Your Questions
Your Questions
Q: Dr. Eppley, I am interested in a lip scar revision. I am a 26 year old female. My lips were very thin and I had gull wing lift operation on my upper lip in November 2013. The result was terrible with many scars on upper lift. I have waited for recovery over 1 year and the situation did not change. I subsequently had two laser resurfacing treatments and a revision to reduce vermilion height with inner stitching. As you can see in my most recent photo, my lips do not look natural and that disturbs me very much even with make up. I want to have better lips and return to my daily life.
Now my doctor offers another operation this month to reshape the whole vermillion border of my upper lift. He will cut my skin in order to discard distorted surface and he will move down the top layer of the skin in order to elongate the skin layer until the pink line to shape the border.Could you please tell me whether it is possible to stretch the top layer of the skin to stretch down to the vermilion? Any kind of information will be very helpful, looking forward to hearing from you very soon.
A: Your upper lip scar revision poses a dilemma. While the scar can be cut out, it is not going to stretch downward. Rather the vermilion will move up to the top of the cut out. This is due to the tightness of the skin and the relative looseness or stretchability of the vermilion tissue. The operation will not work as you have shown or hoped. It will get rid of the scar but at the trade-off of a much fuller or bigger vermilion. For your lip scar revision I would think more about a subtotal scar excision and consider doing it in stages.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 25 years old male inetrested in lip scar treatment. When I was 12 years old I had an accident which resulted in the need stiches in my upper lip. Thereafter my moustache hairs will not grow in this area. Is there any chance for regrowth of hair in that scar part. Please let me know as that would be very kind of you.
A: Upper lip lacerations in men very commonly result in beard hair loss. This is because the scar tissue that repairs the lip tissue does not have hair follicles in it. The wider the scar is the bigger the lack of beard hair will be and the more visibly apparent the lip scar will be. Beard hair will not regrow into a lip scar. Hair follicles must be in the tissues to do so. Your options are either scar excision to bring the hair bearing lip skin closer together or hair transplants into the lip scar itself. Most of the time lip scar revision would be the appropriate initial course of treatment particularly if the lip scar has any width to it and is more vertical on orientation on the lip.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what scar revision procedure would you recommend to help improve this widened, red/pink, rough, indented scar above my upper lip? As you can see, the mustache hair follicles were killed in the car, so there is no hair growth. It is a year old and seems to be done improving on its own. Please help.
A: Your upper lip scar, as you know, is wide, indented and hairless. Fortunately it lies in a near vertical direction which is a perfect orientation for a straight line scar revision. The existing scar needs to be cut out and hair-bearing upper lip skin brought together after removing the indented scar. This brings healthy tissue back to healthy unscarred tissue. This alone may be sufficient and will make a big improvement. Depending upon beard hair growth around the scar afterwards, a few hair transplants could be done if there is not good hair density across the scar. But you don’t want to do any hair transplants before formally removing the scar as that would never look as good. This type of scar revision is an uncomplicated office procedure done under local anesthesia. By removing the lip scar the surrounding beard hair will be closer together and the lip depression removed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to know if I would benefit from a lip scar revision? I had a laceration on my right upper lip that goes from the mid lip to just a hair past the vermilion border. I had 2, absorbing 4-0 sutures put in. And it’s been just a year and the scar seems more pronounced… When I’m not smiling it’s not as bad. But when I talk and smile, it’s definitely noticeable. It’s bumpy and from time to time .i get self conscious when in interacting with people, they tend to stare at scar…The scar is not straight, it has a slight curve. Thank you in advance!
A: Thank you for your inquiry and sending your picture. If the scar is over a year old and is pronounced and bumpy then there is some hypertrophic scar present. This often present as a white scar line that is raised, firm and may offset the vermilion-skin lip border. The only improvement that can be obtained at this point would be an elliptical scar revision pretty much along the line that it lies. Fortunately the scar parallels fairly well the natural vertical lines of the vermilion. This is a simple office procedure done under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting some information on scar revision. My daughter has a lip scar from an injury 5 months ago. Is there anything that can be done to fix the misalignment of the vermilion border and to minimize the white scars on the red part of the lip? Attached are some pictures of her upper lip scar.
