Among the Surma and Mursi people of the lower Omo River valley in Ethiopia, about 6 to 12 months before marriage, a young woman has her lip pierced by her mother or one of her kinswomen, usually at around the age of 15 to 18. The initial piercing is done as an incision of the lower lip of 1 to 2 cm length, and a simple wooden peg is inserted. After the wound has healed, which usually takes between two and three weeks, the peg is replaced with a slightly bigger one. At a diameter of about 4 cm, the first lip plate made of clay is inserted. Every woman crafts her own plate and takes pride in including some ornamentation. The final diameter ranges from about 8 cm to over 20 cm.
In 1990 Beckwith and Carter claimed that for Mursi and Surma women, the size of their lip plate indicates the number of cattle paid as the bride price. Anthropologist Turton, who studied the Mursi for 30 years, denies this. LaTosky, meanwhile, argues that most Mursi women use lip plates, and the value of the ornamentation lies within a discourse of female strength and self-esteem.
In contemporary culture, most girls of age 13 to 18 appear to decide whether or not to wear a lip plate. This adornment has caused the Mursi and Surma women to be treated as if they are a tourist attraction.
The largest lip plate recorded was in Ethiopia, measuring 59.5 cm (23.4 in) in circumference and 19.5 cm (7.6 in) wide, in 2014.