Lip Augmentation Research Articles

A Preliminary Report on the Safety and Efficacy of a Novel MaiLi HA Filler for Facial Correction of Wrinkles, Folds, Volume and Lips

Introduction: The principal author was given the opportunity to assess new hyaluronic acid filler, first before its European Commission labeling during clinical investigations in France, and then after its European Commission labeling in his clinical practice in Geneva, Switzerland. This hyaluronic acid gel benefits from the world’s first patented OxiFree™ technology. This article sought to present preliminary safety and efficacy data from the first private patient series treated in Geneva with this cross-linked hyaluronic acid gel, called MaiLi. Material and methods: Like most of its competitors, MaiLi is available in various variants, including gel for filling fine wrinkles, for deeper wrinkles, folds, and for lip enhancement, in addition to gels for volumizing indications. This cohort study encompassed patients from the authors’ private esthetic clientele in Geneva, Switzerland. Depending on the indications, the injections were performed according to previously described techniques, ranging from the “blanching technique” to deeper injections. Results: Between January and November 2021, overall 45 patients aged 56 years on average were injected MaiLi gels, according to the areas they wished to be treated, with a follow-up period ranging from a few days to 12 months. Based on our current dataset, we confirm that MaiLi fillers have proven very safe, causing no unexpected undesirable effects. The gel’s hold over time related to its remarkable projection capacity was excellent, resulting in quite natural outcomes and a perfect integration into the tissues. These beneficial effects were still evident at 1-year follow-up. Conclusion: The MaiLi hyaluronic acid fillers proved to be well tolerated and safe, with long-lasting effects. Remarkable properties revealed in this follow-up were their projection capacity and suppleness, as well as their ease of use and longevity, resulting in full patient satisfaction. No relevant undesirable effects were observed. There were no edematous reactions following the injections, nor were there any lymphatic circulation disorders.

Lip Augmentation With Hyaluronic Acid Fillers: A Review of Considerations and Techniques.

Lip augmentation has become a key component in addressing cosmetic concerns in dermatology practice today. In particular, hyaluronic acid (HA) fillers are increasingly used for this minimally invasive procedure. In order to achieve the optimal cosmetic and aesthetic outcome, a fundamental understanding of the relevant anatomic components is necessary: this article details lip topography, muscular and subcutaneous organization, and pertinent vascular structures of the lip, while also highlighting important changes that occur with aging. In addition to understanding the disposition of HA fillers, we also discuss specific injection techniques commonly used in practice. Finally, injection of HA fillers is not without complications; physicians must be knowledgeable of both the possibility of complications and management thereafter. This article details anatomical review, specific procedural technique, and safety considerations to be mindful of when using HA fillers for lip augmentation. J Drugs Dermatol. 2023;21(1):23-29. doi:10.36849/JDD.6304.

Head-to-head comparison of 4 hyaluronic acid dermal fillers for lip augmentation: A multicenter randomized, quadruple-blind, controlled clinical trial

Head-to-head comparison of 4 hyaluronic acid dermal fillers for lip augmentation: A multicenter randomized, quadruple-blind, controlled clinical trial

Safe and Effective Lip Enhancement with VYC-15L in Chinese Adults.

Hyaluronic acid (HA) soft tissue fillers are used to restore volume loss to the lips and perioral area. Evaluate the safety and effectiveness of the HA filler Juvéderm® Volbella® (VYC-15L) for lip enhancement in Chinese adults. In this multicenter, evaluator-blind study, subjects seeking lip enhancement were randomized 3:1 to VYC-15L or no-treatment control group (with optional treatment delayed by 3 months). Effectiveness endpoints included 1-point improvement on the 5-point Lip Fullness Scale (LFS) assessed by evaluating investigators (EIs) and subjects, and overall volume of lips and change in lip surface area measured from 3-dimensional images. Safety assessments included procedural pain, injection site reactions (ISRs), and adverse events (AEs). The modified intention-to-treat population included 163 subjects (median age, 34 years; 96.9% female). More VYC-15L-treated subjects had a 1-pointreduction in EI-reported LFS score at month 3 versus untreated controls (84.7% vs 0%; p < 0.0001), and 65% of the treated subjects self-reported a 1-point LFS improvement at month 3. Procedural pain during injection was mild. The most common ISRs were swelling, tenderness to touch, and firmness. One treatment-related serious AE (injection site compression arterial ischemia) resolved in 16 days. VYC-15L treatment was superior to no treatment at 3 months and was well tolerated by subjects. NCT03519204.