A: Your daughter’s residual lip scar is classic for what happens in many lip lacerations that cross the vermilion-cutaneous junction. There remains a residual misalignment of the vermilion edge, white scars on the vermilion and thickening of the involved lip area with a knotty feel to it. This can be improved by a lip scar revision in which the scar tissue is removed by vertical excision and the lip elements then anatomically realigned. The question about the timing of a lip scar revision is determined by when after the injury one is certain that a revision is needed. That is most evident now so it can be done anytime moving forward.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m looking for some lip scar revision. Years ago I had Goretex strips implanted. Doctors finally took the implants out but tubular scar tissue remains that has not gone away even after shots of Kenalog for at least a year. I’ve also used mouth stretchers and massaged which has helped somewhat. However the major problem is that my top lip curls under when I smile which makes me very self conscious. After online research I think the issue is the scar tissue has gotten connected to the vermillion muscle as my scar tissue raises above my actual lip into the white area when I smile, otherwise it looks normal. I hear the only thing you can do is detach the scar tissue from vermillion with a needle subcision and hope it doesn’t grow back together. I wanted to get your thoughts on this procedure, and the likelihood that the scar and muscle will grow back together and whether post op fillers in between would help keep it separated?
A: You are correct in the diagnosis of a linear scar contracture from the path of the previous implants. Since it is impractical to completely excise the scar, scar release (subcision) would be the next logical approach. However, I do not believe that a type of lip scar revision that just includes a scar release alone will suffice as any gaps created in the scar line would just fill back in with more scar tissue. Rather than using injectable fillers after the procedure, I would recommend injecting fat at the subcision sites at the time they are released. You need a tissue graft that has the capability to form live tissue if the scar releases are too work.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having a lip scar revision for my daughter. But I have a couple of questions,. I am really worried about administering anesthesia to her. Is it safe to do on a child who weighs just 35 pounds? Since this is a common type of lip scar revision, do you perform this type of scar revision frequently and on children? Is it better to have the revision now or in a few years after her mouth grows more or when her permanent tooth comes in? Will it create more internal scar tissue? When I put my fingers in her mouth to massage her scar, I can feel the lump, but sometimes it feels soft. I try to keep her lips moisturized with aloe and creams. Also would the revision take place inside her mouth or reopen her scar just above her lip and on her lip? Is it worth putting Claire through this at all? I really do not want to see any scar or lump if she has this done.
A: In answer to your questions:
1) It is impossible to operative on a child’s face (or body for that matter) without them being under anesthesia. To get a good result, they must be perfectly still to work on them. This is never possible on their face until closer to age 12 if not older.
2) Lip scar revisions are vert common in my plastic surgery practice. As part of the Riley Hospital for Children Cleft-Craniofacial team, I have performed many hundreds of cleft lip repairs and revisions as well as traumatic lip laceration injuries.
3) This is an elective scar revision in which the timing is solely based on when you as the parent think it is appropriate or when she, as teenager, deems it a problem. Age or the state of tooth eruption makes no difference in the timing of the lip revision.
4) No topical therapy is going to alter the scar or help make it better. The firmness of the scar can only be altered by scar maturation which requires time which is several years in children.
5) The scar revision would consist of a vertical elliptical excision staying within the confines of the lip.
6) While no scar revision surgery can guarantee any specific result, it is fair to say with your daughter’s scar that substantial improvement will be seen. Whether it will be perfect with no signs of scar at all is impossible to guarantee and maybe even ti expect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am inquiring about lip scar revision for my child. She suffered a fall a year ago and had a laceration of the upper lip. It went on to heal but has done so with a noticeable bump on the lip. I would like an opinion if this could be fixed or do more harm than good if it got fixed..or create more internal scar tissue. Thank you.
