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 been looking for a expert on lip reduction for a very long time. About five years ago I had silicone injected into my upper lip and I have regreted it everyday since, its ruining my life. I would really appreciate it if you could just give me a honest answer as to what be done about it. I want my four front teeth to show again and make the upper lip smaller than my bottom lip. I have attached some pictures of my lip including what it looks like underneath.
A: Based on your pictures I can see that there are many bumps on the underside of your upper lip on the mucosal surface. This would likely be the location of much of the silicone material, either being pooled collections of the oil or silicone granulomas. While it is probably impossible to ever completely get rid of all of the injected silicone material, the good news is that much of it appears to lie in the tissue zone of excision where an upper lip reduction would be performed. A lip reduction typically removes mucosa from the inside of the lip from the junction at the wet-dry vermilion. This allows the upper lip to roll in and become vertically shortened. Where this tissue is removed is also where most of your bumps are so you would get a dual benefit of a less full upper lip and some of the silicone material removed.
Dr. Barry Eppley