What Is Wrong With My Bullhorn Lip Lift?

Q: Dr. Eppley, I researched and read many articles and visited many websites before I had my Bullhorn procedure performed. Unfortunately, I don’t believe my plastic surgeon had much experience with the procedure. At first he removed an eliptical piece of skin inside the nostril (“italian lip lift”) which did nothing to decrease the distance nor pout the lip. (my mouth is tiny, lips were thin and philtrum long)  Next about 5 months later, he did the bullhorn… he did not ever carefully review my anatomy, measure any important distances, nor did he take enough tissue… again, no improvement. Then, 4 months later (late August 2012) he performed the Bullhorn again and I had to inform him that the normal distance between the base and vermillion should be 5-7mm.. my result: right side of my lip droops… on the left the sutures were placed within the nostril, on the left they were not. also, i do not know what he did with the muscle.. I’ll have to get my op report. I know stiffness is expected, but what I don’t know is if I can smile at all. When I do, my smile seems to be distorted a bit.. but I know it’s early. I feel stitches deep and I don’t want to pull them. I would appreciate your feedback, I think I need a second post op opinion, but most doctors don’t want to become involved especially so soon after surgery. However, I am concerned because I also had a facelift with this doctor and I believe it was overcorrected.. can’t move my upper cheeks and have constant swelling and pain around my eyes. Very weird, almost like I can not squint!

A: It is hard to make much of a usual comment when I don’t have pictures to review. Nor do I know exactly what was done during your last procedure in which the more conventional lip lift or bullhorn procedure was performed. The aesthetic result would not be my main concern right now, I would be more focused on the lip tightness and the difficulty with smiling. These are not usual postoperative findings even in the early stage. I have seen too many upper lip lifts where deep sutures were placed into the muscle or even down at the bone level…which is a mistake and should be corrected early before too much scar tissue forms.

Dr. Barry Eppley
Indianapolis, Indiana