A: The upper lip scar that your child has is extremely classic for lip lacerations through the vermilion. They often heal with a redundancy of vermilion scar that appears as a lump along the lip line. Such lip scars commonly undergo scar revision by a vertical elliptical excision of the scar and a smoothing out of the lip line. There is no question improvement can be obtained without the risk of doing more harm than good.
While a teenager or an adult would have a lip scar revision done in the office under local, that is not going to work in a five year-old. This would have to be done under anesthesia for patient comfort and anxiety as well as to obtain the best scar revision result and vermilion alignment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Many months ago, you responded via Real Self regarding my botched gull wing lip advancement. The plastic surgeon also did a v-y advancement under the cupid’s bow. It has ruined my cupid’s bow and my lips have taken on a very flat appearance. I’ve been to 3 plastic surgeons for consults and each one has told me that there is nothing that can be done to correct my problems. You had mentioned on Real Self that you could remove tissue (not skin) to give me a cupid’s bow which would also help with the flat look that I now have. Would you be so kind as to explain exactly what this tissue removal involves. I am somewhat concerned about more scarring. As of now I have scars (small) where the current cupid’s bow is. If you change the cupid’s bow to a more pleasant look, wouldn’t I have additional scars. I just hope that you can explain the procedure a bit more and inform me about any additional scarring. I have attached recent photos which are 6 months after the initial gull wing lip advancement. Thank you so much, and I look forward to hearing from you.
A: What you have, as you know, is a flat or absent cupid’s bow of the upper lip. This is due to a lack of an indentation or greater vertical skin between the normal peaks of the cupid’s bow. To create this normal feature of the cupid’s bow, a few millimeters of vermilion in a curved fashion needs to be removed between the height of the cupid’s bow. You already have a scar line at the skin-vermilion junction so the risk of more visible scarring is very low. How much the prolabial skin will stretch down is uncertain but this is the only lip revision treatment option.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have thin uneven lips due to an injury as a child. When I was seven years old I fell of my bike and split my face open on the concrete. I had a long laceration that ran from my lip down to the underside of my chin and now it is a long wide scar. My lips are naturally thinner but this scar as it crosses the lip also makes the lip uneven as well. Is there a surgery that could correct this lip step-off and in the process make them a bit fuller as well? I don’t expect Angelina Joile lips, but just some normal looking lips. I would appreciate any help you can offer me.
A: Mismatched vermilion-cutaneous edges along the lip line can be easily corrected by either reopening the lip vermilion and realigning the edges or doing a transposition of the edges through a small z-plasty scar revision. Making the lips fuller at the same time can most effectively be done by an upper and lower vermilion advancements. But whether that fine line scar along the lip lines is a good trade-off depends on how thin your lips are and if you have enough vermilion that a filling material or an implant may offer enough size change that would avoid the need for vermilion scars.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a gullwing upper lip lift two years ago. I am very unhappy with the resulting scar. The surgeon who did the procedure said that the scar would end up invisible…it did not. The scar sits 2mm above my vermilion line and is very indented so even if I try to cover the scar with lip liner and concealer it still shows. The surgeon cut very deep and used only eight sutures on the whole of the top lip. Please give me your honest thoughts and whether it can be improved by scar revision. I have attached a picture of my upper lip so you can see how bad the scar is.
