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Background: Implants are the only assured permanent method of lip augmentation. The current style of lip implants is the best version of such implants that have been used to date. Like many other silicone facial implants they offer the ability to be easily inserted as well as removed. But this important quality is also fraught for implant migration and palpability. And in some cases, albeit rarely, the surrounding capsule that forms around the implants can result in lip tightness particularly at the otherwise flexible mouth corners.

When the feel of lip implants is one of persistent tightness their removal usually results in improvement of these symptoms. But residual capsules from the implants and the potential for scar banding across the mucosal lining of the mouth corners, where the insertion incisions were initially made, can result in a contraction on opening that is not resolved by implant removal alone.

Healing, stretching and steroid injections are the standard approaches to scar contractors across any moveable joint interface, including the mouth corners where the joining of the upper and lower lips occurs. This should work the vast majority of the time but when it doesn’t…

Case Study: This female had upper and lower lip implants (Permalip) removed one year previously due to palpability and tightness. Even after one year the mouth corners were tight which made getting dental treatments difficult. A vertical scar contracture band could be seen just inside the mouth corners on each side.

A z-plasty was marked out on both sides and incised. The lips were then stretched to open up the scar and sharp dissection was done down into the orbicularis muscle and scar for maximal release. A small fat graft as harvested from the buccal fat pad to be used as an interposition graft.

As much fat as possible was placed into the released scar space and the z-plasty limbs interposed and closed with resorbable sutures.

The surgical treatment of tightness and scar contractures of the mucosal lining of the mouth corners is the same an anywhere else they would occur across a movable  interface of two structures…release, interpositional grafting and scar band lengthening. The mouth corners may be a small surface in which to work but the basic principles still apply.

Case Highlights:

1) Lip implants and their removal can result in scar contractures at the inside of the corners of the mouth.

2) A z-plasty for the mucosal scar band can be effective but is not usually enough alone to return a more supple mouth corner at maximal opening.

3) A fat graft placed underneath the z-plasty after extended scar release is an effective adjunctive technique for a more supple mouth corner.

Dr. Barry Eppley

Indianapolis, Indiana

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