Your Questions

Q: Dr. Eppley, I am interested in lip reduction surgery. My goal is to reduce to size of my lips by about 30% or a bit more. As you can see from the photos, my lower lip hangs and my upper lip goes out far. I would very much like a more even reduced lip look.

A: Thank you for sending your lip pictures. The typical reduction amount achieved in most lip reductions is in the 20% to 25% range. Sometimes it may be as much as 30% to 35%. But it is always best to think of lip reduction surgery as possibly consisting of two stages to get the ideal lip size reduction result or the best scar outcome. This is more true in very large lip reductions that I have done in many African Americans. The goal is to achieve the maximal lip reduction in one surgery but there are limits as to how much lip tissue can be removed and get the wounds closed in a single surgical event. Thus it may be necessary to ‘walk’ the lip edge backwards through two operations. One should separate the two lip reduction surgeries, if needed, by at least 3 months.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am jnterested in lip reduction surgery. I was having problems snoring, went to sleep doctor, dx’d with sleep apnea. He offered CPAP but said corrective jaw surgery would also fix my problem. I went to oral surgeon and will be later this year having both jaws moved forward about 7mm to fix my sleep apnea. 

I am interested in an upper lip reduction (we can discuss at the appointment, no problem). My only question is do you recommend I wait until after the jaws are moved forward or can it be done before the jaw surgery? Thanks a lot.

A: Because orthognathic surgery, particularly two jaw advancements will have some lip thinning effect, any consideration of lip reduction should be 3 to 6 months after the procedure. It may well be possible that after orthognathic surgery with the jaws advanced you may no longer see the need to have the lips made smaller. Between the thinning effect on the lips from the jaw advancements and the scar tissue created, it is likely that there will be less vermilion show particularly of the upper lip. As the jaw moves forward it does push the lip forward causing some potential rolling in effect of the lip vermilion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Can you do lip reduction surgery for me?? I suffer from neurofibromatosis which makes me produce a significant amount of tumors and makes my face look abnormal. I had a botched surgery when I was 9 to remove a tumor on my top lip. When I became of age i tried (with no luck) to find the surgeon responsible for leaving me with the lips I have now. He removed a tumor from my top lip but never restored a natural shape to them. They are huge uneven and unsightly. They make it hard to form words and I have no ability to form a proper smile. I am at a lost. I’m sorry if this is a long explanation, but no one has been able to help me. I just want to know is it possible to reshape and make my lips fit my face.My surgeon didn’t do a very good job of removing the whole tumor because it slightly grew back. You can see where it tried to come back thus giving me a protruding top lip and explanation of how it affects everything else. The surgery I seek isn’t listed but from what I mentioned its yet another tumor removal with hopes of restoration of lip shape.

A: Neurofibromatosis of the face is a very difficult problem for which there is no real cure. Surgical efforts attempts to remove any neurofibroma tumors and restore as much shape to facial structures as possible. But it is not easy and certainly restoring any type of shape or function to a delicate facial structure like the lips is challenging. For whatever result your lips now have I would not fault the original surgeon. He took on a difficult challenge for which there is really no ideal result. Having operated on many neurofibromatosis patients I can testify to the challenge. Neurofibroma tumors recur or grow new ones and surgery causes considerable scar tissue. This combination leaves the delicate and sensitive lip structure as bound to have some degree of residual deformity.

Hopefully further improvement is possible for lip reduction surgery. I would need to see pictures of your lips to see what possibly may be done now.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley,  I would like to discuss lip aesthetics. I have noticed that in certain people, their lips in the relaxed, open mouth position, there is a nice exposure of the upper teeth. I would say that this is an attractive trait. 

I would like to posses this feature, but unfortunately, I don’t. When I relax my lips and hang them open slightly, I only feel the my bottom lip hangs and only the bottom row of my teeth show. My upper row teeth do not make an appearance because my upper lip doesn’t move when relaxed. Photos attached,

I have fairly thick lips for a male, so I am looking at getting lip reduction. My question is how to achieve that ‘upper teeth open mouth’ look? Would a lip lift help?

Is there a specific name for this look that I can Google?

