"Another look at the artistic mouth" 

Dr Jamal DJOUDI

Aesthetic and anti-aging doctor

Summary

A beautiful and luscious 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 is clear that the conception and realization of a beautiful mouth are very subjective depending on the practitioner and the patient.

How can we establish the characteristics of a beautiful mouth in an objective way?

Art and sociology, to the rescue 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 is made up with lipstick!

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

But beware of the drift

Until recently, patients only came in to fix their "bar code", improve thinning lips or fill in bitterness lines.

The main demand is now mainly on 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 is sometimes difficult for the practitioner not to give in.

Hence the monumental failures that we can all see in the media. Who hasn't hated the lips of Emmanuelle Beart, 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 ordinary patients.

The main reason for this is the lack of artistic training, while anatomical education is ubiquitous.

This is where the problem lies: anatomy certainly allows to rejuvenate somewhat and to avoid side effects, but in no case to elaborate an artistic project for her patient.

Many gross errors are made in good faith, some practitioners systematically applying their own vision of beauty, the result of media pressure and their personal aesthetic experiences. This explains why we see the same mouths, the same frozen foreheads, the same cheekbones in waiting rooms...

Art in the service of aesthetic medicine

The Greeks were the first to elaborate "canons of beauty", thus codifying the proportions, angles, harmony and relationships of the different elements of the face.

Widely copied by the Romans, meticulously reproduced by the artists of the Renaissance, these canons have proven their validity by the immortal masterpieces left to us by artists such as Michelangelo, Raphael, Dürer, Leonardo da Vinci and many others.

Moreover, these rules are still used today. It is therefore imperative that they be used to enrich aesthetic medicine and serve as a basis for our analyses.

What about the mouth?

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

  • Horizontally, the line between the 2 lips (interlabial line) must be at one third of the distance between the base of the nose and the chin (Fig. 1).

  • Vertically, the commissures come in line with lowered verticals of the inner part of the limbus (of the iris) or at the maximum of the inner part of the pupil.

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

So be careful when correcting the bitterness folds not to exceed this value or you will get a "Joker mouth".

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

  • The upper lip is M-shaped, while the lower lip is very flattened U-shaped or more rarely W-shaped.

  • The upper lip is composed of 3 clumps (Fig. 3), while the lower one has only two.

A common mistake is to make only 2 massive upper lip, with a "curtained" or even "harelip" look, as with 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, i.e. the height of the upper lip is equal to 66% of the height of the lower (Figure 4).

  • Proponents of the golden ratio theory advocate a lower lip that is 1,618 times thicker than the upper lip (a ratio of 0.62/1).

However, this ratio produces an upper lip that is too thin compared to the beautiful mouths observed.

More generally, a single number cannot explain the immense variety of aspects that beauty offers us, as Professor Marguerite Neveux shows magnificently in a very well documented book: "The golden ratio, autopsy of a myth".

The hem of the upper lip must be very precise, but only on its internal 2/3. There is indeed an invagination on the external 1/3, the white lip "coming in" to form the commissure.

It is therefore an artistic error to inject the outer third. The projection of the lips, seen from the side, represents the essential error made in aesthetic medicine. In general :

  • 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 (Fig. 5). Lips that are vertically aligned (Fig. 6) or too much projected (Fig. 7: duckbill) are frequent errors.

The lower lip has a concave shape along its entire length and generally does not have a hem unlike the upper lip.  The creation of a hem at this level is a common mistake that gives a very artificial appearance in static and dynamic.

The corners of the mouth are a key element of youth and facial expression, which deteriorates over time. They should ideally be above the inter-labial line, otherwise they will look tired, sad, bitter or even mean.

Sociology: Modern beauty canons are changing.

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

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

A study by Vogue magazine, covering photos of stars published from 1945 to the present day, shows that until 2010, there has been no significant change in the volume and proportions of the lips in relation to each other and to other facial elements.

But things have been changing over the past decade.

Indeed, the media hype of the fashion and beauty industry, the ultra sophisticated tricks of PhotoshopThe desire to imitate the extravagance of their idols pushes some women to ask for excessive or even unrealistic modifications, especially because of social networks: women ask for a more sensual, sexier mouth. With specific, even excessive characteristics concerning the volume and especially that of the upper lip.

Should we give in to demand?

Yes, but in controlled proportions. Sociological studies provide us with precious indications on these limits:

  • The volume can be increased by 150 %: this is the ideal value established on a sample of 450 people (Fig. 8). In practice, the lips can be increased but without making the radial folds of the lips disappear by over-distension, which gives a very unnatural "tench snout" appearance.

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

  • Philtral ridges and a prominent cupid's bow are not suitable for all mouths. Research conducted by Professor Suzanne Ashley of the University of Washington shows that there is a clear correlation between the visibility of the philtrum and the cupid's bow on the one hand and the size of the upper lip on the other.

The thinner the latter, the less philtral visibility there is. It is therefore necessary to keep a coherence between these elements and take into account the natural anterior morphology.

  • Visibility of the upper central incisors at rest, as seen in Georgia May Jaegger or Brigitte Bardot young, and a lower lip "bilobed" as in Angelina Jolie or Lindsay WixsonThese lips are called "pouty lips" by the Anglo-Saxons, because they are reminiscent of a child's lips (figure 9).

Numerous researches have established that pouty lips represent the must of sensuality for the young generation.

But again, not all faces can benefit from such features.

The desire to make the upper central incisors appear can result in very artificial "curtain" or "hare's beak" mouths, and the desire to create a bilobed lower lip can increase the projection too much in relation to the upper lip and the nose-chin line.

The results must be harmonious, but also natural

All of these criteria should therefore generally only apply to the young woman under 40, rarely more.

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

It is also important to keep in mind that changing the dimensions of the mouth can greatly alter other facial features.

For example, when an upper lip is increased, the height of the philtrum is decreased and therefore the height of the chin is optically increased.

In a person who already has a large chin, you should obviously avoid making this mistake.

Here are some examples obtained in the office.

In conclusion

No one will dispute that the realization of a beautiful mouth, and a fortiori of a beautiful face, must be done in 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 thanks to the sociological data.

We are indeed experts, and therefore the only decision makers, guardians of the harmony and naturalness of our "works".

However, it is desirable to acquire this artistic methodology, to "educate the eye" as Monet said. This new way of looking at things will allow us to make much more accurate therapeutic decisions, with the result that patients and their families will be pleased with the aesthetic results.

There is little doubt that in the near future, patient preference will shift to this type of expertise.

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