A: Thank you for sending your pictures. I think without a doubt that the scar and the upper lip shape can be improved. The indentation is so visible because the natural shape of the white roll (where the skin of the upper lip and the vermilion meet) is everted not inverted. While the eversion of the white roll is lost in every lip advancement, it should be flat and not inverted. I suspect that deeper sutures were not used in the closure so that inversion resulted. In addition, I see no definition of the cupid’s bow of the upper lip, which is one of the main benefits that a lip advancement can achieve. In looking at your before pictures, I think you had the wrong lip enhancement procedure from the beginning. You would have been better served with a subnasal or bullhorn lip lift not a vermilion or gullwing lip advancement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, My 3 year-old son fell and cut his lip in two places about 1 year ago. We did not get it stitched up and it healed on its own. I now find that he has 2 scars, obviously more noticeable when he smiles and the skin is taught. To describe the scar if you imagine placing a ruler into his mouth towards the edge of the mouth that would be the location and direction. They are on the bottom lip and go across the interface between lip and face and travel approx half way across the lip It is every parents worst nightmare to be responsible for their child’s suffering. I have spent a lot of time searching but found no helpful guidance until your site. Could you advise me as to what degree the scar will fade and become invisible, if we decided to pursue surgery of some form would this eradicate the visible scar and when would be the best time to operate i.e. soon or as a teenager for example?
A: Many lip lacerations fortunately occur along the vermilion lines or grooves which are the natural weak tissue planes in the lip mucosa. This is the equivalent to having a laceration along a natural skin crease anywhere else in the body. (e.g., horizontal lines in the forehead) This usually results in the best scar but also a perfect location to perform a linear scar revision if needed.
In looking at our child’s pictures, I can see that he has two such lip scars, the one closest to the corner of the mouth being wider and more noticeable. The one in the front of it is not as wide and hence less obvious. At one year after the injury, these scars are mature and will nto fade from what they appear today. Only excisional scar revisional can provide an opportunity for improvement in their appearance. The time to do such s scar revision is whenever you as parents or he decides that it is an appearance issue. The outcome from such a lip scar revision is not based on age. It can work well at any age.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, I have seen on your website you are very experienced with scars and would very much appreciate your opinion please. I incurred an injury to my upper lip which caused the lip to split open and require stitches. The scar remaining, now 2 years old, is within the attached picture. It appears to have 3 elements: the line which is indented, discolouration of the red part of the lip and the bump on the lip. The bump on the lip is the element which is concerning me most in terms of my appearance. Is there anything I can do to improve this such as massage or oils? Is surgery the only remedy?
A: What you have is a classic lip vermilion scar. The edges are mismatched which creates the bump and the indentation. This is very similar to a cleft lip scar after a primary repair which I have seen many times. Given that it is two years old, it is a mature scar. Therefore, no external treatment methods will be successful like massage or even injectable steroids. To get improvement, you need a scar revision. The scar must be excised and the vermilion realigned and leveled by suturing. This can be done as a fairly simple procedure done under local or IV sedation, whichever makes you the most comfortable. I would expect good improvement as the scar is oriented parallel to the natural lip lines of the vermilion…which is always a good sign for a favorable lip scar revision outcome.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a wart removed from my lip about a month ago. It has left scar tissue that really bothers me. It feels lumpy. People tell me they can barely tell but I know it’s there and was wondering what might be the best option for me?
A: To provide a really accurate answer, it would be helpful to know exactly how this lip lesion was removed and where exactly on the upper or lower lip it was removed. I am assuming that it was cut out and involved part of the wet and dry vermilion. (pink part of the lips) Excisions that involve the lip will frequently leave a bump or hard knot behind for a period of time. This is a normal reaction to injury and is a combined inflammatory and scar tissue reaction. This is usually very noticeable due to the sensitivity of the lips and the natural tendency for one to constantly run one’s tongue over it. In most cases, this reactive lump will eventually subside as it heals. It will usually take about 3 to 6 months for it to soften up and feel more natural. In those few cases where this lip knot does not eventually go away, a scar revision would be needed.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr Eppley, I was involved in a car accident several years ago which left me with a big ugly scar on my upper lip. The scar connects with a scar on my nose. It seems like I don’t have that line (margin) of the lip as it is flat. The scar has been revised several times but there has been no improvement. I was wondering if anything can be done to make that line/margin of the upper lip? I know the scar won’t disappear but at least just to have some improvement. Your help will be greatly appreciated.
