Lip rejuvenation in the African American female
In American culture, full, voluptuous lips have long been considered a symbol of beauty, sensuality, sexuality, and youth. But whereas a full, pouty lip is desirable and sought after by most American women, having full lips has historically been viewed as an unattractive feature for a large segment of the African American community.
Far from the influence of celebrity, however, African American women do in fact consider lip procedures when they think about ways to fight aging.
Consequently, I have found lip-rejuvenation and lip-augmentation procedures more common within the African American female population that one might suspect. Over the past 4 years, I’ve performed lip-rejuvenation or lip-augmentation procedures on approximately 150 female African American patients.
Modern Western culture views the full lip as a particularly desirable trait. But whereas Caucasian patients’ interests in lip procedures have arisen from social conditions and cultural resonance, African Americans have historically focused on other parts of their bodies as centers of beauty.
The reason is understandable. Cartoons, advertisements, stage productions, films, and other media popular during the minstrel-show era of the early 20th century helped promote stereotypical images of African Americans. These images portrayed African Americans, both male and female, as caricatures with huge pink, white, or contrasting-colored lips. Over the years, these and other deep-seated images of racism shaped the African American’s self-image. Indeed, during preconsultations for treatments, many of your own female African American patients may recall having been teased early in life about their lips.
Fortunately, with increased sensitivity to ethnocentricity in the broader culture and improved self-esteem within the African American community itself, this trend has shifted dramatically in the last 50 years. Still, the residual effects of those negative influences affect the degree to which African American females consider lip enhancement or restoration.
Specifically, these patients fail to recognize the impact of aging on their lips, even when they present for facial rejuvenation. As the diagnosing physician, you should look for signs of aging around the mouth and lips among your patients in this population. How you evaluate and treat your African American facial-rejuvenation candidates should diverge from how you deal with Caucasian patients.
The Aging Lip
Lip augmentation is defined as a procedure in which fat or a highly biocompatible synthetic substance is placed into the lip—by injection or surgical implantation—to enhance the lip’s size and appearance. The term “lip rejuvenation” includes aesthetic augmentation, but it usually encompasses all procedures that are undertaken to restore the lip to its youthful appearance after it has aged. Other lip-rejuvenation procedures include microdermabrasion and chemical peels.
In Caucasian women, lip aging usually occurs relatively early in life and manifests itself as supravermilion rhytides above and below the vermilion borders. This is due to thinning of the dermis and volume loss, respectively, as well as loss of white-roll definition.
Typical signs of aging around the lip for this population include thin, long, flat, and wrinkled lips that show volume loss in the vermilion; a decreased “Cupid’s bow” height; an ill-defined white roll; and invaginated lateral oral commissures that result in mean- or angry-looking downturned corners of the mouth.
Aging in the African American lip occurs in a similar manner, albeit later in life. Still, some fundamental differences emerge. For African American women, rhytides occur predominately below the vermilion due to volume loss; however, it is generally uncommon to see rhytides above the white roll or vermilion border. Unlike their Caucasian counterparts, African American women have a well-maintained vermilion border. Injections into the white roll or vermilion are not necessary for these patients.
Evaluating the Lips
When you evaluate African American women for overall facial rejuvenation, it is essential to include an examination of the lips as part of the assessment. The examination should include a routine inspection of occlusion, dentition, gingival show, and caudal migration of the wet line. The exam should also include an evaluation of the lips for volume loss and color change.
Obviously, African American and Caucasian facial aesthetics differ. In evaluating the African American female patient for facial restoration, remember to assess the entire labial area for lip restoration, not just the dorsal surface of the lip, as might be the case for a routine lip-restoration exam on non-African American patients.
Volume loss can easily be identified by the vertical rhytides and the fine surface wrinkles that have a “crinkled-cellophane” appearance. Color changes in the lip may be indicated by a dull and darkened appearance. The presence of these aging signs is an indication for lip rejuvenation and should at this point be offered as an option to the patient.
If rejuvenation is indicated and volume replacement is needed, the replacement should restore the lips to their original youthful size and appearance.
Augmentation by Injection
Several 0.7-mL syringes of injectable material are needed to restore lips to their youthful state. Generally, more injectable material is required for African American patients than for Caucasian patients.
I usually have four syringes prepared for my African American patients. This amount of filler would be too taut and uncomfortable for a Caucasian patient.
As with Caucasian patients, the more wrinkles a patient shows, the more filler is required. For African American patients, I reserve two syringes per lip. As you inject, it is crucial to evaluate quickly, before any swelling occurs—but do not confuse edema with swelling. Fillers differ in the time it takes for the lip to swell after injection; 10 to 15 minutes is typical. Take advantage of this “golden period” before swelling begins to determine the amount of filler required.
Rejuvenating a Caucasian patient’s lips generally requires that a fair amount of attention be given to the perioral and perilabial regions. Those areas often require skin resurfacing and dermabrasion. Conversely, African American patients require much less work on their upper lips. And because their aging manifests itself as folds rather than fine lines, these patients benefit the most from chemical peels and microdermabrasion.
When you are replacing volume, be mindful not to underinject; many African American patients will not notice any difference in volume after only one syringeful. Once the initial swelling subsides, they may feel as though no injection had ever been administered.
But it is also important to be cautious and not overinject the lips. Instead, leave some rhytides for a desirable natural and softer look. Bleaching and sunscreen can be used to lighten the lip area, and moisturizer can be used to hydrate the overlying skin.
My office staff calls the patient the evening of the procedure. If the patient complains of discomfort, I see her 3 days after the procedure, but the standard follow-up visit is 5 to 7 days later. Almost without exception, my patients have been extremely pleased with the results of their lip augmentation or rejuvenation, especially when it has been combined with other facial-rejuvenation procedures. PSP
Rosetta Garries, MD, is a plastic surgeon in private practice at Le Pavillon Garries in New York City. She can be reached at (212) 234-3859 or via her Web site, www.veryprettyskin.com.
Gabriel Sheffer is a contributing writer for Plastic Surgery Products.
1. American Society for Aesthetic Plastic Surgery. 2005 Cosmetic Surgery National Data Bank statistics. Available at: http://www.surgery.org/download/2005stats.pdf Accessed April 5, 2006.
The American Society for Aesthetic Plastic Surgery reports that 11.5 million aesthetic procedures were performed in the United States in 2005.1 African Americans represented 5.9% of the patients, or about 680,000.
The top three surgical procedures for African American patients were nose reshaping, breast reduction, and liposuction. The top three noninvasive procedures for African American patients were botulinum toxin Type A injections, chemical peels, and microdermabrasion—all of which are imperative for lip rejuvenation in this patient group.
Have an old photograph of the patient on hand to use as a guide.
Evaluate your patient within the “window of opportunity” before swelling sets in.
Be conservative but effective.