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Classification of the Aging Lips: A Foundation for an Integrated Approach to Perioral Rejuvenation

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Abstract

Background

Although perioral aging is highly individual with several distinct processes taking part simultaneously, there is scarce systematic information which helps to indicate the right rejuvenation approach among the multitude of proposed procedures. Existing data about perioral aging has not yet been transformed into a consistent therapeutic concept. The intention of this study was to provide a simple, yet reproducible classification and to offer appropriate rejuvenation approaches.

Methods

To identify reliable and constant landmarks of the ongoing process of perioral aging, 462 perioral photo documentations were morphometrically analyzed. Based upon the identified landmarks a two-dimensional classification was developed. The classification was validated by three plastic surgeons. Inter- and intra-rater reliability was calculated using Cohen’s kappa coefficient.

Results

Perioral aging can be broken down into changes of the lip shape and changes of the lip surface. Both processes can be classified into three stages each: Lip shape according to the shape in profile view, the lip length in relation to the frontal incisors, and the degree of vermilion inversion. Lip surface according to the presence and degree of radial wrinkles and the visibility of the structural elements Cupid’s bow, philtrum, and white roll. Inter-observer reliability was rated very good (kappa values between 0.819 and 0.963) and perfect for intra-observer reliability (1.0).

Conclusion

A better understanding of perioral aging leads to a simple classification for the aging lips. Using the classification helps to tailor an appropriate treatment to the individual patient and aids to achieve a natural rejuvenation result.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Acknowledgments

The authors would like to thank Saskia Manegold for assistance with graphical illustration. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The authors declare that they have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Center for Plastic and Aesthetic Surgery of the Face and Nose, Bismarckallee 17, 79098, Freiburg, Germany

    Matthias Voigt & Niklas Iblher

  2. Department of Plastic and Hand Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106, Freiburg, Germany

    Vincenzo Penna & G. Björn Stark

  3. Department of Orthopedic and Trauma Surgery, University of Freiburg Medical Center, Hugstetterstrasse 55, 79106, Freiburg, Germany

    Alexander Mehlhorn

Authors
  1. Vincenzo Penna
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  2. G. Björn Stark
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  5. Niklas Iblher
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Correspondence to Niklas Iblher.

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Penna, V., Stark, G.B., Voigt, M. et al. Classification of the Aging Lips: A Foundation for an Integrated Approach to Perioral Rejuvenation. Aesth Plast Surg 39, 1–7 (2015). https://doi.org/10.1007/s00266-014-0415-2

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  • DOI: https://doi.org/10.1007/s00266-014-0415-2

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