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BACKGROUND. The management of the senile lip remains a dilemma. Allogenic fillers often feel unnatural, lip resurfacing is not adequate, and fat transfers may disappear.

OBJECTIVE. To develop a more reliable step-by-step approach to lip augmentation.

METHOD. Lips were divided into types: (1) the simple senile lip that had lost its fullness—treated with fat augmentation; (2) the lip with rhagades—treated with fat augmentation and laser resurfacing; and (3) the duckbill lip—treated with lip advancement, fat augmentation, and laser resurfacing. Tattooing to increase the degree of redness was performed on all types of lips.

RESULT. If there had been a previously full lip, it was possible to rejuvenate the lip by simple augmentation with autologous fat transfer. The average number of fat transfer sessions to generate this pleasing lip was two to three. The lip with rhagades required fat filling, with laser resurfacing to achieve a new contour. The duckbill lip required a lip advancement along with lipofilling and laser resurfacing. All types benefited from lip tattooing.

CONCLUSIONS. It was possible with fat augmentation and/or laser resurfacing to generate a pleasing lip in type 1 and 2 lips. Lip type 3 required a lip advancement along with fat augmentation and laser resurfacing. Lip tattooing accentuated all the lip types.