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Arch Plast Surg > Volume 46(3); 2019 > Article
Archives of Plastic Surgery 2019;46(3):248-254.
DOI:    Published online May 15, 2019.
Perception of upper lip augmentation utilizing simulated photography
Gary Linkov  , Elizabeth Wick, Dorina Kallogjeri, Collin L. Chen, Gregory H. Branham
Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
Correspondence:  Gary Linkov, Tel: +1-314-362-7509, Fax: +1-314-996-8610, 
Received: 1 November 2018   • Revised: 1 April 2019   • Accepted: 23 April 2019
No head to head comparison is available between surgical lip lifting and upper lip filler injections to decide which technique yields the best results in patients. Despite the growing popularity of upper lip augmentation, its effect on societal perceptions of attractiveness, successfulness and overall health in woman is unknown.


Blinded casual observers viewed three versions of independent images of 15 unique patient lower faces for a total of 45 images. Observers rated the attractiveness, perceived success, and perceived overall health for each patient image. Facial perception questions were answered on a visual analog scale from 0 to 100, where higher scores corresponded to more positive responses.


Two hundred and seventeen random observers with an average age of 47 years (standard deviation, 15.9) rated the images. The majority of observers were females (n=183, 84%) of white race (n=174, 80%) and had at least some college education (n=202, 93%). The marginal mean score for perceived attractiveness from the natural condition was 1.5 points (95% confidence interval [CI], 0.9–2.18) higher than perceived attractiveness from the simulated upper lip filler injection condition, and 2.6 points higher (95% CI, 1.95–3.24) than the simulated upper lip lift condition. There was a moderate to strong correlation between the scores of the same observer.


Simulated upper lip augmentation is amenable to social perception analysis. Scores of the same observer for attractiveness, successfulness, and overall health are strongly correlated. Overall, the natural condition had the highest scores in all categories, followed by simulated upper lip filler, and lastly simulated upper lip lift.
Keywords: Lip / Surgery, plastic / Injections / Perception
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