Q: Dr. Eppley, I am interested in lip reconstruction. Attached are photos of my lips. Two years ago, I had a vermillion lip advancement. However, the surgeon did a v/y to the central portion of my upper lip…something that was never discussed beforehand. I’m left with no cupid’s bow and no philtrum. My lower lip hangs down and there are ‘pouches’ just below the lower lip. What can you do to make my mouth look better, and most of important, what can be done to lift my lower lip so that my teeth don’t show and those pouches diminished. Thank you so much in advance.
A: Thank you for sending your lip pictures. Lip reconstruction efforts can be done on both the upper and lower lips. Certainly the upper lip vermilion advancement can be improved because that is straightforward redesign of the shape of the upper lip and advancing the vermilion edges according to the new pattern cut out. This is very predictable and will make a positive improvement. Raising the lower lip, however, is considerably more challenging, not easy, and very unpredictable. Regardless of the dubious success of raising the lower lip, the pooches that lie below and beyond the vermilion of the lower lip can not be improved. Techniques to try and raise the lower lip usually require a sling or suspension of tissue placed across the lower lip from one mouth corner to the other. (technically from a small incision at the end of each nasolabial fold crease to the sling can be threaded through) This sling could be comprised of your own tissue (abdominal fascia) or an allogeneic (cadaveric) sling of dermis can be used. (e.g., Alloderm)
Dr. Barry Eppley