Contouring the Lip versus Filling the Lip
Eser Yuksel, MD1, Melvin Spira, MD2.
1Baylor College of Medicine, Division of Plastic Surgery, Houston, TX, USA, 2N/A, Snowmass Villege, CO, USA.
INTRODUCTION: For 2 decades women search for thicker lips, as it is imposed as a single parameter of beautiful lip. This has led to the increased number of soft tissue filler applications. However, the ideal configuration of the upper lip should be determined by not augmenting the volume only, but defining the contours of the lip. A triangular central elevation, yielding 2 mm of central incisive upper teeth exposure, gives freshness resembling the triangular mouth of an infant. Additionally the cupid bow’s definition and philtrum’s depth needs to be restored as they fade gradually. Lips need to be contoured instead of augmented.
The author suggests application of 3 different modalities to reach the goal. These include, (1):volume enhancement in philtral column and central tubercle in addition to free border augmentation, (2):volume decrease in central philtral area and upper paraphiltral zones, (3):suspension of central lip.
MATERIALS AND METHODS 32 patients underwent the procedure proposed; 12 as an isolated procedure, 20 as an adjunct to rhinoplasty. Patients presenting: long upper lip with faded contour marks were chosen.
Procedure: A transcolumellar incision is extended inferiorly in horizontal plane 5 mm bilaterally within the nose. .Depressor nasi muscle and the proximal border of the orbicularis oris muscle is dissected bluntly.. Using 3/0 supramide, transverse bites are placed through the upper central orbicularis muscle from one nostril to the other within the extended incisions. These sutures are fixed to the caudal septum.
The a augmentation is performed by injecting the autologous fat to the philtral column and central tubercle vertically and free border horizontally.
Triamcinolone injection sites are shown in figure 1.
Photographic evaluation and clinical observation where performed preoperatively and 2 months postoperatively.
RESULTS Photographic comparative pre and postoperative evaluation showed: a decrease in upper lip length with mean of 2 mm, a central upper lip elevation with 2 to 3 mm of upper incisive show, slight increase in vermillion thickness, increase in philtral depth and columnar height. (figure 2). For the global midface assessment different observers and the patients’ own responses which are choices from no change -minimal improvement -significant improvement, -negative change. The results revealed the significant change as a predominant answer. (table 1)
CONCLUSION This change in the configuration of the upper lip may yield a more complete restoration plan in addressing the patients’ lip improvement requests.