Do I Need A Lip Lift Or A Lip Advancement?

Q: Dr. Eppley, I am interested in a lip lift. I have very thin lips and a long upper lip. I want them to have more shape and size although I don’t want them to be too big. I have read about lip lifts but am not sure what I really need. I would like your opinion. I have attached a front and side view of my lips for your recommendations.

Vermilion Lip AdvancementA: Thank you for sending the pictures. What they show to me is that unequivocally need a vermilion advancement and not a sub nasal lip lift. Your lips are very thing from corner to corner, has little cupid’s bow shape and there is a long distance between the base of the nose and the upper lip. This is a contraindication to a subnasal or bullhorn lip lift as it will only move up the central third of the upper lip but leave the rest of the lip behind, potentially creating an unusual and unpleasing shape. Only moving the physical location of the vermilion-cutaneous border, from corner to corner, of both lips can you make a significant improvement in the size and shape of your lips. I have attached an example of upper and lower lip vermilion advancements although this patient is older and she wanted a more dramatic change. The change from a lip advancement procedure is adjusted by the vertical size and shape of the skin excision and can be in any degree desired. The ‘test’ of the change a patient wants with a vermilion advancement is done by having them draw on the new border and shape of the lip with an eyeliner pencil. Then that becomes how much lip advancement is done.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Lip Advancement Be Reversed?

Q: Dr. Eppley, I had an operation on my lips in order to have bigger ones. I had the operation about six months ago. I did not like the result of the operation and two months later I had a second operation. I had scar and asymmetric shape so I did not like the result again. I am regretting my decision for surgery and am missing my previous lips. My problems are the philtrum height is very short, my teeth does not appear because of mucosa and the lips have been stretched too much. I hope you can help in this regard.  I am very unhappy indeed. I want you to remedy this situation soon. I really miss my old thin lips. I have attached some pictures of my lips before and after the procedures.

A: Thank you for sending your lip pictures. You did not say what procedure was done but it appears to have been a lip or vermilion advancement on the upper and lower lips. Unfortunately there is no turning back, so to speak, when it comes to a lip advancement. Once the skin is removed to do the procedure, it can not be replaced later. In essence, you can not reverse a lip advancement procedure. There is no operation to return your lips to their once thinner appearance. The only potential improvement that I can envision is lip edge mucosal resection to achieve a bit of an inner lip roll in and expose more of the teeth.

Your case illustrates why it is always best ti be conservative in a lip advancement. You can always do more but can never do less.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Lip Advancement Make My Upper Lip Even In Size With My Lower Lip?

Q: Dr. Eppley, I am interested in getting a lip advancement procedure that would make my upper lip at least equal to my lower lip. My lips are significantly out of proportion.  I have sent 3 pictures as references. Would you be willing to make such a drastic lip change to make them equal in size/appearance. I really would not be happy with the results if this outcome isn’t achievable. I live out of state and would have to fly in the night before the surgery and then fly out the day after. Would that cause any problems with the procedure and healing process. I am a very healthy 38 year old male with no health conditions. I have had anesthesia for a prior procedure. I am in the health field so I could perform most of the post care protocols. Thanks for your help.

A: Through a lip advancement your upper lip could be made almost even, if not completely even, to that of your lower lip. This is a procedure that could be performed under either local anesthesia (office) or IV sedation (procedure room) Many lip reshaping patients of mine come from afar so distance is not a concern in terms of healing or a cause of any after surgery problems. As you undoubtably know, the only issue with the lip advancement is the fine line scar along the vermilion border which is why it is not as commonly done in men as in women…although this does not mean the scar is any different. I don’t know of you are going to have upper lip hair or not after the procedure so the scar may or may not be of significant consideration.

Dr. Barry Eppley

Indianapolis Indiana

How Long Does It Take Scars From A Lip Advancement To Fade?

Q: Dr. Eppley, Hello! I found you searching the internet and I find your work great. I just can find information about recovery for lips enlargement for this kind of operation http://exploreplasticsurgery.com/wp-content/uploads/2009/01/lip-advancement-surgery-indianapolis-dr-barry-eplpey1.jpg .How long does it take for scars not to be visible anymore? Or how long it takes for it to be slightly visible?

