Labiomental Sulcus Surgery

Q: Dr. Eppley, I was wondering what aesthetic procedures can be done to push the lower lip forward slightly and improve the aesthetics of the labiomental sulcus? I was reading one of your case studies where a man got implants put in in his upper lip, lower lip and labiomental fold. So I was wondering whether a Permalip implant could be placed in the lower lip to give it some more horizontal projection? My lower lip is slightly setback compared to the upper but its not very significant; if this is possible what is the maximum amount of horizontal projection that can be achieved? I only need around 4mm at most. That said I have a very slight overbite where my upper teeth cover around 85% of my lower when biting down. Do you think orthodontics to correct my bite, combined with a Permalip implant could do the trick for a lower lip that is set back roughly 5mm and the above circumstances are taken into account? If I jut my lower jaw forward to the optimal bite position), my lips line up roughly accurately. But I don’t want to go through with lower jaw surgery for such a minor discrepancy. 

Also, my concern is that if I push the lower lip forward, my labiomental sulcus and chin will look too set back in comparison. The chin is fine as I am happy to get an implant placed there. More importantly, I am concerned about how the labiomental groove will appear in two ways. First, the chin advancement will make the groove look more set back. Second, if you think about it on a profile view, the lower lip advancement will pull the tissue forward and make the angle between the border of the lower lip and the middle of the sulcus more acute. My sulcus isn’t very deep, but I would like to have an implant placed there and possibly fillers or fat grafting over the top at the same time. If a custom implant is used can the labiomental augmentation be almost unlimited? 

As a side question, is it possible to give the illusion of a higher or more vertically short labiomental sulcus by strategic augmentation in the lower part of the sulcus, or through any other techniques?

A: In answer to your labiomental sulcus surgery questions, let me first make the following general statements:

  1. The true position of the lower lip is controlled by the position of the teeth. Thus the single most effective method of increasing the horizontal position of the lower lip is by lower jaw advancement. Understandable that is a lot of effort to obtain that relatively small amount of aesthetic change.
  2. Manipulation of the labiomental sulcus is not easily done and any such manuevers do not always produce predictable outcomes. It is a tight tissue area which has limited potential for change in its depth. This is a fixed tissue area for which there is a reason that an indentation exists there.

In answer to your specific labiomental sulcus surgery questions:

  1. A Permalip implant provide some horizontal increase in the lower lip but probably not as  much as 4mms.
  2. I would find it hard to imagine that even a 4mm horizontal lower lip increase would make either the labiomental sulcus and particularly the chin look recessive.
  3. You are overestimating/over thinking the effect of the lower lip on the labiomental sulcus. The effects just aren’t that simple or as profound as you are believing them to be.
  4. You can not change the vertical height of the labiomental sulcus.

Dr. Barry Eppley

Indianapolis, Indiana