Background: There are numerous upper lip aesthetic deformities that can occur of which the most recognized are external. (long upper lip, limited vermilion show, downturned mouth corners) But there are some internal upper lip aesthetic deformities that are less known as their occurrences are far less frequent.
One recognizable internal upper lip aesthetic deformity is the gummy smile. The exposure of too much gum tissue when smiling is well known and provided that there is no vertical maxillary excess effective treatments include paranasal Botox injections and intraoral shortening vestibuloplasties. Both methods reduce the excursion of the upper lip when smiling and reduces the amount of gum tissue seen. While Botox produces a temporary effect an intraoral vestibuloplasty has a permanent effect.
A lesser seen internal upper lip deformity is the double lip. This is a fairly uncommon congenital roll of excess mucosal tissue that abuts up against the wet-dry line of the upper lip. As a result it hangs below the smile line particularly when smiling which not only exposes it but pushes it downward as a result of compression of the upper lip against the maxillary alveolus.
But when if a gummy smile occurs in the same patient who has a double upper lip…
Case Study: This female had the combination of a gummy smile and a double upper lip. Due to Botox injections the excursion of the upper lip was not as significant as it naturally would be. But it still was more than 5mms above the tooth line.
The double upper lip was modest in size and extended between the canine teeth. It hung down about 5mms below the smile line.
Under general anesthesia the excess upper lip mucosal excisional pattern was marked. It was removed using needlepoint electrocautery.
Once the excess mucosa was removed the edges were reapproximated and closed in two layers with dissolvable sutures.
The gummy smile was done with subtotal excision of the vestibule, leaving a cuff of mucoperiosteum to the attached gingiva, and the new level of the vestibule lowered by a two layer closure of the two mucosal edges.
In this patient the double lip size was small but aggravated by the gummy smile. Both were safely done at the same time as the two horizontal excision lines have enough mucosa between them which does not compromise their healing or the amount of mucosal tissue that needs to be excised.
Key Points:
1) The rare double upper lip consists of redundant mucosa behind the wet-dry line.
2) The gummy smile will be exacerbated if a maxillary frenulectomy is performed.
3) The double upper lip can be combined with gummy smile correction during the same surgery.
Dr. Barry Eppley
World-Renowned Plastic Surgeon