Q: Dr. Eppley, I would like to have an upper lip reduction, along with a reshaping of my upper lip. Are you able to perform this surgery? If so, do you use laser surgery for the procedure?
A: I am a bit confused by the combination of an upper lip reduction and reshaping of the upper lip. What do you mean by reshaping and what are you trying to achieve? An upper lip reduction is performed on the inside of the lip at the wet-dry mucosal junction. A horizontal strip of dry vermilion is removed and the remaining dry vermilion is rolled inward, thus reducing the visible vermilion or size of the lip. While this reduces the size of the lip, I am not so sure that I would call it a reshaping. Lasers are never used for skin or mucosal surgery. While they have theoretical appeal because they seem like a better way to do surgery, they actually have worse outcomes, delayed healing and usually bad scars. Lasers essentially burn the tissues that they cut through which causes all the aforementioned problems. They are also associated with wound complications such as edge separation in the healing period because of the tissue burn at the wound edges. They actually cause a more longer healing period and are not used for any plastic surgery operation.
Dr. Barry Eppley
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
Q: I am a 25 y.o male with a substantial overbite that has remained after a long orthondontic treatment at a too late of an age and a recessed chin, altogether creating that “neanderthal” ethnic look to my bottom face.
Rather than living with it or going through a massive jaw surgery, I was wondering since a significant part of the protrusion is actually caused by a fat philtrum – wether there is a procedure that can reduce the philtrum thickness (with an internal stitch in the upper mouth). From a short online enquiry I am starting to think it isn’t possible, and even if that is the case – would still like to know why – is it because it has muscles and not only fat?
I would also like to know why are lip reductions usually very subtle (only about 10%?), and whether there is a vertical reduction in the circumfrance of the lips (I have enough excess lips to go around two mouths…)?
Thanks for your time.
A: Philtral upper lip reductions are not possible because the lip is largely muscle and would cause a lot of lip dysfunction. PLus whatever little bit of thinning could be obtained is not enough to make a visible difference to compensate for maxillary protrusion.
I can explain to you why your perception of lip reduction results is only ‘about 10%’. That has not been my experience where it is more typically a 20% to 30% improvement in my lip reduction surgery efforts. Perhaps, some surgeons are understandably more conservative since you can always take more but you can”t put any back.
Dr. Barry Eppley