Histological changes of lower lip from its cutaneous to mucosa region in males

Background: The morphology of the epithelium of oral lips comprised of keratinized external epithelium (anteriorly) and non-keratinized or sometimes parakeratinized mucous membrane epithelium (posteriorly). Aims and Objectives: Knowledge of morphometry of lip lining helps in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following trauma or tumor excision following craniofacial cancers or cosmetic procedures. It also proves useful in dermatopharmacokinetics, in which we monitor the effect of drugs acting on connective tissue by trans labial route and lip augmentation surgeries (esthetic surgery), where care is to be given for dermal fillers not to be injected in muscle core of lip. Materials and Methods: Ten human male cadavers were procured in the Department of Anatomy, King George Medical University, Lucknow, Uttar Pradesh. The rectangle-shaped skin specimen through lower lip which included skin, mucocutaneous junction, and mucosa was stained with hematoxylin and eosin stain. Total of 30 slides were prepared. Thus, readings were obtained for three regions, respectively, with the help of CatCam E-series HD cameras which were installed in light microscope. The following conclusions were drawn for various parameters. Results: Thickness of skin (epidermis+dermis) of lip ranged from 880 μm to 1171 μm among males. Epidermal thickness increases on moving from cutaneous region to mucosa region of lip. Lowest contribution of stratum corneum in thickness of epidermis was observed in vermillion region, while highest contribution was observed in skin region. It was found to be absent in mucosa region of lip. Rete pegs at dermo epidermal junction was found to be maximum in vermillion region and minimum in skin region. Its depth increased as we move from skin to mucosa region of lip. Pattern of rete pegs also showed a characteristic feature in every region of lip. In cutaneous part of lip, rete pegs were shorter and blunt. In vermillion region, they were narrow, long, and slender, while they were longest with blunt end in mucosa region. Depth of dermis was found to be maximum in skin region while minimum in vermillion region. It ranged between 707 μm and 1100 μm. Conclusion: Care should be taken while using dermal fillers in lip augmentation surgeries, especially in vermillion region due to its close proximity to musculature in core of lip.

Rossolimo–Melkersson–Rosenthal syndrome as a manifestation of lip sarcoidosis

A 38-year-old female patient complained of lip augmentation. With a preliminary diagnosis of RossolimoMelkerssonRosenthal syndrome (monosymptomatic form), chronic fissure of the lower lip, the patient was sent for examination in order to exclude tumor pathology and vascular malformation. According to the results of a comprehensive clinical and laboratory examination, it was found that lip enlargement is due to the formation of granulomas. Additional follow-up by a pulmonologist confirmed the presence of sarcoidosis of the lungs with involvement of the mediastinal lymph nodes. A comprehensive examination made it possible to verify the diagnosis of multisystem sarcoidosis in a patient with macrocheilitis. As a result of complex therapy using surgical methods and systemic glucocorticosteroids, a rapid dynamics of clinical symptoms was observed and remission was achieved. This clinical case demonstrates a combination of sarcoid lesions of the tissues of the mediastinal lymph nodes, lung parenchyma and lips. It was the presence of macrocheilitis that was the main reason for visiting a dermatovenereologist and was the reason for choosing the subsequent tactics of examination and treatment. As a result of complex therapy using surgical methods of treatment and systemic glucocorticosteroids, carried out entirely within the framework of the program of state guarantees of free medical care for citizens, a stable remission of the disease was achieved.

