Lower Lip Sag

Q: Dr. Eppley, I had a question regarding surgery on lower lip sag. I show a lot of teeth (all my lower teeth) when I smile or talk. I have had a few genioplasties which I worry may have caused it to be like this. Also had braces before which may have more my teeth up. Is there any way to fix this? Like a lower lip suspension? I don’t know if it is scar tissue or what it is. I already have full lips so filler would not be very beneficial. Also I am a guy so I don’t want filler to thicken my lower lip. I don’t know what to do but I am so self conscious about this. Do you think the previous scar tissue needs to be removed from the chin area and resutured with more skin lax above the suture so the lips can spring back up ? Is that even possible? I have heard Botox doesn’t really do much to the lower lip and only moves upper lip down which I don’t want to do as I don’t want a long upper lip. Hope you can help.

A: Correction of a lower lip sag is a very difficult problem and often unrewarding surgical effort. The traditional approach to treating it would be a resuspension of the mentalis muscle through an intraoral approach. Althugh having done this many times, it is unsuccessful more than it is successful. It works best when it is combined with chin augmentation or a sliding genioplasty since it adds to the upward soft tissue support.

In reality the lower lip sag is more of a soft tissue defect than one of malposition when it comes to surgical correction. From that perspective, grafting the vestibule with a dermal-fat graft along with the muscle suspension makes the more sense.

Dr. Barry Eppley

Indianapolis, Indiana