Your Questions
Your Questions
Q: Dr. Eppley, this is a question regarding the lip line, particularly the tubercle area. I have an uneven “dip”; the left side has almost a cusp while the right side is much smoother. Other then that, I have full, almost Taylor Swift Lips (except for the left side unevenness), lips. Is there any particular recommendations to make both sides ~symmetrical, particularly the left which the problematic (visual) area? Thank you.
A: What you are referring to is a higher/sharper cupid’s bow on the left side. The goal then would be to lower the higher side to make it match the smoother and lower right side. That can be done through a small excision of the arc of the cupid’s bow done under local anesthesia, just like a miniature reverse lip lift. That would be very effective at lower and ‘desharpening’ the higher cupid’s bow but at the price of a small price of a small scar along the vermilion-cutaneous junction. Whether that would be a good trade-off would depend on the degree of upper lip asymmetry that you have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I recently (3 weeks ago) had a lip lift which I am very unhappy with. I have attached the before and after pictures. What I expected with the lip lift was to have more lips all through out the upper lip, not only in the middle where the cupid bow is (looks like a chipmunk). At the same time I wanted to reduce the length between the lips and the nose. I always had thin lips and always wanted more fuller lips , upper and lower lip with shorter distance between the lip and nose. With the lip lift , I thought the lip would of been less thin on top and would of done fat transfer to have some fullness afterward.
A: Thank you for sending me your before and after photographs. There must have been a miscommunication before surgery because your lip lift did exactly what it is supposed to do and can do…lift up the central third of the upper lip. It can not change the whole upper lip vermilion as the skin is only removed from the central third at the nasal base. The only lip enhancement procedure that can change the entire lip vermilion is a lip advancement where skin is removed alone the vermilion-skin junction from one corner to the other. That is a tremendously effective procedure but does produce a very fine line scar along the vermilion-cutaneous. That is why a lip lift is usually chosen for men although there is nothing inherently wrong with a lip advancement for men either.
You actually have a good early lip lift result. But although the operation may have been done appropriately, it may not have been the right operation for you as it turns out.
Lip lifts are irreversible, meaning you can’t put back the subnasal skin that has been removed. Your options at this point are the following:
1) Give the lip lift a few months to settle and relax because they all stretch out often up to 25% or more over time. Then decide what to do.
2) Jump in early and do lateral upper lip vermilion advancements (leave the cupid’s bow alone obviously) to make the lip vermilion more even and lifted across the lip. You can do fat injections at the same time but you may not need to do so with lip advancements.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I researched and read many articles and visited many websites before I had my Bullhorn procedure performed. Unfortunately, I don’t believe my plastic surgeon had much experience with the procedure. At first he removed an eliptical piece of skin inside the nostril (“italian lip lift”) which did nothing to decrease the distance nor pout the lip. (my mouth is tiny, lips were thin and philtrum long) Next about 5 months later, he did the bullhorn… he did not ever carefully review my anatomy, measure any important distances, nor did he take enough tissue… again, no improvement. Then, 4 months later (late August 2012) he performed the Bullhorn again and I had to inform him that the normal distance between the base and vermillion should be 5-7mm.. my result: right side of my lip droops… on the left the sutures were placed within the nostril, on the left they were not. also, i do not know what he did with the muscle.. I’ll have to get my op report. I know stiffness is expected, but what I don’t know is if I can smile at all. When I do, my smile seems to be distorted a bit.. but I know it’s early. I feel stitches deep and I don’t want to pull them. I would appreciate your feedback, I think I need a second post op opinion, but most doctors don’t want to become involved especially so soon after surgery. However, I am concerned because I also had a facelift with this doctor and I believe it was overcorrected.. can’t move my upper cheeks and have constant swelling and pain around my eyes. Very weird, almost like I can not squint!
A: It is hard to make much of a usual comment when I don’t have pictures to review. Nor do I know exactly what was done during your last procedure in which the more conventional lip lift or bullhorn procedure was performed. The aesthetic result would not be my main concern right now, I would be more focused on the lip tightness and the difficulty with smiling. These are not usual postoperative findings even in the early stage. I have seen too many upper lip lifts where deep sutures were placed into the muscle or even down at the bone level…which is a mistake and should be corrected early before too much scar tissue forms.
Dr. Barry Eppley
Indianapolis, Indiana