A: While I would have to see pictures of the lip scar to be certain, it sounds like you are talking about loss of the philtral height or the philtral ridge. When a scar crosses it, it will likely lose its height or prominence. A skin scar revision alone will not restore the height of a philtral ridge. I have found that an allogeneic dermal graft placed under and along the philtral column underneath the scar area is necessary to resist scar contracture. Please send me some photographs of the scar for my assessment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Hello Dr. Eppley, I wanted to that you for such a fast reply. I have looked through your facial scar revision work you have done and believe you can do something for me. I got a scar along my left lip to the side of my nose over one year ago. I have a few scars since I was a kid but I have gotten used to them. This new scar is by far the ugliest and biggest scar I have gotten. I don’t see anything but the scar when I look in the mirror and it bothers me alot. I understand that half of it is mental but I still would like to keep my face as close to perfect as possible. I already went and saw a doctor who charged me $150 for consultation and really couldn’t help me. I have used Bio Oil, and Mederma regularly and not sure if it’s a good thing to do. My scar is the same color as the rest of my skin but the only problem is its indented. All you see is a deep line which makes my appearance stand out. I went to a place where I paid lots of money and got some kind of liquid that they shot under the skin. It is a filler that only lasts 8 to 12 months. Like I said the scar being indented is the only problem. Whenever I stretch my mouth you can’t see the scar at all, and that’s all I need is to stretch my skin somehow so it stays that way. The filler they have shot in to my scar came in size .8, I have used .2 the first time and .2 the next time. I don’t know if any of this information helps but using that filler didn’t help much. Please tell me if using too much of Bio Oil or Mederma is bad for it. What are you suggestions?
A: Thank you for sending your history and the pictures. You have a mature scar that is obvious, not only by its location, but by its indentation along its entire vertical length. The indentation of the scar, fortunately, is in a favorable orientation being vertical on the side of the lip. That is advantageous for a favorable scar revision outcome.
As you have correctly pointed out, improvement in the scar is only going to come from improving its indentation. There are two options for long-term/permanent improvement. The first is to surgically treat it by doing a formal scar revision, excising the depression from the scar and re-closing it so that it is even. That will require a ‘stepping back’, so to speak, as the scar will be read for a while before the color fades. The other approach is to place a thin dermal graft underneath to push the indentation upward. That avoids cutting out the entire scar and the required time for scar fading. Either option is better, in my opinion, than injectable fillers and any method of skin resurfacing. You may stop the topical treatments as they will have no effect on a mature scar and are not capable of raising up the indentation.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am wondering about reducing an area of my upper lip. Here is the problem. When I was younger, I had an incident that cut an area of my upper lip. My lip healed fine and the cut mark is no longer there. However, it appears that an excess of fat or tissue (not sure what it is) has collected in that part of my lip. I am guessing the procedure may be something like liposuction or something like that. It looks rather simple to do and perhaps could just be fluid in there. Please advise.
A: The bump on your lip that you are seeing is undoubtably scar tissue. It is not fluid or fat. This is an absolutely classic case of scar formation that occurs after a significant cut or laceration on the lip occurs.
While scar forms anywhere on the body after injury (this is how things heal), the lips are uniquely different from what occurs in skin…because they are not skin. Lips are a combination of wet and dry mucosa which is much thinner and more elastic than skin. It has to be so that the lips can be flexible. There is a reason that you can pull on your lips and really stretch them out without tearing them. (up to a point) Wet mucosa is more flexible than the dry mucosa which is the part of the upper and lower lips that we externally see.
The thinness of mucosa, particularly the dry mucosa, makes it very susceptible to forming a thicker scar. This can particularly occur with many lip lacerations which are often left to heal on their own. Such secondary healing almost always leads to a thicker area which disrupts the smoothness of the horizontal lip lines.
Lip scars can easily be re-excised and closed with successful smoothing of the lip line. Lip scar revisions can usually be done under local anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana