Your Questions
Your Questions
Q: Dr. Eppley, I am interested in lip reconstruction. Attached are photos of my lips. Two years ago, I had a vermillion lip advancement. However, the surgeon did a v/y to the central portion of my upper lip…something that was never discussed beforehand. I’m left with no cupid’s bow and no philtrum. My lower lip hangs down and there are ‘pouches’ just below the lower lip. What can you do to make my mouth look better, and most of important, what can be done to lift my lower lip so that my teeth don’t show and those pouches diminished. Thank you so much in advance.
A: Thank you for sending your lip pictures. Lip reconstruction efforts can be done on both the upper and lower lips. Certainly the upper lip vermilion advancement can be improved because that is straightforward redesign of the shape of the upper lip and advancing the vermilion edges according to the new pattern cut out. This is very predictable and will make a positive improvement. Raising the lower lip, however, is considerably more challenging, not easy, and very unpredictable. Regardless of the dubious success of raising the lower lip, the pooches that lie below and beyond the vermilion of the lower lip can not be improved. Techniques to try and raise the lower lip usually require a sling or suspension of tissue placed across the lower lip from one mouth corner to the other. (technically from a small incision at the end of each nasolabial fold crease to the sling can be threaded through) This sling could be comprised of your own tissue (abdominal fascia) or an allogeneic (cadaveric) sling of dermis can be used. (e.g., Alloderm)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been interested in upper lip advancement (vermilion advancement) for a few years. My lips are full but very narrow toward the outer third. is there a maximum measurement of lip advancement that can be done in this area?
A: A vermilion lip advancement can be done to any part of the lip or its entirety. The only limits to vermilion advancement are aesthetic…you do not want the sides of the lips obviously fuller than the central part. Vermilion advancements of the outer third of the lips are not rare in my experience as many people have adequate central upper lip fullness but it tapers quickly down the sides into the mouth corners. This vermilion arrangement creates a mismatch between the vermilion fullness across the upper lip. Advancing only the sides of the vermilion upward is a simple and permanent solution to this aesthetic lip shape imbalance problem. It is done in the office under local anesthesia. There is usually minimal swelling and no bruising with a very quick recovery. The change in the vermilion shape is instantaneous and permanent. The only trade-off is the small fine line scar at the vermilion-cutaneous junction which certainly needs to be carefully considered.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a lip lift. I have very thin lips and a long upper lip. I want them to have more shape and size although I don’t want them to be too big. I have read about lip lifts but am not sure what I really need. I would like your opinion. I have attached a front and side view of my lips for your recommendations.
A: Thank you for sending the pictures. What they show to me is that unequivocally need a vermilion advancement and not a sub nasal lip lift. Your lips are very thing from corner to corner, has little cupid’s bow shape and there is a long distance between the base of the nose and the upper lip. This is a contraindication to a subnasal or bullhorn lip lift as it will only move up the central third of the upper lip but leave the rest of the lip behind, potentially creating an unusual and unpleasing shape. Only moving the physical location of the vermilion-cutaneous border, from corner to corner, of both lips can you make a significant improvement in the size and shape of your lips. I have attached an example of upper and lower lip vermilion advancements although this patient is older and she wanted a more dramatic change. The change from a lip advancement procedure is adjusted by the vertical size and shape of the skin excision and can be in any degree desired. The ‘test’ of the change a patient wants with a vermilion advancement is done by having them draw on the new border and shape of the lip with an eyeliner pencil. Then that becomes how much lip advancement is done.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a speech therapist, and while I would like to look into a possible vermilion advancement for my extremely thin lips (my upper lip is virtually non existent) I am worried about both the cost and the time to heal since I make a living using my lips to help my students and make a living.
A: For the pencil-thin upper lip, there is no better lip enhancement procedure than a vermilion advancement. It physically increases the vertical height of the lip vermilion and reshapes the cupid’s bow area and can be done for subtle or more dramatic changes to the lip. When done by itself, it is performed as an office procedure under local anesthesia. Its cost will usually run around $2,000. It does cause some moderate swelling but much of that is gone by a week after surgery. There are no restrictions after surgery but how that would impact someone performing speech therapy services is not clear to me. I suspect after one week you would be just fine, maybe two weeks at the longest.
