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  • Published

    November 2, 2020

  • Written by

    Dr Garth Dicker

At the Collins Cosmetic Clinic, we see many patients concerned about the appearance of their Lips. The 2 main reasons that our patients seek Lip treatments are to either restore lips to their former appearance (what we term Positive Ageing) or to give the lips a bigger and bolder appearance (what we term Beautification) and we discuss this more on our website

However, a common concern with many of our patients are that if they have their lips treated, that they will end up with inappropriate large ‘duck like’ lips. This does not occur if your lips are properly assessed and then treated by an experienced injector. We know that some extra fullness in the lips can look great but we also know that big overfilled lips do not look good!

Lip treatments are not just about lip size as definition, support and balance are also critical. Symmetry of the lips is far more important than in other areas of the face and the relative sizes of the upper and lower lips and the lip proportions relative to the rest of the face need to be considered in getting the best result from any lip treatments.

Why are Beautiful Lips important?

An attractive appearance can have many positive benefits in everyday life, with studies showing that people regarded as attractive, are considered by others as more interesting and even more intelligent! The lips are an essential part of the symmetry and aesthetics of the face. Lip appearance is a major determinant of facial attractiveness and throughout history full lips have been associated with beauty and youth.

Assessment of Lips

At the Collins Cosmetic Clinic when our cosmetic practitioners examine a patient’s lips we go through an assessment process to work out what can be done to improve the appearance of the lips and meet the specific concerns and needs of each individual patient. We never consider the lips in isolation but as a part of the whole face as the structures around the lips help support the lips and just as the lips age so do the surrounding areas. It is also important to check the teeth as the dental arch and angle of the teeth can affect the mouth and lip area.

The lips are not just the red area around the mouth but includes the whole area around the mouth and when we assess the lips, we examine several anatomical landmarks. The lip area starts at the bottom of the nose and the skin area above the red lip is called the Philtrum and the ridges that run down from the nose are the Philtral columns. The red part of the lip is what we call the Vermilion and the lip border we hence call the Vermilion Border. The curve in the middle of the upper lip is the Cupids Bow and the corners of the mouth are referred to as the Oral Commissures.

The lip area is examined at rest and then during movement, both smiling and puckering. We look at a front on view and then we look at a sideways profile view of the lip area. The 2 main things we assess as cosmetic practitioners when we look at the lip area are the Symmetry of the lips and the Balance between the lips and other facial features.

Symmetry of the Lips refers to how closely both sides of the Lips match up with each other. At the Collins Cosmetic Clinic, we understand that no face is perfectly symmetrical. We also know that any treatments we perform are unlikely to achieve perfect symmetry, but as cosmetic practitioners our aim is to achieve as much symmetry as possible, especially in the lip area, as this is more critical for the best aesthetic result than other facial areas. Thinking of a line in the middle of the lip we compare both sides for symmetry. The differences can be subtle but important to record and this makes Before and After Photos very important. When we notice some asymmetry that patients were unaware of, we often find it more useful to show the patient a photo of their lips rather than pointing it out to them in a mirror.

Balance refers to how the proportions and ratios of a person’s lips and other facial features relate to each other. Beauty and facial attractiveness are very subjective however scientists have for hundreds of years studied what features make someone attractive and then quantify it in numerical terms. The ideal scientific formula that was discovered and is claimed by many to determine attraction and human beauty is called the Golden Ratio. This ratio is also called phi and it is the mathematical ratio of 1:1.618033988 or in simple terms 1/3 to 2/3  Famously Leonardo Da Vinci is said to have used the Golden Ratio for the female face in his Mona Lisa painting and for the perfect male body in his painting of the Virtruvian man. Examples of the Golden Ratio on the face are that the ideal mouth width is phi times nose width, the width between the outer eyes phi times mouth width, and the lower lip height phi times that of the upper lip.

Our cosmetic practitioners at Collins Cosmetic Clinic find the Golden Ratio is a useful concept and can be helpful in the assessment of facial balance but we also appreciate that everyone is different and in many individuals the relationship between the Golden Ratio and facial attractiveness is less definite. As cosmetic practitioners when we assess the balance of the Lips we consider several main features:

Length of Lips: At rest, the end of the mouth should ideally be in line with where the colour of eye meets the white of the eye (called the medial limbus of the eye). If the lips are smaller than this it can give a person a tense and angry appearance.

Height of Lips: In the upper lip we look at the height of the white area of the upper lip (the philtrum) relative to the height of the red part of the upper lip (the vermillion). As we age the white area under the nose becomes relatively longer as the red lip shrinks.

Ratio of Lips:  In Caucasian women the lower lip should be larger than the upper lip. Key point is on front view the height of the red upper lip should be less than the red lower lip about 1/3 upper vs 2/3 lower. We usually measure the lip height from the midline. Women often request treatment to increase the size of the upper lip and it needs to be pointed out the importance of the balance between the size of the upper and lower lips. The unwanted “Duck” or “Sausage” Lips are not just from too much product but also the wrong balance.

Projection of Lips: The lip projection, also called the ‘lip pout’, we assess on the side profile view and in assessment we use two imaginary lines, one from the tip of the nose to the point of the chin, and the other from the base of the nose to the point of the chin.The imaginary line from the tip of the nose to the chin is called ‘Ricketts line’ as an orthodontist, Dr Robert Ricketts, many years ago was concerned that orthodontists were ignoring the aesthetic appearance of the face in the desire for dental alignment. Ricketts was the first to describe using this imaginary line to check lip projection and described that the closer the lips are to this line or even in front of this line the more dominate the lips and teeth will appear. The further behind the line the lips are the more dominate the chin and nose will appear. Rickett’s felt that for the average Caucasian the ideal was for the lower lip to be 2 mm behind the line and the upper lip 4 mm behind the line.

The imaginary line from the base of the nose to the point of the chin was described by researchers from Kinkkale University in Turkey who recommended that ideally the upper lip should project 3.5mm and the lower lip 2 mm in front of that line. They found that an exaggeration of these proportions or the wrong ratio could lead to a “duck-like” or “trout pout” appearance.  We certainly agree with their research paper conclusion when they stated that “Under no circumstances should the lips enter the room before the individual”!

Lip dermal filler treatments are a medical procedure, and as such at Collins Cosmetic Clinic we believe it should only be performed in a medical clinic environment by experienced injectors and not in a beauty salon by a shopping centre nurse who is  paid according to how much product they use. Dermal filler treatments need to be individualized and based on what is appropriate for your best result and not driven by profit margin and the more filler that someone puts into your lips the more they earn!!

Patients should understand that the Lips are the first area that new cosmetic injectors are taught to treat with dermal fillers and many of the nurses in beauty salons have limited experience.  Lip fillers are actually very hard to do well. A recent 2020 Masterclass Webinar on Lip Fillers polled experienced cosmetic injectors in Australia and New Zealand and found 80% of these medical experts identified that the hardest area to get a great result with Dermal Fillers was the Lips.

At the Collins Cosmetic Clinic, we have been performing Lip filler treatments for over 20 years and we are very proud of the reputation of our cosmetic injectors. Our focus is on natural results and we are driven by patient satisfaction not product sales. We love when patients tell us that their friends are commenting on how well they look or that they look great for their age, but no one realises that they have had any treatment. If you would like to find out more about Lip fillers or make an appointment for a consultation feel free to ring our rooms on 03 96545720 or email us on

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