696 Instagram lip fillers trends: A cross sectional analysis of hashtags

Background: Mass media platforms like Instagram have the ability to contribute to society’s perception of what is considered beautiful in this day and age, particularly the desirability of full lip sizes, and result in unrealistic delineations of beauty. Additionally, “influencers” such as Kylie Jenner have a strong impact over social media, and advertising may lead to increasing demand for lip enhancement cosmetic procedures and unfulfilled expectations from cosmetic procedures. Objective: To examine popular Instagram posts that utilize cosmetic lip filler hashtags, survey the presence of skin of color, and analyze social media’s influence of lip size to consider how beauty, in particular lip volume, is delineated in this era of Instagram.

"Bi-Bi" technique for lip augmentation: A retrospective study on 30 cases.

Lip augmentation is achieved mainly by using hyaluronic acid (HA) fillers. The injection procedures are performed either superficially or deeply with a needle or a cannula, and only one type of hyaluronic acid is used. The authors' objective was to evaluate the feasibility, safety, and satisfaction level of a procedure combining two anatomical injection plans, two injection modes (i.e., cannula and needle), and two types of hyaluronic acid fillers. The retrospective study included 30 patients who underwent the following procedure: Intramuscular retro-trace injections of Stylage M (Vivacy® Laboratories) were conducted through a 27-gauge cannula at the level of the upper and lower hemi-lip. Then, intradermal injections of Stylage Lips (Vivacy® Laboratories) using a 33-gauge needle were carried out on the entire lip border as well as the cupid's bow. During a post-injection follow-up, subjects were asked to evaluate satisfaction level and the effect of fillers over time. Elastic (G') and viscosity (G″) moduli of HA fillers were measured with a rheometer (AR2000, TA Instruments) prior to and after extrusion through a 33-gauge needle. Rheological assessment showed that passage through a 33-gauge needle did not alter the viscoelastic properties of HA fillers. After the clinical procedure, no side effects were observed except for standard post-treatment bruises and edema. No vascular incident occurred. Moreover, overall patient satisfaction was high (2.6/3) and there was a long-lasting perception of the effect of the filler. The current study demonstrated that dissociating the anatomical zones of the lip during the injection procedure by means of different hyaluronic acids in the muscular and dermal planes would efficiently and safely provide both lip projection and fullness for a natural and lasting effect.

Optimizing the Lip Aesthetic Ratio Using Surgically Placed Silastic Implants for Lip Augmentation

Introduction: Lip augmentation can be achieved using dermal fillers, biological tissues (fat, fascia, scar tissue, Alloderm), and a permanent soft silastic implant. Patients choosing the permanent lip implant were evaluated for aesthetic outcome, patient satisfaction, complications, and the use of dermal fillers postoperatively. Materials and Methods: Retrospective review of lip implant augmentation was performed in a single private practice. Analysis of aesthetic outcomes, adverse effects, methodology to determine optimal lip implant size, surgical technique caveats, and the use of dermal fillers before and after lip implant placement was carried out. Aesthetic outcomes and patient satisfaction were assessed by direct patient questioning and surgeon observation. Results: A total of 100 lip implant augmentation patients with 192 implants (92 combined upper and lower lips, 4 upper lip only, 4 lower lip only) were placed by the author between May 2011 and September 2021. From a patient satisfaction standpoint, 97% were happy with the final lip augmentation outcome. There was a complication incidence of 8%, with implant asymmetry the most common. Some patients (7%) underwent dermal fillers, both polymethylmethacrylate to the vermillion border and hyaluronic acid filler to the bulk of the lip to provide additional lip enhancement. Discussion: Silastic lip implant satisfies the following factors for lip augmentation: precise, accepted by the host, modifiable, natural feel, readily reversible, and permanency. The author’s quantitative method uses primarily the “golden ratio” (1:1.62) as the most impactful metric of size determination of the upper and lower lip followed by two-third incisor dental show. Most patients (94%) used lip dermal fillers prior to surgery to assess satisfaction with lip augmentation. Our results revealed larger lip implant size placement (4- and 5-mm diameter implants) compared with the largest study published. Lip bulk augmentation with hyaluronic acid fillers injected superficial to the implant capsule may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome. It is best to be an advanced filler injector and to use a microcannula for filler placement. Conclusions: The soft silastic lip implant procedure is a simple surgical procedure with a high patient satisfaction rate and low complication rate. Knowledge of lip aesthetic mathematical ratios and degree of dental show is imperative. Additional lip enhancement to lip bulk and vermillion border using both temporary and permanent dermal fillers may be performed safely after permanent lip implant placement to achieve the patients’ desired outcome.

