgery and Hand Surgery, 2020
Satoshi Takagi, Ayumu Tsukamoto, Yoshihisa Kawakami, Sachio Tamaoki, Hiroyuki Ohjimi
In holoprosencephaly-related median cleft lip, the premaxillary structure is completely missing or critically rudimentary. As limited skin and soft tissue volume was available for cheiloplasty, it was quite challenging to reconstruct the lip and nose into a fine structure that forms the cupid bow, philtrum ridge, philtrum dimple, or labial tubercle. The simplest cheiloplasty should involve a straight approximation of the lateral upper lip [2–4]. But if a straight scar on the upper lip center is present, the shape of the philtrum structure cannot be determined. For the philtrum reconstruction, Sadove et al. applied a free skin graft [6]. We used skin grafts in our surgical procedure for restoring the philtrum shape; however, it was limited to the region covering the cephalad area and the philtrum dimple. A small white lip approximated with a lateral upper lip segment can fill the caudal area up to the philtrum dimple and simultaneously push the red lip downward, which can mediate the formation of a proper cupid-bow shape.
Evaluating safety in hyaluronic acid lip injections
Published in Expert Opinion on Drug Safety, 2021
Tyler Safran, Arthur Swift, Sebastian Cotofana, Andreas Nikolis
The esthetic destination of the lip enhancement should be based on an understanding of esthetically pleasing volume and proportions, both intrinsic to the cupid bow architecture as well as in harmonious balance to the lower face. Depending on cultural and current norms, upper to lower lip ratios and fullness can vary from the neoclassic golden ratio most commonly described for Caucasians (1:1.6 in vertical height) to an even balance of 1:1 in Afro-Americans and Asians. Furthermore, the contrast in color between white skin and red vermillion should be accompanied by a difference in volume where the red vermilion is voluminous and convex whereas the ergotrid (white skin) is flat and contoured. Respecting this distinct difference is key to successful lip volumization procedures.