The Effect of Lip Protrusion with Different Vermilion Heights on Facial Profile Esthetics: Perspective from Orthodontists, Oral and Maxillofacial Surgeons, and Laypeople

Aim: This study evaluated the effects of lips protrusion and vermilion height on facial profile aesthetics and the need for tooth extraction from the perspective of orthodontists, oral surgeons, and laypeople. Methods: Four profile photographs of two men and two women with high (HVH) and low vermilion height (LVH) were selected. The photographs were modified so that the lips were protruded and retruded in the range of -6 to +6 mm relative to the true vertical line to create three photographs with protruded and three with retruded lips. The photographs were rated regarding facial profile attractiveness by 30 orthodontists, 31 oral and maxillofacial surgeons, and 50 laypeople using a visual analog scale. The raters were also asked whether they recommended premolar extraction for correction of lip protrusion. Data were analyzed using ANOVA, the chi-square test, and the Tukey test. P<0.05 was considered as significant. Results: Mostly, the highest score was given to normal lips. The lowest score went to +6 mm protruded lip in the male with HVH. In all retruded cases, the male and female with LVH received lower scores than the male and female with HVH. The differences between the three rater groups were not significant in most images. Concerning the tendency for extraction, there were no significant differences between groups in normal lip and +2-mm protrusion. In the female with +4-mm protrusion, the tendency of laypeople for extraction was significantly lower. In +6, the tendency of laypeople to extract in LVH cases was less than in other groups. Conclusion: Overall, in cases of LVH, the protrusion was more acceptable, while for HVH cases, retrusion was more tolerable. Laypeople had less desire for tooth extraction, especially in LVH cases.