Background: Lip augmentation continues to be a very popular non-surgical facial enhancement procedure. It is done in almost every case with some form of injectable filler. But fillers do not work well in very thin lips and some patients do tire of repeated injection sessions as fillers last only a limited amount of time..
Case Study:This is an interesting but different case of a 45 year-old female who had reasonably sized lips with a defined cupid’s bow in the upper lip. She had been having lip augmentation with injectable fillers for the last three years in both the upper and lower lips. But she wanted to have a permanent procedure which would eliminate the expense and pain of periodic lip injections.
Her surgical lip options included a non-resorbable lip filler (Advanta), lip advancement, lip lift, and a mucosal roll-out. (i.e., V-Y mucosal advancement) She did not want any foreign material in her lip nor did she want the prolonged swelling and unpredictability of a mucosal-based procedure. This left her with the skin excisional procedures of either an advancement or a lift. The difference between the two is that a lift procedure does not exist for the lower lip and it will only make the central part of the upper lip fuller. (even though it hides the scar along the base of the nose) Because she wanted fuller lips, particularly as they tapered into the corners of the mouth, a lip advancement was her only acceptable surgical option. She was willing to accept fine line scars at the junction of the lip and skin for both lips.
The operation was performed as an office-based procedure under local anesthesia. She did receive oral sedation one hour prior using Valium and Phenergan. Using a mirror, the new lip borders were marked out to her satisfaction. (how much skin to be removed and how much more vermilion would be exposed) Intraoral dental blocks were first done prior to actual anesthetic injections into the lips.
The skin was then precisely cut out along the marks and the vermilion advanced out and sutured into its new position in multiple layers. The skin sutures were removed one week later.
The lip advancement is a very effective procedure that provides a permanent solution for fuller lips. It does exactly what creates a bigger lip (increased vermilion height or exposure) without making it look unnatural. (sticks out) For very thin lips this is often the only procedure, injection or otherwise, that creates a significant change. Because of the scar, a lip advancement is not a procedure that should not be used recklessly without careful consideration of the permanent scar.
Even though many patients may tire of having their lips injected, the scar may not be a good trade-off for many. If one has some lip fullness already, the use of a lip implant may be a better option than a fine surgical scar.
Case Highlights:
1) Skin excision is a permanent option for lip augmentation. It creates a very significant amount of lip fullness, particularly when done on both the upper and lower lips.
2) It is rarely used as a substitute for injectable fillers because of potential scar concerns. It is more commonly used for thin lips that do not respond well to injectable fillers.
3) When the scar concern is not an issue, it can be done as an office procedure with minimal recovery marked mainly by temporary lip swelling.
Dr. Barry Eppley
Indianapolis, Indiana