Background: The lips are composed of both wet and dry tissue known as vermilion. Known as the pink or red part of the lips its presence and size determines whether the size of the lips is interpreted.
But the one red tissue one does not want on their lips is a hemangioma. Hemangiomas are benign blood vessel tumors that develop in the first few months of life. They can grow rapidly, appear bright red and distort the tissues wherein they lie. Once they reach their maximum size they remain stable in size and then undergo a phase of involution. (shrinking) Many hemangioma will almost completely go away but in their wake they often leave distorted skin which is stretched and discolored.
Hemangiomas often occur on the lips and can involve both the lip proper (vermilion) and the adjacent skin. Removing the sequelae of a hemangioma around the lips can be tricky since you do not want to distort the lips in the process of removing any mottled skin.
Case Study: This 40 year-old female had a hemangioma that involved the lower lip as a child. While most of the hemangioma shrunk down there always remained distortion of the lower lip from damaged tissues. Because of the discoloration and tissue distortions the upper lip always looked somewhat bigger than the lower lip. (more vermilion exposure) Most of the tissue distortions were beyond the vermilion-cutaneous margins into the skin below the lip.
The natural vermilion edge of the lower lip was marked and two options for excision were planned. (subtotal vs complete) It could be seen that complete excision of the abnormal tissues would create too big of a lower lip with the resultant lower lip advancement. A line that removed 50% of the distorted skin was chosen. Under local anesthesia, a strip of lower lip skin was removed and the vermilion edge of the lower lip brought out to close it.
A vermilion or lower lip advancement is typically an aesthetic procedure to make the lips look bigger. (more vermilion exposure) But in tumor resections it can be used to improve lip symmetry and size even if it does not result in complete removal of all abnormal tissue.
Highlights:
- While hemangiomas shrink in most children, they often leave behind redundant discolored skin.
- In removing residual hemangioma from the lip and lip margin, a vermilion advancement can achieve a subtotal reduction of it and improved upper and lower lip symmetry.
- Lip advancements, regardless of why they are performed, should not be overdone since they are irreversible.
Dr. Barry Eppley
Indianapolis, Indiana