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
Q: Dr. Eppley, Hello I live in Europe and would like to do the lip advancement as an alternative to injectable fillers for permanent lip enhancement. But I would like to know where you do it and how much it costs?
A: Most lip (vermilion) advancements are done in the office under local anesthesia. Using initial infraorbital nerve blocks (like going to the dentist) and then followed by direct infiltration into the lips, the procedure thereafter is painless. If a patient prefers it can also be done supplemented by oral valium or Xanax or even IV sedation for a completely comfortable experience. It takes about 90 minutes to perform. The amount of vermilion advancement is determined by the patient prior to the numbing by making marks using calipers and a fine marking pen…and then having the patient approve the amount of lip increase with a mirror. There is some mild lip swelling afterwards and very minimal discomfort. Patients generally do not take any pain medication afterwards. For patients that are geographically close to me, I place tiny 7-0 size sutures that are removed 10 days after surgery. For my far away patients, I use a fine 6-0 dissolveable sutures and skin glue so no return is necessary for suture removal.
For the properly selected patient, lip advancements are a powerful lip enlargement procedure that produces a permanent result.
The total costs of the procedure are around $ 3,500.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had a lip lift performed several months ago. I have attached some before and after pictures. As you can see the incision isn’t on the borderline and its now indented and puckers. I’m really so unhappy and paranoid with the scar and am now so desperate for revision. I was so impressed with your website you actually used 48 stutures on the womens top lip, I did count 🙂 In my surgery the surgeon only used 8 stiches. as you can see in the pics. In you lip lift proceedure do you actually cut right through all the skin lares? Only when I had my lip lift surgery the surgeon did numb my upper lip with a dental block, but the pain was still horrendous. Also as I wasn’t having my bottom lip operated on it wasn’t numbed, therefore I actually felt my actual top lip resting (flipped over) onto my bottom lip. Is this normal procedure to actually sever top lip so completely that it is able to flap over like that? What I’m asking really is do you cut so deep and if so do you place internal stiching of any kind? Its all a bit complex for me but I really need to know the whole procedure. Thank you in advance and looking forward to your reply.
A: Thank you for sending your pictures. Technically, what you had done is known as a lip advancement or vermilion advancement. A true lip lift is done with an incision under the nose. I prpare patients with a dental block first and then inject directly into the upper lip once one is numb. It should be a virtually painless procedure to go through after the dental blocks and local infiltration. During the procedure, only full-thickness skin is removed and no underlying muscle. There is a two -layer closure with some deeper sutures for the dermis and fine sutures for the skin closure.
Your scar is a bit wide and indented compared to a typical result lip advancement result in my experience. That could easily be improved and a little more skin removed and more of a cupid’s bow made to get a better result.
Dr. Barry Eppley
Indianapolis Indiana
Q : I am 52 years of age and my upper lip seems to be getting longer. When I was younger my upper lip didn’t seem to be as long. When I smile I barely show any upper teeth at all anymore. Is there some form of lip surgery that can help me?
A: A long upper lip can develop in some patients due to the natural process of aging. The upper lip can literally lengthen due to shrinkage of the vermilion (pink portion of the lip) which gets smaller and actually rolls inward. These age changes of the lip can be accentuated by tooth loss. Loss of lip volume combined with other falling facial features makes the skin portion (between the base of the nose and the vermilion) of the upper lip a bigger percentage of upper lip length.
There are two specific procedures for shortening the upper lip. Both involve removing skin in a horizontal fashion at either the top or bottom skin portion of the lip. The subnasal lip lift, also known as the bullhorn lip lift, removes skin from right under the nose and truly is a lifting procedure. Removing skin just above the pink lip line is known as a vermilion or lip advancement. This advances the pink part upward directly. Both result in fine line scars although the subnasal lip lift places the scar in a more hidden location in the crease under the nose.
While both of these procedures are effective at creating a slightly shorter upper lip, both will increase the amount of vermilion show. The subnasal lip lift is limited to increasing only the central pout of the upper lip with lip shortening. The vermilion advancement moves the entire pink portion upward from one corner of the mouth to the other.
Which procedure is best for any patient depends on the anatomy of their upper lip, specifically the shape and thickness of the vermilion.
Dr. Barry Eppley