Peripheral facial nerve palsy after lip augmentation: an unusual case presentation

The demand for lip augmentation has increased over the recent years. Facial palsy is not a frequently encountered presentation post cosmetic fillers, there is little literature on this. Therefore, it is important to highlight the findings of this case and to discuss the possible pathophysiology and management, should a similar case arise. CPD/Clinical Relevance: This case report discusses an incidental finding of left-sided facial nerve palsy post lip augmentation.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82 Year-old White Female Cadaver and Unilaterally in a 68 Year-old White Female Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first-year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82 year-old White female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68 year-old White female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is needed in multiple medical specialties for its reconstructive use, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in various surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many PLM anatomical variations and their possible contributions to pathological processes.

Dynamic muscle discord in the context of non-surgical lip enhancement

Dynamic muscle discord (DMD) is a fundamental concept in facial soft tissue augmentation with dermal fillers, particularly in perioral rejuvenation and lip enhancement. It is frequently observed in patients with facial skeletal and soft tissue deficiencies. The lack of adequate structural support may result in compensatory muscle hypertonicity or confer a mechanical advantage in certain muscle groups over their antagonistic counterparts. This discord in activity between the various muscle groups can affect the posture and profile of mobile facial features both at rest and during facial expression. Unfortunately, despite being a condition that commonly presents to varying degrees in patients seeking lip enhancement, DMD is often poorly diagnosed and undertreated. The author describes the causes, consequences and treatment of this condition in relation to the perioral region, as illustrated by a case study discussion.

Palmaris Longus Inversus Muscle Present Bilaterally in an 82‐Year‐old Cadaver and Unilaterally in a 68‐Year‐old Cadaver

The palmaris longus muscle is one of the most variable muscles in the human body. Palmaris longus muscle anatomical variations include reversed (palmaris longus inversus muscle), duplicated, triplicated, bifid, hypertrophied, accessory (additional) slips, and/or complete absence. During anatomical dissection of fifty cadavers in the 2019 undergraduate first‐year anatomy course at the Uniformed Services University of the Health Sciences, we found a palmaris longus inversus muscle bilaterally on an 82‐year‐old white female cadaver and a unilateral palmaris longus inversus muscle on the right forearm of a 68‐year‐old white female cadaver. Due to the prevalence of anatomical variations in the palmaris longus muscle, adequate knowledge of such prevalence and clinical significance is necessary in various medical specialties for its use in reconstructive surgery, and the possibility and treatment of clinical syndromes. An accessory (additional) palmaris longus muscle, hypertrophied palmaris longus muscle, hypertrophied palmaris longus inversus muscle, or just the presence of a palmaris longus inversus muscle, can all cause compression to adjacent neurovascular structures, such as the median nerve, ulnar nerve, ulnar artery, and/or the anterior interosseous artery, in the distal forearm and wrist. Palmaris longus tendons are used as grafts in a variety of surgeries, such as extensor tendon repair in rheumatoid arthritis patients, injuries of flexor tendons and repair, lip augmentation, reconstructive hand surgery, frontalis suspension sling in ptosis correction, plastic surgery, and pulley reconstructions. Surgeons, physicians, radiologists, and physiotherapists must be knowledgeable of the many palmaris longus muscle anatomical variations and their possible contributions to pathological processes.

A brief overview of lip augmentation with hyaluronic acid-based dermal fillers

Alexandra Mills and Professor Syed Haq provide an overview of lip augmentation procedures using hyaluronic acid-based dermal filler, injection technique and the role of the ageing process

Efficacy and safety of hyaluronic acid fillers for lip augmentation in a Chinese population.

