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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘lip advancements’

Postoperative Instructions for Lip Lifts, Lip Advancements and Corner of Mouth Lifts

Sunday, January 27th, 2013


Surgical lip enhancements involve removing select areas of skin to increase the vermilion show of the lips or change the angle of the corner of the mouth. These are precise and measured amounts of skin removal that result in fine line scars either under the nose, along the lip edges or extending out from the corner of the mouth slightly.

The following postoperative instructions for excisional lip enhancement surgery are as follows:

1.  Lip lifts/advancements and corner of the mouth lifts have a minimal amount of postoperative discomfort. Few patients ever require pain medication and a few Tylenol or Alleve are all that most patients need for a few days after surgery.

2.  There are no dressings applied after lip and corner of mouth surgery. Only antibiotic ointment is used to keep the suture lines soft and supple, whose primary intent is to make suture removal eventually easier.

3. Be aware that your lips will get increasingly swollen over the next few days after surgery. This is normal and not a cause for concern. Lip swelling does not start to go down until three days after surgery and will take a week or two to go away completely. The use of ice packs on the lips is very useful the first day after surgery to control swelling and improve comfort. You may use them as long as you like. Corner of the mouth lifts have little to none of this after surgery issues.

4. The lips and corner of the mouth suture lines may get wet without any danger of increasing the risk of infection. So feel free to wash your face and shave (men) as needed.

5. The incision lines at the base of the nose (subnasal lip lift), lip lines (lip advancement) or corner of the mouth lift will have sutures that need to be removed in a week after surgery. (unless you are an out of town patient). Apply antibiotic ointment to them three times a day to keep them slightly moist. If any blood has accumulated on the suture lines during the first day after surgery, clean it off with a little water or hydrogen peroxide on Q-tips. There is no need, however, to use hydrogen peroxide on clean suture lines. Just apply the antibiotic ointment.

6. Your lips will feel a little tight when you open your mouth widely. That will take several weeks to a month to return to normal. You may stretch open your mouth and lips as much as feels comfortable. You may eat whatever you like.  Focus on liquids and soft foods for the first few days after surgery.

7. After sutures are removed and the incision lines healed (several weeks), massaging the lips and stretching them gently will help make them feel softer sooner and regain their normal suppleness again.

8.   You may return to any physical activity and work as soon as you would like based on your comfort level with pain and your facial appearance

9.   You may drive when you feel comfortable and can react normally and are off pain medication.

10. If any lip redness, tenderness, or drainage develops after the first week of surgery, call Dr. Eppley and have your pharmacy number ready.

Consent for Plastic Surgery: Lip Lifts, Lip Advancements and Corner of Mouth Lifts

Sunday, January 27th, 2013


Every plastic surgery procedure has numerous issues that every patient who is undergoing a procedure should know. These explanations are always on a consent form that you should read in detail before surgery. This consent form, while many perceive as strictly a legal protection for the doctor, is actually more intended to improve the understanding of the various lip enhancement procedures. The following is what Dr. Eppley discusses with his patients for these procedures. This list includes many, but not all,of the different outcomes from surgery. It should generate both a better understanding of the procedure and should answer any remaining questions that one would have.


Enhancements of the lips can be done by a variety of synthetic or fat injectable fillers to increase the size of the pink part of the lip. (vermilion) Whether the results achieved by injection techniques is comparable to that of tissue excision and lifting should be thoroughly understood before surgery.


The goal of lift lifts and advancements is to shorten the distance between the base of the noses and the upper lip and increase the amount of vermilion show. A lip lift will increase the central lip pout and vermilion show. A lip advancement will increase vermilion throughout the whole lip from one mouth corner to the other. The goal of a corner of the mouth lift is to lift up the sagging mouth corners and create a more horizontal smile or lip line.


There are limits as to how much the lip can be lifted or advanced and how much the corners of the mouth can be changed. The limits to these changes are based on trying to keep the lips looking natural and not overdone and to not making excessive visible scarring.


Expected outcomes include the following: temporary bruising and swelling around the lips and the corner of the mouth, temporary lip numbness, permanent scars at the junction of vermilion-skin junction (lip lifts and advancements) and away from the corner of the mouth. (corner of mouth lift) All excisional lip procedures may create some temporary stiffness on movement and mouth opening. Healing of the scars and settling any scar irregularities is a process that takes months (6 to 12) to see the final result in many cases.


Significant complications from lip surgery are very rare but could include infection. More likely complications could include aesthetic deformities such as asymmetry and irregularities of the vermilion-skin junction (lip lines) asymmetry of lip (vermilion)sizes or mouth corners, suture reactions along the incision lines, and under vs. overcorrection of the desired lip sizes or corner of the mouth changes. Any of these risks may require revisional surgery for improvement.


Should additional surgery be required to adjust the  shape of the lips or corner of the mouth, this will generate additional costs.

Lip and Corner Tuckups for the Aging Mouth

Tuesday, October 13th, 2009

One of the telltale and most bothersome signs for women as they age is the development of an aging or “old mouth”. Besides the lines and wrinkles that form in the surrounding skin, other anatomic changes occur that change its overall appearance. The upper lip begins to get longer and thinner. The drooping skin from above the lips forces the corners of the mouth to turn downward. As the corners turn downward, furrows extend from the corner of the mouth downward, known as marionette lines. The lower lip sags and the horizontal groove beneath it (labiomental sulcus) becomes more pronounced. The nasolabial folds or lip-cheek grooves, which bracket the mouth from above, become deeper.

