Background: While considerable cosmetic effort goes into making lips larger, the need or desire for the opposite effect is much more limited. Reduction of lips that are perceived to be too big is largely limited to certain ethnic groups and some lip enhancement patients that wish to reverse their unnaturally large and distorted lips.

While lip reduction is usually for large lips or macrocheilia,, it can also be done for removing abnormal or damaged lip tissue. One of the more common pathologic conditions is that of dry lips. The lips are of two different types of coverings. The outer or visible vermilion of the lip is dry and is only wetted periodically by our tongues or application of lip balms or lipsticks. The non-visible lining of the lip is the wet vermilion or mucosa which is always moist due to its more intraoral location and its moisture-secreting glands.

For unknown reasons, some people will have areas of the dry vermilion which are too dry. This can cause chronic cracking and even bleeding of the ‘too dry’ vermilion. Very frequent wetting of these areas by saliva is needed (which actually causes the reverse effect) and the use of chapstick and other lip emollients is done many times throughout the day. Dry and cold weather aggravates the lip problem.

If the location of the abnormally dry vermilion is amenable to surgical removal without causing lip distortion, this is a possible permanent surgical cure.

Case: This 27 year-old male was bothered by chronic drying, chapping and bleeding of his upper and lower lip. While this problem was present on both lips, it was greatest on the lower lip. The areas of excessively dry vermilion were horizontally located along the edge of the wet and dry vermilion. Two circular areas of dryness could be particularly seen on the central lower lip.

Lip reduction was planned doing a horizontal edge excision of the dry vermilion from one mouth corner to the other, The width of the excisions were greatest in the middle of the lip (7mms lower lip, 5mms upperlip) and tapered down to zero stopping just shy of the mouth corners. Most by not all of the problematic dry vermilion was included in the excision pattern.

The lip reductions were done under general anesthesia as an outpatient and were accomplished in an hour. Closure of the upper and lower lips was done with very fine resorbable sutures. Ointment was applied as the only dressing to the lips. There were no eating or drinking restrictions after surgery. Diet was based on comfort.

Other than some expected lip swelling, there was no significant discomfort other than some temporary lip tightness. The sutures dissolved uneventfully and the lips went on to heal quickly. The patients reports that most of the lip dryness problem is resolved, stated as about an 80% to 90% improvement.

Case Highlights:

1) Lip reduction, while commonly done for reducing the size of the lips, can also be done for certain conditions of chronic dryness and cracking.

2) Lip reduction for dry lips involves the removal of a strip of dry vermilion where the cracking may be most prominent.

3) Lip reduction is a simple outpatient procedure that uses dissolveable sutures that do not require removal. The lips will swell but the discomfort is minimal.

Dr. Barry Eppley

www.eppleyplasticsurgery.com

Indianapolis Indiana

The vast majority of cosmetic lip changes are for enhancement in the desire to get a fuller look. However, there is a small percentagesof people who feel that their lips are too full and prominent. When the lips are excessively large, they may not only interfere with lip competence and function but may also a source of social ridicule and joke making.

Big lips (known medically as macrocheilia) can occur for multiple reasons, many of them from medical conditions. While it is true that large lips are features almost always associated with ethnic races other than that of Caucasians, a surprising number of lip reductions that I have performed in my Indianapolis plastic surgery practice have been in Caucasians. 

One of the more unusual excess lip problems is that of the double lip which occurs only in the upper lip. This is not really a function of too large of an upper lip (vermilion) but due to an extra roll of mucosa on the inside. As one smiles and the upper lip elevates, this excess roll of mucosa become evident and is seen as a horizontal roll of tissue beneath the upper lip.  

The obvious goals of lip reduction surgery are to achieve a more proportionate size of the upper and lower lips relative to the rest of the face. For many patients,  the large lips are the most dominant feature of the entire face and attract an undesired amount of attention.

Lip reduction surgery is fairly simple and straightforward but the key is in the planning. Initial surgical marks are made at the wet-dry junction but this may change based on which part of the lip is more prominent, the dry vermilion or the wet mucosa. For some large lips, the dry vermilion is the dominant part to remove. For others, it can be more of the wet vermilion and mucosa. Careful rolling back of the lip must be done to make this determination. Wherever the area of excess lip that is to be removed, you never want it to far forward where the final scar may show with the lips in repose. A wedge of excess lip is marked out and tapered as it goes into the corners of the mouth to prevent dogears excesses.

Lip reductions can be done under local anesthesia  if they are only an isolated procedure. Once anesthetized, the wedge excision removes primarily outer mucosa and the underneath submucosa. (in medical macrocheila the lip tissues removed may be deeper and more extensive) It is not necessary to remove muscle for cosmetic reduction and the labial artery should be preserved. I find that a pinch technique is very useful. By this method, the planned amount of mucosal excision is pinched up with a special instrument until the entire desired amount is in the pinch. This is then cut off with scissors and closed with a resorbable running suture. Only antibiotic ointment or vaseline is applied to the dry vermilion after to keep it moisturized as the lips swells and is prone to cracking and soreness.

Expect the lip to swell considerably  (may even look bigger than before surgery) and not to seek the results of surgery for a few weeks. In the end, the lip reduction result will be the exact amount that was removed, usually a 4 to 6mm reduction of actual horizontal lip size.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis

In today’s society, large and full lips are highly desirous. This is most evident in the large plethora of lipstick and lip care products as well as being one of the top places on the face for the use of injectable fillers. Despite the trend to go bigger, there are a few patients who actually want their lips to be smaller. Most commonly, these are non-caucasian patients who naturally have very full lips or someone who has a rare congential facial problem which results in large lips, medically known as macrocheilia.

Lip reduction surgery is a fairly simple procedure that can be done under local anesthesia or some form of sedation. It involves a transverse elliptical excision of lip tissue that runs from one corner of the mouth to the other. The key is the location of the excised tissue and the resultant scar. The exposed portion of your lip, the pink portion, is called the vermilion. The vermilion has both a dry and wet surface. The wet portion of the vermilion is the non-exposed part that sits just below the highest point of the dry vermilion (lip line) on the inside of the mouth. Removing excess vermilion here and allowing the lip to roll back and look smaller places the fine line scar in a non-visible location.

Reducing the size of the lips through this inside the mouth approach produces a modest size reduction, never a dramatic one. If one removes too much from the inside, the lips can have an unnatural rolled back appearance. In reality, the best place to reduce the visible size of the lips is by removing vermilion at the front edge where it meets skin. But this would create a visible scar which is why it is not done even though it is more effective at creating lip reduction.

Any form of lip surgery will create considerable swelling in the first few days after surgery. This is normal as the lip swells easily. (just think of when you just bumped it and see how quickly it swells!) As a general rule, the lip swelling subsides at a week out and the lip will look the same then as before surgery. You won’t be able to see visible lip size reduction until several weeks after surgery. So one has to be patient to see the results. Dissolveable stitches are used to close the incision on the lip as this is not a very nice place to have stitches that need to be removed later.

Lip reduction can be done on either the upper or lower lip, or both at the same time. That is a patient’s preference based on their aesthetic concerns.

Dr. Barry Eppley

http://www.eppleyplasticsurgery.com

http://www.ologyspa.com

Clarian North Medical Center, Carmel, Indiana

Clarian West Medical Center, Avon, Indiana

Indianapolis