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Dr. Barry Eppley

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Surgeon Dr. Barry Eppley

Posts Tagged ‘lip lifts’

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.

Durability of Excisional Lip Lifts

Thursday, November 1st, 2012

Excisional methods of lip rejuvenation, known as lip lifts, are an historic treatment. While pushed aside with the introduction and widespread adoption of injectable fillers, they are making a comeback with the realization that fillers can not solve all insufficient or aging lip problems. They are beginning to reappear in publications and at meetings as a viable method for making lips bigger by increasing vermilion show and decreasing the vertical lip distance between the base of the nose and the upper lip.

Like any form of lifting, a good question is how long does it last? This is most relevant to the true upper lip lift known as the subnasal or bullhorn upper lip lift because it pulls the lip upward. The vermilion advancement also known as the gull wing lip lift involves less pull to create its effect although its sustained results are still relevant.

In the September 2011 issue of the Archives of Facial Plastic Surgery, a study was published in the long-term analysis of surgical correction of the senile upper lip. This was a retrospective review of 30 patients who had either a lip lift or a lip advancement performed for an aging upper lip. (15 lifts, 15 advancements) Digital imaging analysis was used to standardize each patient’s before and after results. The mean follow-up of the patients was just over four years. The revision rate was 7% with all revisions occurring in the vermilion advancement patients and none in the subnasal lip lift patients. Interestingly, all revision occurred in patients who were smokers. Besides significant improvement in lip appearance in all patients, both types of lip lifts showed sustained results out to the duration of the study.

Unlike synthetic injectable fillers and even fat, permanent lip augmentation is elusive. Lip lift and advancements are well known to offer significant improvement and this study supports the observation that those results are sustained and thus permanent. I do find it interesting that the study did not show a difference between subnasal lip lifts vs vermilion advancements as lip lifts have historically been known to have some degree of ‘relapse’ and secondary relaxation lengthening of the result. Based on this study and the technique used (no muscle manipulation or suturing) there is no need to overcorrect a lip lift since significant loss of the result is not seen.

Despite the durability of lip lifts, they still play a minor role in lip rejuvenation. Because of the scar burden that they create and the volumetric benefits of fillers, lip lifts are reserved as a salvage procedure for failed lip rejuvenation attempts by other methods. Even in a patient who has a very thin lip regardless of age and seems like a good candidate for a lip lift, I want them to try fillers first to prove that surgical modification of the lip is desired.

Dr. Barry Eppley

Indianapolis, Indiana

Plastic Surgery’s Did You Know? Lip Lifts

Friday, July 6th, 2012


Lip augmentation is a very familiar and popular procedure. By injecting a variety of substances into the lips, they become bigger and more sensual. But not all lip issues can be adequately treated by injectable fillers alone, particularly older lips. Lips as they age often get longer, thinner and turn down at their corners. Adding volume rarely is the best solution. Facelift surgery does little to benefit the mouth area. But unlike the face, the lips can also be lifted. A lip lift can shorten the upper lip and give it more pout through an incision under the nose. The downturned corners can be reversed by a corner of the mouth lift. Volume through injectable fillers can also be done at the same time for additional rejuvenation. This look is consistent with what is portrayed in the sensous lips of models who have a short upper with a pout and a turned-up mouth. Such changes in the older lip can not be done with injections alone.

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



Lifts and Advancements for Lip Enhancement

Friday, January 18th, 2008

Non-Injectable Lip Enhancements


By far, the most popular form of lip enhancement or rejuvenation is by injecting any of the commercially-available forms of hyaluronic acid gels (e.g., Restylane or JuvaDerm) By injecting into the body of the lip or along the white roll, good results can be consistently obtained in the vast majority of patients. However, there are some patients with very thin lips in which injecion treatments do not produce a good result. And by good result, I am referring to a natural lip that is both bigger and aesthetically pleasing. When the amount of vermilion (pink) show is small, injections may make the lip bigger primarily by making it stick out. This is not very aesthetically pleasing and usually makes the patient standout as ‘someone who has had their lips injected’. A look that not a one of my patients would ever want.


In these atypical cases, it is usually an older woman who has lost much of her upper lip with age (because she had a small one to begin with) or, rarely, a younger patient who simply has very little upper lip and a poorly-defined (flat) cupid’s bow. The surgical procedures of vermilion advancement or subnsasal lip lift are better for these thin lip patients. With the vermilion advancement, a strip of skin along the white roll is removed and the vermilion ‘advanced’ upward and sutured into place. This is a powerful procedure that can make an upper lip fuller….forever. But at the price of a fine line scar along the border of the vermilion and the upper lip skin. The cupid’s bow can be highlighted and better defined with this procedure as well. For those patients who cannot accept an upper lip scar and, only want the cupid’s bow area enhanced, then the subnasal lip lift is an option. Skin is cutout along the base of the nose and the entire middle-third of the upper lip is lifted as it is sewn into place. It is important to remember that the subnasal lip lift will do nothing for the sides of the upper lip which lie beyond the nostrils which is the tail of the cutout. This results in a more lip scar in a better location but the effect is not as great as the vermilion advancement procedure.

In either case, It is extremely important to use these procedures as a ‘last measure’ for a thin lip problem. I always have the patient go through a trial of lip injections first, even if I think it will not work well. They may very well make the patient happy….and that is the ultimate goal. If not, then they have qualified themselves to be willing to make the trade-off of a lip scar for a significant change in their lip appearance.


Lastly, remember the vermilion advancement procedure can be used on the lower lip as well. When both lips are done together, the effect can be quite dramatic.


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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