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Dr. Barry Eppley

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Posts Tagged ‘lip reduction’

Case Study – Upper and Lower Lip Reduction

Sunday, January 17th, 2016


Background: Aesthetic lip changes are largely about augmentation and are accomplished by using injectable fillers. Hundreds of thousands of such lip injections are done each year around the world. The opposite of lip augmentation, lip reduction is done in far fewer numbers. While the exact numbers of lip reduction are not known, it is probably fair to say that for every several hundred of lip augmentation procedures done, one aesthetic lip reduction is performed.

Lip reduction illustrates a basic plastic surgery principle that it is relatively easy to make a face or body part bigger but much more challenging, and often more limiting to make it smaller. Lip reduction is performed by largely removing excessive vermilion show and keeps the scar at the dry and wet vermilion junction. Removing oral mucosa behind the vermilion is largely ineffective as a lip reduction method because mucosal tissue is very flexible and easily stretches.

Case Study: This 25 year-old African-American man felt his lips were too big and not well proportioned for his face. He wanted their protrusion reduced with less vermilion show.

Upper and Lower Lip Reduction results Dr Barry Eppley IndianapolisUnder IV sedation anesthesia, an upper and lower lip reduction were performed through dry vermilion excision. At the central part of the lips, 8mms was removed from the lower lip and 5mms at the upper lip. The excision tapered towards the corner of the mouth but the two ends never connected or crossed the the mouth corners.

Upper and Lower Lip reduction results side view Dr Barry Eppley IndianapolisHis postoperative results showed a lip size reduction that was very satisfying to him. It did take up to six months after the procedure for all normal sensation of the lips to return. The scar line at the back side of the dry vermilion was barely detectable.

While lip reduction surgery can produce a visible lip size reduction, there are limits as to how much lip size can be achieved in a single surgery. While very large amounts of dry vermilion can be removed one does want a scar line that goes beyond the height of the lip edge and becomes potentially visible. Thus it is prudent to not attempt too much tissue lip tissue removal in a single procedure.


  1. Upper and lower lip reduction can be safely done at the same time.
  2. Lip reduction generally reduces lip size by about 1/3 at the most as a single procedure.

3) Greater amounts of lip reduction than 30% to 35% requires a two-stage reduction procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Lip Reduction for Dry Lips

Friday, December 3rd, 2010

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 vermilionor 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

Indianapolis Indiana

Getting Better Lip Proportions with Lip Reduction Surgery

Tuesday, September 1st, 2009

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

Indianapolis, Indiana

Reducing the Size of the Lips

Wednesday, March 25th, 2009

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

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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