As one ages, both the upper lip and lower lip undergoes several changes. Both lose volume and become smaller. The upper lip elongates often to a point where it hides the upper teeth when the mouth is gently parted. Contrarily, the lower lip drops to expose the lower teeth at rest. Note, the young mouth when parted is quite the opposite; the upper teeth are exposed and the lower teeth are hidden with the mouth slightly parted open.
Thus, the aging lips is not just a matter of volume loss. There are significant changes in both shape of the lip and position on the face. The lips, like many other parts of the face and body, drop with age. While lip augmentation does a wonderful job at restoring volume and lip pout, it only addresses one of many factors that paint the picture of the aging lip(s).
To adequately restore youth to the lips, the lips often need lifting as well as volume. The upper lip lift and lower lip lift are powerful techniques to reshape the face. One more technique must be mentioned to complete the spectrum of lip reshaping, and that is the corner of the mouth lift. The three procedures are often performed together under local anesthesia to dramatically improve the aging face.
Upper Lip Lift
The upper lift will elongate and lose its arch with aging. In fact, not only does the “ski slope” profile of the upper lip disappear, it often involutes. Fillers to the elongated involuted lip tend to offer very little rejuvenation. In cases where the upper lip has aged to this degree, the only technique to restore youth to the upper lip is by excising redundant skin, which in turn, rotates the lip back to recreate the slope that has been lost. Fat or fillers may be added to restore volume, but the rotation of the upper lip with a lip lift often obviates the need for this.
The upper lip lift does not just raise the lip to a higher position on the face and roll out more of the mucosa . It can also reshape the lip from a flattened appearance to the cupid bow shape of youth.
Candidates for the Upper Lip Lift
Not everyone is considered a good candidate for the upper lip lift. Some of the features that should be present include: descent of the upper with hidden upper teeth when the mouth is parted, thinner upper lip than lower, and a flattened appearance of the lip. A common mistake is to perform a lip lift on a patient who has a elongated, but large upper lip. In such patients, it may be necessary to perform a mucosal resection to reshape the upper lip as it tapers to the corners to avoid a trout pout appearance.
The other concern that is often pondered by the plastic surgeon is to whether or not a lip lift is a safe procedure in someone who has had a open rhinoplasty. In an open rhinoplasty, an incision is made along the columella, necessarily transecting the columellar artery. The columellar artery, along with the angular artery which enters the nose just above the nasolabial folds, feeds a large portion of the nose including the nasal tip. The lip lift incision should provide no risk for creating ischemia to the nose. However, the inferior columella may theoretically be at risk of vascular compromise if both procedures are performed concomitantly. Fortunately, this is an uncommon sequela. In healthy men and women who do not smoke the combination of a lip lift and open rhinoplasty is safely performed without healing complications.
Fair skinned men and women with light eyes are ideal candidates for this procedure because one of its major drawbacks is the scar. While the scar is camouflaged well along the border of the nose (and in some designs hidden within the nostril), in peoples who heal poorly this can be a real problem. Thus, it is important to take note of a history of keloiding or poor healing. Olive or dark skinned men and women who may be prone to poor scarring are not automatically excluded as good candidates. However, it must be stressed to them that scar care is a real priority and that scars may need to me revised after surgery once tension on the lip subsides.
Heavy smoking is a contraindication for many procedures in plastic surgery, such as abdominoplasty and breast lifts because nicotine and other chemicals in tobacco compromise the microvasculature and may impede wound healing. The face, because it is more vascular than the abdomen and breast, tolerates nicotine abuse much hardier. However, performing a lip lift with a heavy smoker, or a smoker in combination with an open rhinoplasty may be rolling the dice. Even if the wound heals well, the potentially poorer scar may not be satisfactory to the patient.
Any man or woman who cannot tolerate a scar on their face is not a candidate for a lip lift. Lip lift scars are generally not perceivable within normal talking distance. Women, because they wear make up, can readily conceal any scar that they deem to noticeable. Men, however, may have a harder time camouflaging a scar.
The Upper Lip Lift Procedure
The upper lip lift procedure can be performed rather easily under local anesthesia. In fact, there exists a great advantage to performing this operation with the patient awake. Adjustments may be made in real time with a patient looking in the mirror. Once tissue is excised, it cannot be reversed. Thus, with the patient awake excisions can be simulated with the uses of tailor tacking stitches.
Proper markings are the key to natural looking results and a well hidden scar. While many designs have been described, Dr. Neavin prefers modifications of the bullhorn to best simulate a reversal of aging. Generally, no more than 7 mm of excision can be performed at any one point without greatly increasing the odds of an overly widened scar. In lips that must be lifted more than 7 mm, it may be necessary to stage the lift into two operations.
After the upper lip is marked, the tissue is injected with lidocaine with epinephrine. At this point, simulation of the proposed resection can be shown to the patients. Several stitches are placed from the upper marking to lower marking and a mirror is given to the patient for approval before cutting tissue.
Once the patient agrees to a proposed excision is made. Skin is removed. A dissection is performed under the skin from the lower border of the incision toward the upper lip. a portion of the muscle around the lip, the orbicularis, may be sutured to deeper tissues to stabilize the upper lip and reduce tension off the skin closure.
The incision is then closed in multiple layers with both stitches that will dissolve and stitches that will need to be removed in the office in 6-7 days.
Fat or filler may be injected into the lip to add volume.
V-Y Lower Lip Lift
The V-Y lower lip lift may be better described as an advancement of tissue than an actual lift. Here, mucosa inside the mouth is recruited and mobilized to create more fullness to the lower lip which in turn, adds height and substance.
The V-Y lower lip lift address two elements seen in the aging lower lip: volume loss and exposure of lower teeth with the mouth parted. With advancement of mucosa, the lower lip is essentially remodeled into a fuller lip. The fuller lip may cover more or all of the lower teeth at rest.
Candidates for V-Y Lower Lip Lift
Men or women who, when the mouth is parted at rest, expose their lower teeth may be candidates for this procedure. Because all incisions are within the mucosa, unsightly scars are almost never a problem. And because the lips are so vascular, healing should proceed without any complication. Lastly, because the lower lip is ideally up to fifty percent or larger in width than the upper lip, even patients with large lower lips are not contraindicated from having this procedure.
The V-Y Lower Lip Lift Procedure
The patient is marked. Usually two to three “V” markings are made within the lip, depending on the desired result. The incisions are made through mucosa, then the tissue is advanced created a “Y” incision. The incisions are closed with absorbable stitches.
Fat or fillers may be injected to add volume to the lower lip.
Corner of the Mouth Lift
As the mouth ages, the corners of the mouth may point downward created folds. Dermal fillers can improve this deformity to a degree, but the experienced injector is all too familiar with its limitations. In fair skinned people, the corner of the mouth lift can prove to be to be the perfect solution for the angry, downturned corner of the mouth appearance because the scars form so favorably. In olive or dark skin patients, one must weight the benefit versus the risk of an unfavorable scar that may be difficult to hide.