A: Other than some moderate lip swelling, there usually is no bruising with lip advancement surgery. Patients report little to no pain as the upper lip will have some temporary numbness. So the recovery is very quick as there are no physical restrictions after surgery. The scars from lip advancements heal very quickly and are minimally visible in 3 to 4 weeks after surgery although that will be somewhat dependent on the patient’s age and the preoperative shape of the lip. (younger patients take a little longer than older patients) Full scar maturation is a process and one should anticipate that the final appearance of the scar is one of months and not weeks. As there will always be a permanent lip scar, one has to have a thin and small lip that justifies that trade-off. One can wear lipstick one week afetr surgery so scar camouflage is easily done through the scar maturation process.

Dr. Barry Eppley

Indianapolis,Indiana

How Soon After An Upper Lip Advancement Can I Work As A Speech Therapist?

Q: Dr. Eppley, I am a speech therapist, and while I would like to look into a possible vermilion advancement for my extremely thin lips (my upper lip is virtually non existent) I am worried about both the cost and the time to heal since I make a living using my lips to help my students and make a living. 

A: For the pencil-thin upper lip, there is no better lip enhancement procedure than a vermilion advancement. It physically increases the vertical height of the lip vermilion and reshapes the cupid’s bow area and can be done for subtle or more dramatic changes to the lip. When done by itself, it is performed as an office procedure under local anesthesia. Its cost will usually run around $2,000. It does cause some moderate swelling but much of that is gone by a week after surgery. There are no restrictions after surgery but how that would impact someone performing speech therapy services is not clear to me. I suspect after one week you would be just fine, maybe two weeks at the longest.

Dr. Barry Eppley

Indianapolis, Indiana

How Can My Lip Scar Be Improved And My Lips Be Made Bigger At The Same Time?

Q: Dr. Eppley, I have thin uneven lips due to an injury as a child. When I was seven years old I fell of my bike and split my face open on the concrete. I had a long laceration that ran from my lip down to the underside of my chin and now it is a long wide scar. My lips are naturally thinner but this scar as it crosses the lip also makes the lip uneven as well. Is there a surgery that could correct this lip step-off and in the process make them a bit fuller as well? I don’t expect Angelina Joile lips, but just some normal looking lips. I would appreciate any help you can offer me.

A: Mismatched vermilion-cutaneous edges along the lip line can be easily corrected by either reopening the lip vermilion and realigning the edges or doing a transposition of the edges through a small z-plasty scar revision. Making the lips fuller at the same time can most effectively be done by an upper and lower vermilion advancements. But whether that fine line scar along the lip lines is a good trade-off depends on how thin your lips are and if you have enough vermilion that a filling material or an implant may offer enough size change that would avoid the need for vermilion scars.
Dr. Barry Eppley
Indianapolis, Indiana

Which Is Better For Thin Lips – A Vermilion Advancement or a V-Y Advancement?

Q: Dr. Eppley, I am thrilled about which intervention I have to have done to my lips. They are both thin and fillers give me a duck look. I can’t decide if a vermilion advancement or a V-Y plasty is the best for me. Thank you for taking the time to answer me!

A: Usually the vermilion advancement  or lip advancement works best in very thin lips because they lack adequate vermilion height for exposure. The V-Y advancement is an internal mucosal roll procedure that primarily creates greater central lip pout and increased vertical lip length, in essence a greater effect on mucosa than the vermilion. They actually are quite different procedures on their effect on creating lip size and shape. The vermilion advancement is also much more versatile in shaping the cupid’s bow area of the central upper lip which the V-Y advancement can not do.

Dr. Barry Eppley

Indianapolis, Indiana

Can My Upper Lip Advancement Scar Be Improved?