A: The procedure yo are seeking does not have a specific name because it is a combination of two well known procedures to try and create the effect you are after. What you need is a combination of a sub nasal lip lift with an upper lip smile line reduction. The lip lift will raise up the central part of the upper lip. (ratio of about 4 :1, meaning for 4mm of skin removed under the nose it will move the smile line level of the upper lip 1mm) Then a horizontal reduction of the vermilion-cutaneous junction of the upper lip of about 4 to 5mms will help raise up the bottom of the upper lip. Together you should be able to develop some natural upper tooth show. The lower lip will, of course, need to be reduced by about 7 to 8mms to match better with the upper lip.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am unhappy with my nose and I have been considering rhinoplasty for a while as well as jaw augmentation. For my nose, my first main concern is that I don’t like the bulbous tip it has. I’d like the tip to look pointier and to project a bit more. Second, I think my nose is too wide. I would like my nostrils to be narrower from the front view. I have attached a few photos of my face, as well as a couple models whose noses I like.

For the jaw, I have been considering some combination of chin and especially jaw angle implants. Perhaps even sliding genioplasty, the latter I understand is the only way to add vertical chin height. I basically want to create a stronger looking profile that balances my face.

I also have a few secondary procedures I am considering but not sure about. A reduction of my lower lip reduction (I think it is too big compared to the upper, and might make my chin appear larger if it were reduced). And also forehead augmentation (to reduce the appearance of my sloping forehead/prominent brow bone)

I am trying to figure out which procedure/s would produce be the best result in my case.Would it even be possible to do all of them at once?

A: Briefly, all the facial procedures you have discussed can be done as the same time and it would not be rare in my experience to do so. But first we must go through each procedure and determine what is the best approach for each change and how much change you desire for each area. Options in rhinoplasty and jawline enhancement are best done through initial computer imaging. I will do some computer imaging using your pictures of these changes and this will be a good starting point for our treatment planning discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, Do you take out the inner or outer layer of the lip? How noticeable is it after the procedure? Will people know I had surgery done? Will my lips look bigger then before the procedure for a few weeks? Can lip reduction change the look of my smile? Will I show more teeth when I smile? I’m concerned that when I have a big smile it will show too much of my gums at the top of my teeth. I would like to keep my smile the same. Is this possible?

A: You are asking a lot of good questions about lip reduction. The success of any lip reduction procedure is based on removal of the vermilion portion of the lip, what you probably mean when you say the ‘outer layer’. One incision is made at the wet-dry junction (mucosa-vermilion border of the lip) and the actual reduction comes from what is removed in front of it. (dry vermilion) One should expect fairly significant swelling to appear within the first two days after surgery and not look more normal again for up to ten days after surgery. As long as a lip reduction is not overdone (too much tissue removed), it should not adversely affect one’s smile. Certainly it is not at risk for causing too much gum exposure when smiling.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am of African descent and I want to improve the shape of my nose and make my lips smaller. Sadly in my attempt to reduce the size of my upper lip and nose I ended up with a crooked nose and lips. The worst part being that my lips remained just about the same size. 

A: My assumption, based on your pictures, is that an implant was placed in your nose since that is about the only thing that can make the nose deviate like that after a rhinoplasty. When trying to improve a nose shape like yours (originally), the fundamental principle is one of a strong columellar strut to support the tip and a good dorsal augmentation. While an implant can be used for the dorsal augmentation, it should never be used for the tip-columellar support as it has a high propensity to deviate…just like yours has done. (not to mention placing the skin over the tip of the nose at jeopardy for vascular compromise) You need a good cartilage graft for support for your revision rhinoplasty and this almost always requires a piece of rib to do so. The implant may be able to be salvaged and used, but once you need a rib graft for the columella you might as well abandon the implant and go with a completely natural graft approach. There are other additive techniques that can be done, such as nostril narrowing, but the dorso-columellar buildup (augmentation) is the key.

From a lip reduction standpoint, if the tissue removal amount and location is not just right, a minimal result is seen and scar contracture can result in the lip. Since you already have a linear contracted lip scar, that would serve as the posterior (inner) incision location with a more aggressive excision done out on the anterior (outer) vermilion. It is the vermilion which needs to be reduced if any size reduction is to be obtained.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had a lip reduction six months ago which, quite frankly, did very little. It may have resulted in a 10% reduction of my lip size. I am now considering further lip reduction surgery for better results but have a few questions.

1) I’m looking for very specific results so I need to be sure you are confident in your ability to perform a reduction of at least 1/2 of the size on each lip? I want results that are very significant and not subtle.

2) I would also like to reduce the bulkiness of each lip, in other words, less meaty.

3) In the technique you do will the scars be visible? What can I expect after everything is healed? Will there be any noticeable scars on the visible/dry part of my lips?

4) Will there be 2 scars, one from the prior surgery and one from this one, or can you remove the tissue from where the old scar is?

A:  In answer to your lip reduction questions:

1) Significant reduction can be obtained but there is a balance between reduction and the location of the scar. The only way to get significant lip reduction is to remove the DRY exposed vermilion not the wet invisible mucosa like you had the last time.