Skin resurfacing methods, such as lasers and chemical peels, are useful to decrease wrinkling around the mouth area. But they often only improve just a part of the problem. Injectable fillers add a good method of rejuvenation because they replace lost volume and help provide a small lift to some areas of the mouth. When combined with skin resurfacing, some nice changes in the aging mouth can be seen.

In some cases, the mouth or perioral area requires some surgical manipulation to get that more youthful look.  There is a set of small but very effective mouth procedures that are more effective at lifting and upturning than any injectable filler alone. The goal here is to have fuller lips with a more even or horizontal smile line. These perioral rejuvenation procedures include lifts of the lip, corner of the mouth, and smile lines.

The simplest lift is that of the upper lip. It is performed to shorten the long lip of aging, allowing the upper teeth to show slightly when the lips are slightly open. By using a wavy or bullhorn-shaped ellipse of skin under the nose, the central part of the lip is upturned. Lip advancements, however, are more widely used as they affect the entire upper lip. Lip advancement achieves exposure of more of the pink mucosa (vermilion) and removes some of the vertical lip lines that run directly into the lips. A small strip of skin outside the lip line is removed to make the lips look bigger

There is really only one way to lift the downturned mouth corners. The corner of the mouth lift is performed to elevate the down turned corners of the mouth so that the smile line (lips at rest) becomes more horizontal. This makes one’s mouth appearance more perky. This is done by  removing a small triangle of skin above each corner which changes the location and angulation of the sides of the mouth.

Just beyond the corner of the mouth can lie folds of skin which hang down. While it is tempting to think that this loose skin can be improved by a facelift, it usually is not. These “parachute” folds of skin can be improved by direct excision of loose skin and fat in the lower portion of the nasolabial fold. This excision of skin places a small scar along the lower end of the nasolabial fold. It can also help with some minor lifting of the corners of the mouth as well.

Any direct excision of skin in the mouth area do result in scars. Patients have to be willing to accept that trade-off for the benefit of mouth rejuvenation effects. While most of these scars heal well and very indiscriminately, some may need revision or smoothing out later. In my Indianapolis plastic surgery experience, these small revision rates are most commonly needed for corner of the mouth lifts and about 10% to 15% of patients may benefit by them.

Dr. Barry Eppley

Indianapolis, Indiana

Upper Lip Aging – Anatomic Analysis and Rejuvenation Strategies

Friday, August 14th, 2009


Rejuvenation of the upper lip is a commonly requested and performed procedure. There are numerous strategies for treating an aged upper lip and one of the basic approaches is to add volume. Usually through injectable fillers, volume is added to create a more protruding and pouty lip. This is based on the fundamental belief that volume loss is a significant part of lip aging.

 The plastic surgery literature is replete with literature that describes aging changes of the upper lip and subsequent treatments for it. A consistent theme is that the upper lip gets longer, the visible vermilion becomes less, and the lip gets thinner. To verify that such changes do occur as espoused, an anatomic studies on the aging lip in the August 2009 issue of Plastic and Reconstructive Surgery was published.

Using cadaver specimens, the upper lips of younger (< 40) and older (> 80) females were histologically evaluated. By comparing the two groups, a histomorphometric analysis was done. Their results revealed that the skin significantly thins with loss of elastic and collagen fibers. The underlying orbicularus muscle also undergoes atrophy as well. But the overall lip volume does not change due to an increase in subcutaneous tissue. The lip does indeed thin but that is due to a volume redistribution, changing from width to length. Thus, the longer lip appearance.

These histologic changes are not earth-shattering but they do provide support for many of the lip treatments that we currently do. The use of laser resurfacing helps smooth out upper lip wrinkles but it does not make it thicker, which is one reason why upper lip wrinkles return over time. While the lip may not lose overall volume, it does become thinner in cross-sectional width. Thus adding volume, regardless of the method, is useful for returning thickness.

What is interesting about this anatomic study is that it shows that the upper lip does lengthen. This indicates that surgical methods that shorten the upper lip, such as vermilion advancements, are effective at treating one important problem of upper lip aging. If it were not for the fine line scar that results, lip advancements would be much more commonly done as they do have a powerful rejuvenating effect. Shortening the long upper lip and exposing more vermilion addresses two of the three upper lip aging problems.

Because there are three fundamental age-related changes in the upper lip, no one treatment approach is completely satisfying. Combinations of lip treatments are always needed for good results. This can include various combinations of volume addition, skin resurfacing, and lip shortening techniques. (vermilion advancements or subnasal lip lifts) Which combination of two of them is decided based on how inherently thin one’s lip was to start with. In my Indianapolis plastic surgery practice, I most commonly perform volume addition and skin resurfacing for the younger patients with early signs of lip aging and lip advancements and skin resurfacing for the more advanced aged lip. All of these can be performed under local anesthesia in the office. Complete recovery is one week or less.

Dr. Barry Eppley
Indianapolis, Indiana



Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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