Q:  Dr. Eppley, I had a gullwing upper lip lift two years ago. I am very unhappy with the resulting scar. The surgeon who did the procedure said that the scar would end up invisible…it did not. The scar sits 2mm above my vermilion line and is very indented so even if I try to cover the scar with lip liner and concealer it still shows. The surgeon cut very deep and used only eight sutures on the whole of the top lip. Please give me your honest thoughts and whether it can be improved by scar revision. I have attached a picture of my upper lip so you can see how bad the scar is.

A: Thank you for sending your pictures. I think without a doubt that the scar and the upper lip shape can be improved. The indentation is so visible because the natural shape of the white roll (where the skin of the upper lip and the vermilion meet) is everted not inverted. While the eversion of the white roll is lost in every lip advancement, it should be flat and not inverted. I suspect that deeper sutures were not used in the closure so that inversion resulted. In addition, I see no definition of the cupid’s bow of the upper lip, which is one of the main benefits that a lip advancement can achieve. In looking at your before pictures, I think you had the wrong lip enhancement procedure from the beginning. You would have been better served with a subnasal or bullhorn lip lift not a vermilion or gullwing lip advancement.

Dr. Barry Eppley

Indianapolis, Indiana

How Is A Lip Advancement Done?

Q:  Dr. Eppley,  Hello I live in Europe and would like to do the lip advancement as an alternative to injectable fillers for permanent lip enhancement. But I would like to know where you do it and how much it costs?

A: Most lip (vermilion) advancements are done in the office under local anesthesia. Using initial infraorbital nerve blocks (like going to the dentist) and then followed by direct infiltration into the lips, the procedure thereafter is painless. If a patient prefers it can also be done supplemented by oral valium or Xanax or even IV sedation for a completely comfortable experience. It takes about 90 minutes to perform. The amount of vermilion advancement is determined by the patient prior to the numbing by making marks using calipers and a fine marking pen…and then having the patient approve the amount of lip increase with a mirror. There is some mild lip swelling afterwards and very minimal discomfort. Patients generally do not take any pain medication afterwards. For patients that are geographically close to me, I place tiny 7-0 size sutures that are removed 10 days after surgery. For my far away patients, I use a fine 6-0 dissolveable sutures and skin glue so no return is necessary for suture removal. 

For the properly selected patient, lip advancements are a powerful lip enlargement procedure that produces a permanent result.

The total costs of the procedure are around $ 3,500.

Dr. Barry Eppley

Indianapolis, Indiana

Can My Lip Lift Result Be Improved?

Q:  I had a lip lift performed several months ago. I have attached some before and after pictures. As you can see the incision isn’t on the borderline and its now indented and puckers. I’m really so unhappy and paranoid with the scar and am now so desperate for revision. I was so impressed with your website you actually used 48 stutures on the womens top lip,  I did count :-)  In my surgery the surgeon only used 8 stiches.  as you can see in the pics. In you lip lift proceedure do you actually cut right through all the skin lares? Only when I had my lip lift surgery the surgeon did numb my upper lip with a dental block, but the pain was still horrendous.  Also as I wasn’t having my bottom lip operated on it wasn’t numbed, therefore I actually felt my actual top lip resting (flipped over) onto my bottom lip.  Is this normal procedure to actually sever top lip so completely that it is able to flap over like that? What I’m asking really is do you cut so deep and if so do you place internal stiching of any kind? Its all a bit complex for me but I really need to know the whole procedure. Thank you in advance and looking forward to your reply.

A: Thank you for sending your pictures. Technically, what you had done is known as a lip advancement or vermilion advancement. A true lip lift is done with an incision under the nose. I prpare patients with a dental block first and then inject directly into the upper lip once one is numb. It should be a virtually painless procedure to go through after the dental blocks and local infiltration. During the procedure, only full-thickness skin is removed and no underlying muscle. There is a two -layer closure with some deeper sutures for the dermis and fine sutures for the skin closure.

Your scar is a bit wide and indented compared to a typical result lip advancement result in my experience. That could easily be improved and a little more skin removed and more of a cupid’s bow made to get a better result.

Dr. Barry Eppley

Indianapolis Indiana