Should An Upper Lip Lift Or A LeFort Osteotomy Be Done First?
Q: Dr. Eppley, I am 21 years old. In March I have planned some maxillofacial surgeries. Currently I have a chin implant large anatomical. I have a problem in my maxillary prognathism which is vertically long. A maxillofacial doctor also diagnosed me with micrognathia. I have no problems with my bite. My upper jaw is too long like my upper lip. Then I realized I needed an upper lip lift and a Lefort 1 osteotomy. The only plastic surgeon I have seen thinks I need a upper lip lift (remove 6-7 mm) but the problem is that I have a gummy smile. My question is what is best to do first? And how long should I wait to do them?
A: With a vertically long maxilla and an overlying long upper lip, it is an interesting question as to which one should be done first. If I make the assumption that you really need both bone and soft tissue shortenings, whichever one is done first will leave you with an increased aesthetic deformity before the second stage correction. In these situations, it is always best to do the underlying foundational change first. Because the bone surgery is more involved and may change what is eventually done in the amount of upper lip lifting, the LeFort impaction procedure should be done first. Once the bone level is set then the upper lip lift can be done based on the position of the lip to the maxillary anterior teeth. Also dependent upon how long your upper lip is and how much vertical maxillary shortening is needed, it is also possible to both together…but using only a conservative upper lip reduction as more can be done later if needed.
Dr. Barry Eppley