2) You really can reduce the thickness or meatiness of the lip per se. Right underneath the vermilion lies the labial artery which gives the blood supply to the lip as well as the orbicularis muscle which is responsible for some of its movement. Thus you can see that trying to debunk the lip by a deeper wedge excision is fraught with potential problems. All you can do is remove the surface vermilion to have less visible show but really thinning out the thickness of the lips is not surgically advised.

3) as per #1. The key point is…the bigger the reduction the more likely the scar may be visible.

4) The old scar would be removed with the new excision.

Dr. Barry Eppley

Indianapolis, Indiana

 Q: Dr. Eppley, when it comes to lip reduction surgery I have one question for you that I have been thinking about lately. As you written previously with a lip reduction the dry vermilion on the lip is what is removed but how does this affect the lip’s functionality? Currently because the dry vermilion bothers me so much I peel it off as it begins to flake and after peeling it off it grows back hours late in a continuous cycle. Now if the dry vermilion is removed does that mean skin will never grow back in that area? And if this is the case what is left on the top lip in the area in which the dry vermilion has been removed?

A: In a lip reduction procedure, whether it is for size reduction or for the treatment of chronic dry/chapped lips, a portion of the dry vermilion is removed in front of the wet-dry line. The dry vermilion removed is ‘replaced’ by the wet mucosa which advances forward from the inside of the lip. The wet mucosa is very soft and supple and thus its replacement of a portion of the dry vermilion poses no functional limitations to the lip.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My upper lip is big and hangs over my teeth. i am looking for a lip lift. I am in my mid 50s Am I good candidate for it. Will my upper lip look bigger or the same.

A: An upper lip lift, presumably through a subnasal incision location, would produce only a minimal amount of lip lift as it relates to improving tooth exposure. It would make the central part of the upper lip look bigger. If you are happy with the current size of your upper lip, a subnasal lip lift would not be the appropriate procedure. If you do not mind more vermilion upper lip enlargement, then it would be a reasonable procedure to do. But it may take a concurrent lip tuck-up done from the inside the lip as well to get the desired amount of improved tooth show.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I  am sending you pictures of my face and how I want to look like at the end of surgery. The first 3 is me, the last 2 is how I want to look like.  I believe we will need a nose job, mouth reduction, and some facial bones work. 

A: Thank you for sending your pictures and demonstrating your objectives. First, let me make some general statements about your facial enhancement objectives. If your goal is to look very close to the pictures you have shown, that is not a realistic goal. Besides some similarities in skin color (actually his skin is much lighter than yours) he has a completely different facial bone structure and soft tissue makeup. Your facial structures are radically different. Thus there is no way with any surgical procedures that you are going to look remotely like him. It is simply not possible. You can not be made to look like someone else. You can be a better facially balanced and proportioned you but you can not be him. While I understand why his face and those objectives are appealing, you will have to focus on what you do within the limits of change in your own face.

What I see on your face that can be improved is the following.

1) Your facial bone structure is known as bimaxillary protrusion where the jaws and the teeth stick out. That can not be changed but your chin is comparatively very short. A sliding genioplasty to move the chin forward would improve your facial proportions.

2) Your nose is very classic being low and broad. Building up the nose with a rib graft rhinoplasty and narrowing the nose will create more of a narrow and slimmer looking nose. Your thick nasal skin prevents your nose from ever being very refined but this will help.

3) You have a tremendous amount of lip tissue, particularly in the size of the exposed vermilion. (pink tissue) An upper and lower lip reduction will help although there is a limit as to how much lip reduction can be achieved.

I have done some imaging which is attached so you can see how these proposed changes may help in a realistic facial enhancement effort.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, my question is actually regarding lip reduction. Two years ago I had silicone injected into my top and bottom lips. One year ago I had a lip reduction procedure performed. Since last march I have been receiving steroid and 5-FU injections into my lips to help calm the swelling. Now my doctor is telling me I need another lip reduction. My problem is that the first surgery was botched. After reading your website about where lip reduction incisions should be placed (inside vermilion cutaneous border) I realized that my surgery placed my incisions about 1/4 inch away from this location. My incisions were made in the mucosa region roughly halfway between the nose and the vermilion ridge on the top lip and just above the labiomental groove on my bottom lip.  Now the entire cutaneous region surrounding the pink part of my lips protrudes and is swollen from these ill placed incisions. My surgeon believes the the swelling is due to residual silicone left in my lips from the first surgery. I know there is silicone left in there because I can feel it. However, I don’t believe that is what is causing the distortion. My question to you is what do I do now? 

