Lip augmentation is an extremely popular cosmetic procedure. Various surgical techniques have been described. However, only a few studies have specifically addressed lip augmentation with superficial musculoaponeurotic system (SMAS). Postoperative analysis never extended beyond one year so far. The authors present a retrospective single-blind cohort study (n=26) based on a five year postoperative follow-up. SMAS was harvested during standard biplanar rhytidectomy. All patients had a simultaneous upper and lower lip augmentation, using two strips of SMAS. Every cheek area allowed to harvest on strip of SMAS. Evaluation was performed using pre- and postoperative photographs (three months, one year, and five years) the were graded by 12 blinded observers using a validated lip augmentation grading scale. Both the superior and the lower lip showed statistically significant increases in volume at all intervals after SMAS augmentation. The overall increase in volume was not dramatic, however, longevity and safety was documented during follow-up analysis. The degree of increase seemed to weaken slightly over time, but remained statistically significant even at five years.