Lip Analysis and Macrocheilia in Young Jewish Israeli Men

Abstract

Sir: With the growing ease and popularity of lip rejuvenation and augmentation surgery,1 the establishment of norms of lip and lower face parameters has become particularly important for plastic surgeons. Macrocheilia, or excessively prominent lips, is not only considered unaesthetic, it may also interfere with oral function. The objectives of this study were to develop norms for lips and lower face parameters in relation to ethnic origin, and to numerically define macrocheilia. The study population consisted of a random sample of 403 men aged 18 to 19 years of Jewish Israeli origin undergoing dental screening after high school graduation. Participants completed a questionnaire on background data, including ethnic origin of both parents, and their lip and lower face parameters were measured. Lip incompetence was defined as unconsciously fully parted ptotic lips in rest position.2 Mean lip length at rest and while smiling was 3.15 ± 0.29 cm and 4.04 ± 0.32 cm, respectively. Mean upper and lower maximal lip thickness was 0.64 ± 0.13 cm and 0.98 ± 0.16 cm, respectively. Lower lip mucosal exposure was observed in 80 patients (20 percent) and lip incompetence was observed in 62 (15.4 percent). Lower lip thickness was significantly related to labial incompetence and mucosal exposure (p < 0.0001). Mucosal exposure was significantly related to lip incompetence (p < 0.0001). Six types of profiles were defined according to the most prominent feature in the lower third of the face. In most cases (63.8 percent), the upper lip was the most prominent feature, followed by the lower lip and chin (Fig. 1, left). In 29.3 percent of cases, the lower lip was the most prominent feature, followed by the upper lip and chin (Fig. 1, right). Five ethnicities were identified in the sample: Ashkenazi, Sephardic, Ethiopian, former Union of Soviet Socialist Republics, and mixed. None of the lip parameters was associated with ethnic origin except for upper lip thickness, which was significantly greater in the Ethiopian subgroup (p < 0.05). The lip and lower face norms in the sample of young Israeli men were close to Caucasian norms described in previous studies. Considering that 95 percent of the study population had a lower labial thickness of 0.66 to 1.3 cm (mean ± 2 SD) and an upper labial thickness of 0.38 to 0.9 cm, we defined macrocheilia as a lower vermilion thickness of more than 1.3 cm and an upper vermilion thickness of more than 0.9 cm, accompanied by mucosal exposure and incompetent lip.Fig. 1.: (Left) The upper lip is the most prominent feature, followed by the lower lip and chin. (Right) The lower lip is the most prominent feature, followed by the upper lip and chin.There may be a common Jewish norm for lip parameters, resembling the norm for Caucasians. Lower lip incompetence and mucosal exposure are not as rare as we assumed. Vermilion thickness of more than 1.3 cm for the lower lip and 0.9 cm for the upper lip accompanied by mucosal exposure and incompetent lip might serve as a definition of macrocheilia. Sagit Meshulam-Derazon, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqva and Sackler Faculty of Medicine Tel Aviv University Liran Levin, D.M.D. Department of Restorative Dentistry Maurice and Gabriela Goldschleger School of Dental Medicine Neta Adler, M.D. Dean Ad-El, M.D. Daniel J. Hauben, M.D. Department of Plastic Surgery Rabin Medical Center Beilinson Campus Petah Tiqva and Sackler Faculty of Medicine Tel Aviv University Tel Aviv, Israel