A: While this is water over the dam now so to speak, your situation illustrates the problem with permanent injectable materials particularly in the lips. Once in there there is virtually no way to get it out in any completely satisfactory manner. Lip reduction will remove part of it through direct excision but a fair quantity will still remain in lip areas not amenable to the excision. While your lip reduction incisions may have been placed a little too far inward on the musosal surface, I would not consider this botched surgery. That is just not the most effective position to place them for maximal lip reduction. As to what to do now? I would give yourself a good year from the lip reduction and see how things are then. This will give the maximum amount of time for swelling to go down and the scars to soften. Whether another attempt at lip reduction is worthy will be more apparent then.

Q: Dr. Eppley,  I would like to have the following done for ssome facial changes:

1) upper lip lift to reduce the distance between the base of my nose and upper lip (lip to nose ratio reduction by more than half my current natural lip to nose ratio) I am a fan of the lip to nose ratio as typically seen in women even on men as well.

2)  I would like also a  reduction in the bottom lip to the size of my top lip

3)  I would like profile surgery, in specific mouth protrusion surgery to westernise the protrusion of my mouth which as you know is commonly seen in Asian and african americans.  I understand there are implants and other methods used to achieve a western profile.

4)I would like a medium chin implant to improve my profile, more projection towards the bottom, when carving the shape of such implant, please note the design of my beard which I purposefully shape especially toward the bottom to almost mimic or complement the shape of my cupids bow along the border of my top lip.  We can obviously discuss this more in detail if there are any misunderstandings as to the shape chin I am going for.  You can best describe such shape as masculine and very edgy.

5) I would like an implant to give more height to my nasal bridge, with a tip that more length and projection without making the nose appear from the frontal view to be more bulky and thicker than its current state.

6) Finally a resection or crescent-shaped or wedge alar flare reduction to address nostril flare.  We can discuss what options would be best, maybe an alar suture cinch procedure or wedge resection.   

7) Remove fat underneath chin area.

8) Please use computer imaging for what potentially can be done as a valuable tool for us to communicate. 

A: Thank you for your inquiry and sending your pictures. Let me respond to your 8 issues/concerns as follows:

1) A subnasal lip lift can reduce the distance between the upper lip and the base of the nose, but not by half. That is too much and would create a very unusual looking upper lip. As a general rule, I reduce it either by 1/4 or up to 1/3 the vertical distance as measured along the philtral columns. This provides reduction but keeps a more natural look without the upper lip looking like a snarl.

2) The lower lip can be reduced by an internal horizontal wedge excision at the wet-dry vermilion line. Most lip reductions can reduce their size by about 1/3.

3) I am not absolutely sure what you mean by ‘westernized mouth protrusion surgery’ but I think you may mean paranasal base augmentation to help improve the concave profile around the base of the nose and the upper lip.

4) Your chin is horizontally deficient and an improved shape could be obtained by a chin implant that provides 7 -9mm increased projection and a more square shape.

5) A rhinoplasty using an implant for dorsal (bridge) augmentation as well as a columellar extension would help improve the nasal height and tip projection. This can also be done with a rib graft and their are arguments for both approaches (implant vs graft) based on their advantages and disadvantages.

6) Without question, the alar wedge resection for nostril narrowing is far superior to that of the alar cinch suture.

7) Submental liposuction for fat removal with the chin implant would be a good benefit.

8)I have attached some realistic imaging to give you an idea of what may be able to be achieved with these procedures.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am looking to improve the appearance of my lips, acne scars, and face contouring. I have very large lips and the upper lip is very full and bigger than the lower one, it gives me a duck lip appearance. The upper lip rests above the lower lip instead if the other way around. What would be the best thing to do about that? I have also attempted to loose weight to slim the face yet there is much fat around the lip area and the cheek bone area which does not go well with the full cheeks. I am attempting to achieve a slim-defined male model type of face as well as diminish the appearance of my acne marks. Somehow my facial features don’t mix well with one another. I believe my face is feminine in a way, is there a way to give it a more masculine look?

A: While many people want to achieve an upper lip size that matches the  lower one, you have an opposite concern. The upper lip can be reduced by an internal vermilion reduction to reduce its size and roll back the pout of the upper lip. That leaves any scar on the inside of the upper lip.

From a face standpoint, I don’t see large buccal fat pads to remove but I could see some benefit by perioral liposuction to reduce the perioral mounds out to the side of the lips. While you did not provide a side profile view, chin augmentation with more width and horizontal projection may be more masculinizing for you. But I would need to see some additional photos to be sure that is of benefit.