Hyaluronic acid (HA) is an effective dermal filler for facial rejuvenation. This study aimed to observe the clinical efficacy of HA injection for lip augmentation in Chinese patients. From May 2019 to April 2020, 70 patients with lip fullness scale (LPS) ≤3 underwent local HA injection using the "three-point" injection technique. All patients were followed up to observe the clinical efficacy, LPS, adverse events, and complications. All 70 patients were followed up for 12months. Statistically significant improvements were observed in the height of lips within 6-9months post-treatment (p<0.05). The LFS improved significantly at follow-up compared with baseline (p<0.05). Local redness occurred in two patients, and serious swelling occurred in three patients. These adverse events were generally tolerated and disappeared gradually within 1week. No other serious adverse events and complications were reported in the remaining patients. Hyaluronic acid injection can be used for lip augmentation in the Chinese population. The "three-point" technique is simple, safe, and effective and does not cause serious complications.

Delayed Granulomas as a Complication Secondary to Lip Augmentation with Dermal Fillers: A Systematic Review.

Introduction Lip augmentation with dermal filler is rising in popularity. There are generally minimal side effects that are mild and transient. However, long-term complications may occur and include lumps, bumps, nodules, or granulomas. To better understand this uncommon but challenging outcome, we aim to perform a thorough systematic review of the published literature related to nodule or granuloma formation after cosmetic soft tissue augmentation of the lips. Methods A search of published literature was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines in April 2021 and included PubMed, ScienceDirect, Embase, Google Scholar, and Cochrane databases. The Medical Subject Headings (MeSH) terms used included the following terms: “lip filler,” “hyaluronic acid,” “lip injection,” “lip augmentation,” “silicone,” “poly-L-lactic acid,” “calcium hydroxyapatite,” “polymethylmethacrylate,” “complications,” “reaction,” “granuloma,” and “nodule.” All studies were reviewed by two independent reviewers. Any discrepancies were resolved by a third reviewer. Results The initial search for filler-related nodules or granulomas yielded 2,954 articles and 28 were included in the final analysis containing 66 individual cases of lip nodules. All but one patient was female. The mean age was 50 years. Nodules presented on average 35.2 months or 2.9 years after initial treatment. Thirty-seven nodules underwent histological analysis, the majority of which identified the presence of a foreign-body granuloma. Silicone was the most reported filler used followed by hyaluronic acid. Most cases resolved following multiple treatments including oral antibiotics or steroids followed by surgical excision. Conclusion Understanding the sequelae of lip augmentation with filler products allows clinicians to provide safe and effective treatment. Nodules that present months to years following dermal treatment may represent a foreign-body granuloma. A combination of oral antibiotics, intralesional or oral steroids, and surgical excision successfully treated the majority of cases in our study.

Safety and Effectiveness of a Novel Hyaluronic Acid Gel for Lip Augmentation.

To compare the safety and efficacy of a novel hyaluronic acid injectable gel with 0.3% lidocaine (test device) with that of a commercially available injectable hyaluronic acid gel with 0.3% lidocaine (comparator) for lip augmentation. Eligible patients (n = 158) with an overall score of very thin (n = 0) or thin (n = 1) on a 5-point Lip Fullness Grading Scale (LFGS) participated in the double-blind, randomized, multicenter study. Efficacy was assessed periodically over 6 months on a per protocol (PP) population (definitive) and a modified intent-to-treat (mITT) population (supportive). In the PP population, the mean change from baseline (day 56) in LFGS score was 1.52 for the test device and 1.53 for the comparator. This 56-day change was the primary efficacy endpoint. The 95% confidence interval (CI) limits for the mean difference in scores (test device minus comparator) were -0.33 and 0.31. In the mITT population, the corresponding 95% CI limits were -0.26 and 0.31. In both populations, the lower limits, -0.33 and -0.26, were higher than the prespecified -0.50, indicating that the test device was non-inferior to comparator. The adverse event profile was similar between the treatment groups. Ninety-three percent of patients treated with test device considered themselves improved, much improved, or very much improved at day 168 compared to 82% of those treated with comparator. The corresponding investigator improvement ratings were 100% and 76%, respectively. For lip augmentation, the efficacy and safety of the test device is non-inferior to comparator. J Drugs Dermatol. 2022;21(1):13-20 doi:10.36849/JDD.6548.

