INTRODUCTION

A beautiful and pulpy mouth is the dream of almost every woman.

The demand for aesthetic medicine is growing, especially among young people.

However, between unrealistic expectations and questionable or even failed results, it must be said that the design and realization of a beautiful mouth is very subjective, depending on the practitioners and patients. 

How then can the characteristics of a beautiful mouth be established objectively?

Art and sociology, to the aid of aesthetic medicine, provide us with very precise answers.

The mouth: a weapon of mass seduction

According to recent data, the mouth represents between 25 and 30% of the reasons for consultation in aesthetic medicine.

A study from the University of Manchester, conducted by Professor Geoff Beattie, explains this craze: in the first 10 seconds of a meeting with a woman, a man spends more than half of his time looking at the mouth of his interlocutor, and up to 7.3 seconds if she has put on lipstick!

Women know it: the mouth is their “weapon of mass seduction”, and augmentation procedures allow them to make better use of it. At least they hope so, but…

But beware of drifting

Until recently, patients came only to repair their “bar code”, to improve a thinning of the lips or to fill in bitterness wrinkles.

Now the main demand is now mainly for an increase in the volume of their lips.

But this request is not always reasonable.

In the age of Internet 2.0 and the dictatorship of social networks, it sometimes becomes difficult for the practitioner not to give in.

From où the monumental failures that we can all see in the media.

Who does not have hated the lips of Emmanuelle Béart, Meg Ryan or Donatella Versace?

Unfortunately, all these horrors are not only committed by renowned experts on international stars, but also every day by ordinary doctors on lambda patients.

The main reason for this is the lack of artistic training, whereas anatomical teaching is omnipresent.

This is where the problem lies: anatomy can make you look younger and avoid side effects, but it is not a good way to develop an artistic project for your patient.

Many gross mistakes are made in good faith, with some practitioners systematically applying their own vision of beauty, the result of media pressure and their personal aesthetic experiences.

His explains why we see in the waiting rooms the same mouths, the same frozen foreheads, the same cheekbones

Art at the service of aesthetic medicine

The Greeks were the first to elaborate “canons of beauty”, codifying the proportions, angles, harmony and relationships of the different elements of the face to each other.  

Widely copied by the Romans and meticulously taken up by the artists of the Renaissance, these canons have proven their validity by the immortal masterpieces that we have left from artists such as Michelangelo, Raphael, Dürer, Leonardo da Vinci and many others. 

What’s more, these rules are still in use today. It is therefore imperative that they enrich aesthetic medicine and serve as a basis for our analyses.

 

What are they concerning the mouth?

The position of the mouth in the face is almost mathematical:

  • Horizontally, the line between the 2 lips (interlabial line) must be situated at a third of the base distance from the nose to the chin (fig. 1).

  • Vertically, the corners of the mouth should be perpendicular to the lowered verticals of the inner part of the leaf blade (of the iris) or at most to the inner part of the pupil. 

  • This width should not generally exceed half the width of the face at the interlabial line (fig. 1: BC<AD/2).

  • When correcting the bitterness folds, care must be taken not to exceed this value, otherwise a “joker’s mouth” will result.

  • The shape of the mouth is very variable according to the shape of the philtrum, the respective thickness of the lips, their volume, etc. Overall, from the front:

  • The upper lip has an M shape, while the lower lip has a very flattened U shape or more rarely a W shape.

  • The upper lip is made up of 3 massive (fig. 3), while the lower lip has a very flattened U-shape or, more rarely, a W-shape has only two. 

  • A common mistake is to make only 2 massifs at the upper lip, with a “curtain” or even “hare’s beak” look, as in the case of a famous French actress mentioned above. 

  • The ratio of upper lip to lower lip is very important:

  • Artistically it is 2/3 or 0.66, that is to say that the height of the lip is equal to 66% of the height of the lower one (fig. 4).

  • The proponents of the golden section theory advocate a lower lip 1,618 times thicker than the upper lip (a ratio of 0.62:1). This ratio produces yet an upper lip too thin compared to the beautiful mouths observed.

  • More generally, a single number cannot explain the immense variety of the beauty offers us, as beautifully demonstrated by Pr. Marguerite Neveux in a well-documented work: “Le nombre d’or, autopsy of a myth”.

The hem of the upper lip must be very precise, but only on its inner 2/3. 

There is in fact an invagination on the outer 1/3, the white lip “re-entrant” to form the corner. 

It is therefore artistically a mistake to inject the outer third.

 

The projection of the lips, seen from the side, represents the essential part of the errors committed in aesthetic medicine. Generally speaking: 

  • The 2 lips are behind a line joining the tip of the nose and the chin (fig. 5).

  • The upper lip always overhangs the lower one (fig. 5).

  • Lips that are vertically aligned (fig. 6) or too protruding (fig. 7: duck’s beak) are frequent errors

  • The lower lip is concave over its entire length and generally has no hem unlike the upper lip.

  • Creating a hem at this level is a common mistake which gives a very artificial appearance in both static and dynamic situations.

  • Commissures are a vital element of youthfulness and facial expression, which deteriorate over time.

  • They should ideally be located above the interlabial line, otherwise they will look tired, sad, bitter or even mean.

Sociology: The modern beauty canons are changing

The artistic characteristics of the mouth have little change throughout history.

They are quite identical in the Venus de Milo, the Mona Lisa or the women of the end of the 20th century.  

A study by the magazine Vogue© on photos of stars published from 1945 to the present day shows that until 2010, no significant changes occurred in the volume and proportions of the lips between them and in relation to other facial elements. 

 

But things have been changing over the last decade.