Acne scars can be improved by fractional laser resurfacing but it is important first to have the acne eruptions under control. With laser resurfacing the ointments needed afterwards as it heals can cause a lot of pore obstruction and an onset of new eruptions.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had silicone placed in my upper lip and now I want it reduced a little. Is this possible? I have attached a picture of my lips.

A: Thank you for sending your pictures. I am assuming that your are referring to silicone oil droplets for your lip augmentation as opposed to silicone formed cylinder implants. Silicone oil droplets can not be easily removed from the lip tissues (without a lot of tissue destruction) because they are spread out in many small droplets through the lip tissues. This is the same whether it is in the lips or anywhere else in the body. Depending upon the lip problem (size vs lumps or granulomas), the treatment would be different. Lip size concerns is best dealt with by a lip reduction procedure based on some vermilion excision at the wet-dry line. Lumps or granulomas have to be treated by individual excision or drainage based on where they are located. I am assuming that your lip concerns are that of size.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I read your very interesting article about lip lifts. I was wondering if it would be possible to do the same but on the inner side of the lip? My upper lip is quite thick and juts out a bit. The outward rotation and protrusion of the lip which he conventional procedure causes would not be a good thing for me. Would that be possible?

A: A subnasal lip lift is designed to shorten the skin distance between the base of the nose and the lip vermilion and lift the central portion of the upper lip giving it more of a pout. Doing the reverse, or the procedure on the inside of the lip, has another name known as a lip reduction.

In a lip reduction, a wedge of mucosa is taken internally to derotate the lip and give it less of a pout or fullness. Unlike the lip lift which is done high on the outer lip, a lip reduction is done closer to the vermilion or low on the inside of the upper lip. This is because the outer skin is different than the inner mucosa. Mucosa is more loose and stretches more than skin. Therefore, doing the resection way away from the lip margin in a lip reduction would cause no change in the visible lip shape.

Basically, you are talking about a lip reduction procedure which is well known, successful, and fairly easy to do.

Dr. Barry Eppley

Indianapolis Indiana

Q: Does Dr. Eppley have experience with lip reduction procedures (making lips smaller instead of fuller? How is the surgery done and how successful is it?

A: The number of requests for lip augmentations exceeds the number for lip reductions by about 1000:1. Every request that I have ever had for a lip reduction is almost always in an ethnic patient, most commonly African-Americans although not exclusively so. I usually perform about six or eight cosmetic lip reductions per year, if you are counting lips and not patients. Lip reduction is done by removing a wedge of lip tissue at the junction of what is known as the wet-dry vermilion. This is a very distinct line of demarcation between your dry vermilion (pink part of the lip that is seen on the outside) and where the wet mucosa begins on the inside of your lip. That area is easy to see when you roll your lip outward. The dry vs wet part of the lip is quote obvious. This is where the incision line is placed most of the time. The actual part of the lip that is reduced is the dry vermilion. Usually about 5 to 7mms is removed in the central area of the lip and then it tapers outward towards the corner of the mouth. (commissure) The lip is then rolled back and closed so that the visible part is reduced and the scar remains behind in a more inconspicuous area. The key in lip reduction is not to overdo it or remove too much. There is no way to put back lip tissue. One can always remove more later if quite not enough has been removed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in having lip reduction surgery some time in the near future. However, there is not much detailed information or before and after pictures regarding the procedure. Is it possible to enhance or alter the look of the cupid’s bow while simultaneously reducing the size of the upper and lower lips?

A: Lip reduction is far less common than its cousin lip augmentation. I would estimate that for every 1,000 lip augmentations done by any method, one lip reduction is done. Much like breast augmentation, lip enhancement is more glamorous than going the opposite direction. As a result, much less is written about it and very few pictoral results are available to be viewed. This does not mean that it is not done very successfully, just that the requests for it are very few.

Lip reductions are exclusively done from incisions further inside the lip. While it could be done by an incision at the junction of the lip skin (vermilion) and the facial skin, this would leave a visible scar. In addition, rolling the lip tissues outward  towards the incision, even while removing lip tissue, works against the objective of trying to show less lip. By removing excess lip tissue by an incision at the junction of the wet-dry line (vermilion-mucosal junction) just inside the visible lip rolls the lip inward helping to reduce its show.

By the way lip reductions are done, the cupid’s bow on the upper lip is not changed. While it could be changed through direct excision and flattening of the bow, this would again leave a small but visible scar at the central portion of the upper lip.  

Dr. Barry Eppley

Indianapolis, Indiana