Q: Dr. Eppley, My question is about the limits of a lip lift and the use of one in a postoperative Lefort patient. In most of the pictures I’ve seen it looks like a surgery that merely helps make the vermilion more visible but it doesn’t really “lift” the lip if it’s really hanging. I received orthognathic surgery years ago to make my face shorter and since then my upper lip has been hanging lower than usual. It also looks flat and dead instead of curled up and reactive to facial tension. I was wondering if a lip lift could help in this case and if one with muscle hemming (a technique that I rarely see talked about) would be a better option. Thanks.
A: Your correct in that a subnasal lip lift primarily exposes more vermilion (and reduces the skin distance between the nose and the lip) bit does not lift the bottom edge of the lip vermilion any higher. A subnasal lip lift is largely a static procedure not a dynamic one. Many upper lips after an intraoral vestibular incision used for a LeFort 1 procedure become somewhat less animated due to the stripping of the collateral muscle attachments. I can’t see, however, how a muscle hemming procedure of a subnasal lip lift would improve that problem. It would likely cause other adverse effects on upper lip movement and smiling which is why it is not written about much and is largely shunned today.
If you want to raise the upper lip with a subnasal lip lift it should be combined with a horizontal horizontal mucosal resection on the inside of the lip.
Dr. Barry Eppley