Lip Surface Anatomy with Dr. Rodriguez

Hi. My name is Dr. Ricardo Rodriguez and today we’re going to talk about the surface anatomy of the lip. The reason for this video is so that you can communicate with your doctor better about the things about your lip that you might want to change, or that you’re not satisfied with.

It might also help you look at things in finer detail than you otherwise would.

You know, when we don’t know the names of things we tend to describe things in general; whereas, when we know the terms specifically for each part, we start ourselves looking at each one of those parts more discriminatingly and can tell, in better detail, what’s going on.

So, we’re going to describe certain parts of the anatomy such as the columella, the nasal sill base, the philtrum, the white roll (which is a very subtle structure on top of the lip), the vermillion (which just means “red,” which is the red part of the lip), the corners of the mouth, and then finally we’re going to talk about asymmetry because everybody that I see always tells me, “Doctor, my lips are a little bit different, one side than the other,” and I can just tell you, every single patient that I’ve seen in my life has asymmetric lips.

So let’s start out here with these two patients. One of them is my daughter (right over there) and then this one is my daughter-in-law. They’re both very good looking young women in their thirties, but my daughter-in-law’s Asian and so you can tell this very pronounced, distinctive Cupid’s bow, which can be seen more often in Asians. And, also, you tend to see it in their dolls and if you’ve ever seen a Kabuki performance where they just paint over their lips centrally, so it’s obviously an anatomic feature, but sometimes an aesthetic ideal. And then on Western lips what’s more common is a more subtle tapering towards the corners of the mouth.

Now we’re going to talk about the columella. The columella is the little bridge in here between the two nostrils and it’s important for me, surgically, to align my closure so I always know where the columella is and I want to keep it in the same place.

Sometimes when surgeons do a only a skin closure the columella tends to get dragged down and it gives the impression that the nose is longer. And it’s not longer, it’s just that the columella can get dragged down making the total length of the nose seem longer.

Next, I’m going to talk about the nasal sill. The nasal sill is basically the floor of the nostril. What I want you to see here is that on some patients the floor of the nostril is much more well marked. Okay, and that can be a surgical landmark for me, because if I place my scar, or the incision, right on the nasal sill, it’s not very noticeable, even if it is going across the whole front of the lip. However, when a patient has a very indistinct nasal sill where you can barely see it, then I will go in with a scar a little bit into the nasal sill so that it doesn’t look like a linear scar running across an empty space.

In any case, the surgical planning is different on every patient. Some patients, like me, I have, on one side, I have a nasal sill and on the other side I don’t. So in that case I would place my scar on one side underneath the nasal sill and then on the other side I would go slightly in.

Now, we’re going to talk about the philtrum. The philtrum usually comes from the edges of the columella down to the apex of the Cupid’s bow. And it’s different, right, some patients are going to have a little bit more of a triangular philtrum and some patients have more of a quadrilateral or more like a rectangle. Neither thing is normal, or abnormal, it’s just a normal anatomical variant. But it is important to me when I bring the lip up to know what type of a philtrum it was because if it is a quadrilateral philtrum I want to bring it straight up; whereas, if it’s more triangular I want to bring the edges in.

Another thing about the philtrum is that it gives that sense of volume in the center of the lip with all the different contours and I find that sometimes with aging patients, the whole philtrum tends to get flattened out. So then when I’m going repairs, I try to centralize the lip and give a little bit more contour, again, to the philtrum.

So here you can see a more or less quadrilateral type philtrum there and here represented a more pyramidal one. Again, just normal variants.

Then next thing we’re going to talk about is the Cupid’s bow. Now, it’s because of Cupid, the God of love, and his bow was presented like this and that is because the lip, you know, it’s a sensuous organ, or a structure, and you can see that on some people it’s much more pronounced and acute and on some people it’s more level. Now, neither one is preferable, it really depends on the individual and some people come to me wanting a very accentuated Cupid’s bow. And in those cases I would just tend to do a central Lip Lift. However, on a patient who wants a more evenly distributed Cupid’s bow, I would tend to do more of a full incision which goes out on the side of the nostrils to the tip to elevate more of the lip.

