Beauty ideals and aesthetic standards vary across social perceptions and cultural preferences. In modern culture, plump and well-defined lips tend to be preferred. However, the characteristics of ideal lip should have fullness and volume, a correct balance between the upper and lower lips and a well-defined vermilion border. Lips should also be harmonious with other facial features of the individual. Enlarged, full lips in a very small face will not be aesthetically pleasing as this would be out of proportion with the rest of face. Sexual dimorphism should also be kept in mind when treating lips, as men have a larger mouth width, philtrum width, total lip height, and lip volume compared to women. Despite general differences in men’s lips and women’s lips, it is possible to transform masculine lips to more feminine lips and vice-versa.
Preoperative assessment and communication with patient is imperative to yield desirable outcome. The selection of an appropriate surgical procedure is dictated by the patient’s expectations, dento-maxillofacial proportion in relation to the lips, choice of anaesthesia, recovery period and risks involved. There are various treatment modalities available to improve the appearance of the lips:
TYPES OF CHEILOPLASTY
1. Upper and lower lip reduction surgery
Lip reduction surgery is a procedure for patients who have naturally large and prominent lips. The lip reduction procedure is performed under local anesthesia on out-patients basis or may be performed under general anesthesia if they are undergoing multiple procedures. A horizontal incision is made on the inner side of the lip mucosa. Excess mucosa, fat and muscle from the lips are removed. The wound is closed in layers. Lip reduction procedure can be performed on the upper and lower lips to improve the patient’s appearance and balance. These wounds usually healed well without any visible scars.
2. Upper lip lifting surgery (Upper lip shortening)
The upper lip lifting surgery is for patients who presented with excessively elongated upper lip. Normally, the ideal length of the upper lip to the columella of the nose is between 12-15 mm. If the length is significantly longer than the average, patients can take the advantage of the upper lip lifting or lip shortening procedure. There are two types of upper lip lifting surgery:
- Subnasal or “Bull-horn” Lift: An incision is made along the lower edge of the nose which is the junction between the nose and the upper lip. The excess amount of skin and a thin strip of lip muscle are removed. The upper lip is lifted by suturing the cut edges together. As a result, the upper lip is pulled upward. It is really important to close the incision in layers to prevent unsightly scars.
- Vermilion Advancement: In this technique, an incision along the vermillon border of upper lip. The segment of skin is removed from just above the vermillon border of upper lip. The wound is meticulously closed in layers to minimize scarring. In that manner, the upper lip is effectively pulled upward and shortened.
3. Lip augmentation
Lip augmentation is performed by injecting a natural or synthetic bio-compatible material. Proper placement of the material is important to create fuller-looking lip while reducing wrinkles that form around the outer edges of the lip. There are three common techniques used in lip augmentation:
- Filler injection such as hyaluronic acid fillers(eg: JUVÉDERM® and Restylane®) or smooth calcium hydroxyapatite (CaHA) microspheres (eg: Radiesse®) are few of the commonly used fillers for lip augmentation. The results of this procedure usually last approximately 9-12 months.
- Lip implant such as AlloDerm® consists of acellular human cadaveric dermis. It is placed through two small incisions to create fuller lips. Since all the cells from the donor tissue are removed, there is no rejection associated with the use of AlloDerm®. The results can be permanent.
- Fat transfer is performed by carefully harvesting fat from your abdomen or hips. The fat is then delicately processed to isolate fat cells. These fat cells are then injected into the proper plane of the lips to create a fuller appearance. Sometimes overcorrection is necessary as not all of the fat will survive. Occasionally repeated injections are required for a permanent effect.
PRE-OPERATIVE EVALUATION
Communication is vital in order to achieve the desirable goals. During the initial consultation, patient will have the opportunity to discuss with the plastic surgeon about the treatment plan. The plastic surgeon will work closely to reach an agreement about the expectations from the surgical procedures involved and their long term outcome. Every patient is different, therefore a specific treatment regimen is planned to suit an individual’s need. The preoperative evaluation includes:
- Discussion about the treatment plan and options
- Medical conditions, drug allergies and previous medical or surgical treatment
- Discussion on anaesthesia and its risks
- Discussion on the likely outcomes of the treatment and any risks or potential complications
- Physical examination
- Photography for preoperative and postoperative evaluation.
RISKS AND SAFETY
The decision to have lip surgery is extremely personal. Patients have to consider if the benefits will achieve their goals and if the risks and potential complications are acceptable. Therefore, it is important for patient to understand that every surgical procedure has its own complications and down time. However, if a patient is assessed properly before the surgery and postoperative care is given adequately, these risks can be eliminated or reduced.
Some of the common risks of lip surgery:
- Infection
- Bleeding
- Poor wound healing
- Irregular healing of scars including contracture (puckering or pulling together of tissues)
- Residual irregularities and asymmetries
- Lip discoloration
- Lip contour irregularities
- Lip sensitivity
- Swelling due to blood clot or fluid accumulation
- Injury to deeper structures such as nerves, blood vessels or muscles
- Anaesthesia risks
- Possibility of revision or staged surgery
POST-OPERATIVE EXPECTATIONS
During the initial healing phase, patient may experience swelling, numbness, discomfort, bruises and discoloration around the lip areas. These symptoms vary from each patient and they usually last for about 2-3 weeks. Instructions will be given on wound care, medications to apply or to take orally to aid healing and reduce the risk of infection and when to follow-up with the plastic surgeon. If sutures are used, they will be removed about 5-7 days after the surgery. As the swelling at the lip resolved, the healing will continue for several weeks and the final outcome of the surgery will be visible once the wound healed completely.
POST-OPERATIVE CARE
- Regular application of prescribed ointment and cleaning the surgical wound as instructed
- Avoid excessive sun exposure during the healing phase
- Regular use of sun screen on the scar area
- Application of topical scar gel and massage around the scar area will improve the appearance and texture of the scar
– COPYRIGHT OF DR LEOW AIK MING