Lip rejuvenation and filler complications in the perioral region

Lip and perioral augmentation procedures have become increasingly popular over the last two decades due to cultural trends, emphasizing youth and beauty. An understanding of lip anatomy and aesthetics has traditionally formed the basis for successful results. However, as new technology becomes available, patient standards have increased, requiring an intricate understanding of filler properties and the advantages of different technical approaches. This chapter touches on pertinent anatomy and aesthetics of perioral evaluation. It also provides an overview of the properties of the fillers currently available in the United States marketplace for perioral rejuvenation. The technique and materials currently favored by the senior author are described in greater detail. Finally, the chapter will overview potential complications and recommended management.

A Prospective, Open-Label, Multicenter, Real-World Study of VYC-17.5L Hyaluronic Acid Dermal Filler in the Lips.

BackgroundHyaluronic acid (HA) injectable gels are used to define, enhance, and volumize facial regions, such as the lips, a common treatment area.ObjectivesTo evaluate the effectiveness and safety of the HA injectable gel Juvéderm Volift (Allergan, Aesthetics, an AbbVie Company Irvine, CA) with Lidocaine (VYC-17.5L) for lip augmentation in real-world clinical practice.MethodsThis prospective, open-label, multicenter study initially designed for 6 months, then extended to 12 months, enrolled adults with an overall grade of minimal to moderate on the Lip Fullness Scale 2 (LFS2). Optional touch-up and repeat treatments occurred at day 14 and month 12, respectively. The primary endpoint was a ≥1-point improvement on the LFS2 at day 30. Other endpoints included improvements on the FACE-Q Satisfaction with Lips questionnaire, Global Aesthetic Improvement Scale (GAIS), subject assessment of natural look/feel of lips, and investigator assessment of dynamic lip lines upon animation. Injection site reactions (ISRs) and adverse events (AEs) were recorded.ResultsOf 60 subjects enrolled (mean age, 36.8 years; 98.3% female), 59 were evaluable for efficacy at day 30; 13 (21.4%) received touch-up treatment. Thirty-six of 40 subjects completed the extension study (month 12). LFS2 responder rates were 93.2% at day 30 (primary endpoint) and 39.0% at month 12. Mean scores on the FACE-Q questionnaire improved from baseline by 45.2 points and 23.6 points at day 30 and month 12, respectively. Most subjects showed improvements on the GAIS. The majority of ISRs were mild/moderate; no serious AEs occurred.ConclusionsVYC-17.5L was effective and well tolerated for lip augmentation through 12 months posttreatment.Level of Evidence: 4

Gender-Wise Histological Differences in the Human Upper Lip

Introduction: Knowledge of morphometry of lip lining help in deciding the best site for choosing graft for its better uptake during several dermal grafting procedures following craniofacial cancers or cosmetic procedures. It also proves useful in dermatopharmacokinetics, in which we monitor the effect of drugs acting on connective tissue by translabial route and lip augmentation surgeries (esthetic surgery) where care is to be given for dermal fillers not to be injected into the muscle core of lip. Materials and Methods: Ten human male cadavers and 10 human female cadavers were procured. The rectangle-shaped skin specimen (1 cm × 1 cm) through the upper lip was stained with hematoxylin and eosin stain. A total of 40 slides were prepared. Readings were obtained with the help of CATCAM E series HD cameras which was installed in light microscope. Results: The mean value of thickness of skin (epidermis + dermis) of the lip was 664.72 μm among males while 769.20 μm among females. Conclusion: The epithelium of females is marginally thicker than males. Edp: sc (epidermis/stratum corneum) ratio can suggest that giving drugs through translabial route will be easy in females as compared to males in the upper lip as the stratum corneum is the main barrier in drug transfusion and its absorption secondary to epidermis as a whole. The number of rete pegs per field at the dermoepidermal junction was higher in males which ensures more stability of skin of male lips compared to females.