Your Questions
Your Questions
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, Hi. I have a few queries about possible procedures which may enhance my smile and lip shape. First of all, I have quite a small mouth, as in the horizontal distance from corner to corner of my lips is quite short, and therefore my mouth at rest is small and my smile does not show many teeth. Is there any procedure, such as lip lengthening, which can make my mouth opening wider- hence make the horizontal distance of my mouth at rest longer, and to make my smile wider? My next issue- which I think is related, is that my top lip covers quite alot of my top teeth when smiling, and also I would like my top lip to be more outturned or ‘pouty’. Is there a surgery which can reduce the distance between the nose and the lip to reveal more vertical distance of the teeth when smiling, and to achieve a more “pouty” shape? I’m not sure if it would help to send photos, but I can if that is needed. Thank you in advance!
A: What you are seeking is a horizontal widening of the corners of the mouth and a vertical shortening of the upper lip. There are surgical procedures for each of those changes. The upper lip can be vertically shortened, the upper lip become more pouty and more upper teeth can be shown through either a subnasal lip lift or an upper lip vermilion advancement. Which one is better for you would depend on seeing a picture of your lower face for my assessment and what location of scar would be preferable. (under the nose or along the vermilion-cutaneous border) The corners of the mouth can be widened through a commissuroplasty procedure where a v-shaped segment of skin is removed (about 5 to 7mms per side) and the corner vermilion advanced outward on each side. Whether that fine line scar around the corners of the mouth is acceptable would be the concern.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 51 year-old female that is unhappy with my upper lip. It has become flaccid with age and my philtrum is elongated and flat. My lip droops over my teeth and subsequently you do not see my upper teeth when I smile. I want to shorten my philtrum and open up my smile to see more of my teeth and try to look more youthful. I am open to all suggestions.
A: Thank you for your inquiry. You are describing perfectly the need and benefits of an upper lip or vermilion advancement. This is an excisional procedure where a predetermined amount of skin in a very specific shape is removed and the vermilion of the upper lip advanced or moved upwards. This will not only shorten the upper lip, between the base of the nose and down to the top of the cupid’s bow of the upper lip, but it will also cause more upper tooth show. To get the philtral columns more pronounced like ridges and not completely flat, dermal graft inserts can be placed vertically along their length at the same time as the upper lip advancement. This can be a procedure done under local anesthesia in an office setting.
Dr. Barry Eppley
Indianapolis, Indiana