Q: Dr. Eppley, I have an active depressor septi muscle in a way my upper lip is very shortened during smiling. this muscle has been partially cut during a nose job and it was perfect, but after a few months it has reattached.
Therefore, i would like a permanent outcome… a complete cutting of the muscle. Can you do the incision from inside the mouth? Can you explain to me please the process of the surgery?
A: Since the depressor septi muscle can not grow back or reattach itself after surgery, the temporary improvement you saw was due to swelling and temporary muscle inactivity from the rhinoplasty surgery. Once the muscle recovered from the surrounding surgery, it recovered to full motion like that prior to the nasal procedure.
The depressor septi muscle can be cut from inside the nose or from inside the mouth. I find the intraoral approach to be the most assured at getting a complete release of the muscle. This also allows the best view of the muscle from its origin at the incisive fossa of the maxilla to its insertion on the nasal septum. By electrocautery the muscle can be visualized and released in a controlled fashion.
Dr. Barry Eppley