Now, let’s talk about the corner of the lip in here. That is a normal turn down and it occurs in the majority of the population. However, there are some patients where the vermillion border will go almost to the side without tapering much. And that gives the impression of a fuller lip all the way around. Nowadays, with a fuller lip look that everybody likes, that tends to be more of a desired objective. Whereas, I think that twenty years ago, thirty years ago, people used to want more of a defined and acute Cupid’s bow. Normally, the Lip Lift will not lift this part on the side. To lift that, or to make more vermillion show, you need to do a separate procedure which is called a Corner Lip Lift.

Now, let’s talk about the white roll. The white roll is not really a structure that you see and you’re conscious of, it’s more or less something that you’re subconsciously noticing and it’s this ridge of tissue in between the normal lip which is flat and then it sort of rolls into the vermillion. And usually, the white roll doesn’t go all the way out. In most patients it turns out where the lip forms that little turn down in the corner. But most of the time the structure, it’s not that it’s whiter, but it catches the light more, and so you appreciate it as a 3-dimensional structure. The reason the “gull-wing” type of Lip Lift is not performed as much anymore – it used to be an incision right along this border – and what happened was it would flatten the transition between the skin and the lip. And it always looked abnormal, more like the lip was painted on, rather than a structure with a distinct edge from the upper lip. Now, on some people, like here, you can see the white roll is more subtle but it sort of ends around this area – much less distinct than on this patient.

Now, as long as you make a scar with a lateral lip lift, or the corner lip lift, and you stay outside of the white roll, that scar’s not very noticeable. But as soon as you start getting into the white roll, you start noticing the scar more.

Now we’ll talk about the vermillion proper. The vermillion, it usually has these little indentations, or creases, that’s normal. I think that what happens sometimes when people do lip fillers is that they stretch out all of those normal creases and that’s why the lip tends to look abnormal. So, for me, a more natural way of getting more vermillion show is lifting the lip because as you bring out the skin of the lip you do tend to show more vermillion. Now that’s a general rule, it doesn’t always work on a 1 to 1 basis, but generally the vermillion will be more visible but in a way that’s more natural, with the normal creases in it.

As we said before, the shape of the vermillion or the way the vermillion shows, really goes together with the Cupid’s bow. But still you can see that in some people, the vermillion tends to be a little bit fleshier than on other people.

Now finally, we’re going to talk about asymmetry. This is a very well-known model, my daughter was able to tell me right away who she was, I can’t remember her name, and this is Lauren Hutton. This is more from my era, from the 70s and 80s, so you can tell how old I am. But anyways, in both cases they have very pronounced asymmetries. Like Lauren Hutton had one side with a very pronounced corner lip turn down whereas on the other side the lip tends to go up more and more into the corner. And this patient, even her philtrum is like going off to the side. And then this Cupid’s bow is much higher than the other one. You know, it just goes more higher, and acute, whereas this one is more tapered and to the side. So, both of these women are beauties. And nobody notices that they aren’t symmetric, nobody and looks and them and points out, “oh wow, you’re asymmetric.” On the contrary, those asymmetries are a large part of their appeal.

So, in closing, what I would like to tell you is that though it is good to look at your lip, don’t go crazy on it. There are generally things you might want to change or you might not, but as I’m showing you here, there are all sorts of asymmetries in all lips. Don’t worry about it. And, even after surgery, some of those asymmetries are going to persist.

So anyways, look, I hope you like the video. I’m going to be putting out more videos specifically about the musculature of the lip and how that affects smiling and the appearance of your smile and other subjects such as a gummy smile and some people want more of a gummy smile and some people want less of a gummy smile. How you smile, some people smile straight to the side and some people have more of an angular smile… And finally, how the muscles affect the aging of the lip. A lot of people think that the lip is losing volume and most probably is as people age, but I find that a lot of the aging on the lip is a descent of the muscle in itself and a downward curving. So anyways, we’re going to deal with all of that in future videos. Just let me know in the comments if you have any questions that I can clear up. In the meantime, I hope this helped and I’ll be seeing you soon again.