Can A Rhinoplasty And Subnasal Lip Lift Be Done At The Same Time?
Q: I am interested in getting my nose fixed and have my upper lip shortened at the same time. I have been some research on lip lifts and it seems wonderful and the results are exactly what I want. But you have written that a rhinoplasty can not be done at the same time. That bothers me because I did not want to recover twice. But I have been doing some searching and som,e doctors do both at the same time but some don’t. Is there a possible reason/ I really want to have my surgery with you because you have the best before and after pictures I’ve ever seen for noses that are similar to mine.
A: The reason that I don’t combine an open rhinoplasty and a subnasal lip lift is because of the potential risk of skin necrosis. When done together, there will remain a small area of columellar skin between the two incisions, that of the open rhinoplasty and about 6 to 8mms below that of the subnasal lip lift. The survival of that skin depends on having an adequate blood supply coming into it. Part, and may be most, of the blood supply to that skin is cut off by making those two incisions at the same time. While it is likely that it would be fine with some blood supply coming from the septal mucosa, there is some risk that it might not be and that skin would then die. That would be a cosmetic disaster and my concern is more then theroetical…I have taken care of a patient who had that exactly happen when those two procedures were done together by another surgeon. Given that the lip lift can be done as a simple office procedure later under local anesthesia with very little recovery, I don’t think the risk is worth it for an elective cosmetic operation.
If one was doing a closed rhinoplasty, in which a columellar incision is not used, then a subnasal lip lift could be done at the same time. It is likely that is the type of rhinoplasty the doctors who say they do it at the same time are performing.
Dr. Barry Eppley