Author : Dr. Sidhartha Chandra : Prof., Dept. of Prosthodontics, K.D. Dental College & Hospital

Abstract  :

The lip lift is a procedure that elevates the position of the upper lip with respect to the teeth giving a broader smile. The amount of pink lip that is seen is also increased giving the patient wider lips. The lips can also be made fuller with lip augmentation by injecting abdominal fat into the lips at the same surgical session. The overall effect of the lip lift is a more esthetically pleasing mouth with a youthful appearance. The patient satisfaction rate is very high. There are many variations to the lip lift technique which are discussed.

Introduction

The ideal of youthful lips is often described as a lozenge shape with a pronounced Cupid's bow and significant fullness in the upper and lower lips. However, with aging, the lips tended to shrink and lose definition.1 They may also begin to sag and reduce the amount of teeth revealed with a relaxed smile. 6

A lip lift is a cosmetic surgical procedure that attempts to improve the appearance of lips by reshaping to advance the vermilion border or give the lips have what is perceived to be a more pleasing shape. Lip lift is to be distinguished from lip enhancement, another name for lip augmentation, which is often performed as a non-surgical procedure.

With collagen as the only available filler material, and that proving a very unsatisfactory option. it was sought to develop a surgical alternative that would increase the size of lips and give them a more youthful contour. Several variations were developed for the lip lift technique.7

Variations on the Lip Lift Technique

1. One way to achieve advancement of the vermilion is the gull wing lift. The gull wing lift removes skin (and sometimes other tissue) directly from or above the white roll—the white line of skin that borders on and sets off the vermilion. In this technique, often complicated incisions are used to remove one or more cuts of tissue that significantly alter the shape of the lips by moving up the vermillion from both peaks of the Cupid's bow out toward the side of the lips (the commissure). Incisions are also made below the lower lips to move more vermilion out on the bottom lips. This is described as a short procedure (20 minutes), with swelling that lasts 1–2 weeks and lip tightness that requires 2–4 months to resolve. Asymmetry, undercorrection, and hypertrophic scarring are listed as complications.1

2. Another variation, called the subnasal or sometimes bull horn lift, involves the removal of an oval or wavy oval of tissue from directly beneath the nose. Skin is pulled up and securely stitched to advance the vermilion.6 8 This can sometimes lead to an exacerbation of drooping commissures, and therefore is commonly accompanied by what is known as a corner lift. 5

3. In the corner lift (or external angle oral commisuroplasty), triangles of tissue are removed from above the commissures to elevate the corners of the mouth.2 A descending wedge of tissue can also be removed to add contour to the Cupid's bow or to reduce "bulky" lips. 6

4. In another variation of the procedure, an incision is made inside the mouth to loosen the mucosa and vermilion, which are then advanced and secured, leaving an exposed portion inside the mouth, which may take 2–4 months to completely heal. 2

5. Another variation uses a "W" incision inside the mouth to create several "V" flaps, which are then used in a V-to-Y plasty technique to advance the vermilion of either or both lips. 2 This procedure leaves no exposed area inside the mouth, but can be painful and have a lengthy recovery period.4

6. Another variation is the thread lift, in which a square stitch is placed from one nostril to the other and down to the peaks of the Cupid's bow. This variation has fallen out of favor because the results are short-lived.

Complications

• Numbness
• Stiffness
• Pain
• Parasthesia
• Lip distortion
• Lip lengthening
• Smile deformation
• Speech impediment
• Visible scarring

Conclusion

Although many surgeons report satisfaction with their procedure to be "high," the variation in procedures and the controversy over them suggests that no one variation has sufficiently high satisfaction to become the accepted procedure.7 Most of the procedures result in a visible increase in the amount of vermilion visible. The lip lift procedure may be done in the office under local anesthesia with minimal discomfort. An incision is placed directly beneath the nose and a small strip of skin and tissue is removed.

The lip is elevated to its new position exposing about 1/8" of teeth and permanently increasing the volume of the pink part of the lip. The procedure takes about ninety minutes and the sutures are usually removed after a week.The result of the lip lift is a more youthful and pleasant shape to the mouth and lips. The teeth will show more and the patient almost always looks happier and relaxed.

Lip Lift Procedure

Before After Case 1	Before After Case 2
Before After Case 1	Before After Case 2
Before Lip Lift After Lip Lift Case 1

References

1 Fanous, N. 1984 Correction of Thin Lips: "Lip Lift." Plast Reconstr Surg. 74(1) 33-41.
2 Aiache, A.E. 1997 Rejuvenation of the Perioral Area. Derm Clinics 15(4) 665-672.
3 Wilkinson, T.S. 1994 (a). Practical Procedures in Aesthetic Plastic Surgery.
4 Rohrich, R.J. et al. 2000. Early Results of Vermilion Lip Augmentation Using Acellular Allogeneic Dermis: An Adjunct in Facial Rejuvenation. Plas reconstr surg 105(1) 409-416.
5 Weston, G.W. et al. 2009. Lifting Lips: 28 Years of Experience Using the Direct Excision Approach to Rejuvenating the Aging Mouth. Aes Surg J 29(1) 83-86.
6 Austin, H.W. 1986. Lip Lift. Plas reconstr surg 77(6) 990-994.
7 Jacono, A.A. and V. C. Quatela. 2004. Arch Facial Plast Surg. 6 172-177.
8 Greenwald, A.E. 1987. The Lip Lift. Plast Reconstr Surg. 79(1) 147.
9 Wilkinson, T.S. 1994(b). "Lip lift" resection. Plast Reconstr Sur