Indeed, the media hype of the fashion and industry beauty, the ultra-sophisticated tricks of Photoshop, and above all the desire to imitate the extravagances of their idols, are pushing some to ask for excessive or even unrealistic changes, particularly because of social networks : women are indeed asking for a more sensual, sexy mouth.  

With specific, even excessive characteristics concerning volume and especially the upper lip.

 

Should we give in to the demand ?  Yes, but in controlled proportions. 

Sociological studies provide us with valuable indications on these limits:

  • The volume can be increased by 150%: this is the ideal value established6 on a sample of 450 people (fig. 8).           

  • In practice, the lips can be increased but without removing the radial folds of the lips by over-distension, which gives a very unnatural “tench muzzle” appearance.

  • The upper lip can be augmented, but no more than the height of the lower lip.

  • An important study8 has established that the ratio preferred between the upper and lower lip is 0.68/1, which almost perfectly corroborates the academic artistic ratio (0.66/1), but not that of the golden ratio (0.618), nor the ratio requested by our patients (1/1 or even more).

  • The philtral crests and a well-drawn, prominent cupid’s bow are not suitable for all mouths.                     

  • Works conducted by Prof. Suzanne Ashley of the University of Washington shows that there is a very clear correlation between the visibility of the philtrum and Cupid’s bow on the one hand and the size of the upper lip on the other.         

  • The thinner the upper lip, the less philtral visibility.   

  • It is therefore necessary to keep a coherence between these elements and to consider the natural anterior morphology.

  • A resting central upper incisors visibility, as seen in Georgia May Jaegger or Brigitte Bardot when young, and a “bilobed” lower lip, as in Angelina Jolie or Lindsay Wixson, constitute what Anglo-Saxons call “pouty lips” (or sulky lips, because they are reminiscent of those of a child,(Figure 9).                 

  • A great deal of research has established that pouty lips are the must-have of the sensuality for the younger generation.

  • But again, not all faces can benefit from such characteristics. If you want to make the upper central incisors appear, you can obtain very artificial “curtain” or “harelip” mouths, and if you want to create a bilobed lower lip, you risk increasing the projection too much in relation to the upper lip and the tip line of the nose and chin.

The results must be harmonious, but also natural.

All these criteria should therefore generally only apply to women under 40 years of age, rarely more.

For older patients, a classic ratio consistent with age should be respected. 

It should also be borne in mind that changing the size of the mouth can strongly alter other facial characteristics. 

For example, when we increase the upper lip, we will decrease the height of the philtrum and thus optically increase the height of the chin. 

In a person who already has a large chin, one must obviously avoid making this mistake.

Below are a few examples obtained in practice.

Conclusion

No one will dispute that the creation of a beautiful mouth, and a fortiori a beautiful face, must be done according to the rules of art.

These rules constitute a framework from which one can nevertheless escape according to the characteristics of each face.

It will also sometimes be necessary to go beyond the limits to adapt our gestures to the evolution of the demand, but always in proportions that we will control thanks to artistic references and sociological data. 

We are in fact experts, and therefore the only decision-makers, guardians of the harmony and naturalness of our “works”.

But it is therefore advisable to acquire this artistic methodology, “to educate the eye” as Monet used to say.

This new way of looking will then enable us to make much more refined therapeutic decisions, with the key to the aesthetic results that patients and their entourage will be delighted with.

There is little doubt that in the near future, patient preference will go towards this kind of skill.

Bibliography

1. Beattie G. Red lips hold men’s gaze longer than nude ones in the Independent journal. University of Manchester. 2010 december, 3.

2. Chiu A, Fabi S, Dayan S, Nogueira A. Lip Injection Techniques Using Small-Particle Hyaluronic Acid Dermal Filler. J Drugs Dermatol. 2016 Sep 1;15(9).

3. Djoudi J. Is beauty pre-programmed ? Revue Française de Chirurgie Esthétique et Plastique, 2011 April 14.

4. Heidekrueger PI, Szpalski C., Weichman K., Juran. S, Claussen C., Ninkovic M., Broer PN. Lip Attractiveness: A Cross-Cultural Analysis. Aesthet Surg J. 2016 Sep 27

5. Hennekam RCM, Cormier-Daire V, Hall J, Mehes K, Patton M, Stevenson R. 2009. Elements of morphology: Standard terminology for the Nose and philtrum. Am J Med Genet Part A 149 A:61-76.

6. Hogarth B. The painless portrait. Editions Taschen 1997 Jan 01.

7. Popenko NA, Tripathi PB, Devcic Z, Karimi K, Osann K, Wong BJ. A Quantitative Approach to Determining the Ideal Female Lip Aesthetic and Its Effect on Facial Attractiveness. JAMA Facial Plast Surg. 2017 Feb 16.

8. Nephews M. The golden section, autopsy of a myth.

9. Peter R., Ryan H., Scott W. Analysis and Classification of the Upper Lip Aesthetic Unit. Journal of Plastic and Reconstructive Surgery September 2013.

10. Talamas H., Mavor K., Axelsson J., Sundelin T., Perrett D. Eyelid-openness and mouth curvature influence perceived intelligence beyond attractiveness. J Exp Psychol Gen. 2016 May;145(5):603-20.

11. Wollina U., Goldman A. Sustained attractiveness and natural youthful appearance by upper lip rejuvenation. Wien Med Wochenschr. 2017 Apr 5.

12. Zankle A., Eberle L., Molinari L., Schinzel A. Growth charts for nose length, nasal protrusion, philtrum length from birth to 97 years. J Med. Genet 2003 ;119 :95-8.