Therapeutic options for lip augmentation

Aesthetic ideals vary with emerging fashion trends and within different cultures. However, over the past few decades, fuller lips have been considered a desirable trait. Many younger patients are presenting for lip augmentation to achieve the sought-after look commonly seen in many fashion magazines. In addition, as individuals age, they lose lip volume, with a thinning of the red lip, some effacement of the vermillion border, and elongation and flattening of the white portion of the lip. Rejuvenation of the lips plays a key role in restoring a more youthful appearance. As a result, lip augmentation appeals to a wide spectrum of patients who present with various different aesthetic goals and expectations. Numerous therapeutic options exist for aesthetic lip augmentation, ranging from temporary and permanent injectable fillers to implants and other surgical techniques.     

Secondary unilateral cleft lip repair: combining rotation-advancement principles with a cross-lip muscle-vermilion flap

Any lip without a complete philtral complex looks unnatural. This important anatomical entity can be recovered in many lips primarily closed with straight-line or Mirault-Blair-Brown-McDowell procedure. In these patients, combining a rotation-advancement upper lip revision with tubercle reconstruction using a cross-lip vermilion-orbicularis oris muscle flap results in a rotation-advancement scar ideally located in the skin of the upper lip and no scar in the skin of the lower lip. The tubercle is reconstructed as a unit from lower lip vermilion and muscle. The scar in the lower lip is restricted to the vermillion and therefore becomes extremely subtle and difficult to detect. The many scars resulting from a standard Abbe flap are avoided. Even patients with lip deformities considered too mild for a standard Abbe flap no longer need be denied lip revision when the cupid's bow is deficient.     

Notch-free vermillion after unilateral cleft lip repair: The Charles Pinto centre protocol

A notch on the vermillion is one of the most common complications following the repair of a unilateral cleft lip. Several methods have been described for the secondary correction of a notch. However, there are only a few reports on how the notch can be prevented during primary lip repair. Causes of a vermillion notch were analysed at the Charles Pinto Centre for Cleft Lip and Palate and each possible cause addressed by an appropriate procedure. This protocol was then followed in every patient. In this manner, we have been able to avoid notches in unilateral cleft lips altogether and more significantly, junior trainees in our department have also been able to consistently avoid a notch in their repairs.     

Frontal stage in cervicofacial lift: the "helmet crest" technique associated with rapid expansion]

The frontal level is generally the less and the last concerned in facial ageing and the classical incisions of the cervicofacial facelift provide no changes in the frontal and glabellar wrinkles. To avoid such residual defects, the authors perform for the lost ten years an important push back of a central band of the vertex (the so called "Helmet crest") by means of a bilateral triangular excision subsequently closed by VY. This push back needs a very large undermining in the subgalea plan, from the eyebrow and glabellar region to the crest of the hemet itself. The VY closure is now really facilitated by a rapid expansion obtained by a special T shaped expander which allows not only cutaneous expansion but also aponeurotic expansion of the reputedly inextensible galea. This technique avoids the coronal incision and its serious sequelae and may be carried technique out at the same time as cervicofacial face lift. It allows a personal, equilibrated tension of the facial mask which is the essential condition for a good presentation of natural expression of the face.     

Evaluation of Lip Augmentation with Gore-Tex Facial Implant

Although numerous materials, including autogenous, homogeneous, and alloplastic materials, have been used for lip augmentation with varying degrees of success, no ideal one has been found to achieve a soft and long-lasting result. Gore-Tex implant has been successfully used in cardiovascular surgery. So far, it has not been used much in lip augmentation. In this study, a Gore-Tex SAM facial implant (1.8 mm in diameter) was used for lip augmentation in 23 lips of 17 female patients. In 10 consecutive lips with three segments of the implant each, a computer-assisted imaging system was used to scrutinize the results. The results have shown that the three segments of the implant enhanced the lip projection with about 0.98 mm in mean (p < 0.01) and the exposed vermillion width with about 1.94 mm (p < 0.01) in the over 6 months follow-ups. No major complications, only some minor ones, were seen. For lip augmentation, we find that only minor changes can be achieved with three segments of the Gore-Tex facial implant. We feel that it is safe and believe it gives a permanent result which is not the case with collagen injection and usually not the case with lipofilling despite reinjections. Furthermore, we consider the implant quite expensive at present.     

Lip and perioral trauma

The management of perioral injuries is a complex topic that must take into consideration the unique anatomy, histology, and function of the lips to best restore form and function of the mouth after injury. Basic reconstructive principles include three-layered closure for full-thickness lip lacerations. Additionally, special care is needed to ensure an aesthetic repair of the cosmetically complex and important vermillion border, philtrum, and Cupid's bow. Infraorbital and mental nerve blocks provide lip anesthesia for laceration repair without distorting crucial aesthetic landmarks. Prophylactic antibiotics are usually indicated in perioral injuries due to wound contamination with saliva. Perioral burn management is controversial; however, most lip burns can first be managed conservatively. Splinting, plasties, and other reconstructive options are available after secondary healing of perioral burns. Hypertrophic scars are common in the perioral area after trauma. The mainstays of treatment for hypertrophic scars on the lips are silicone elastomer sheeting and intralesional steroid injections. For large perioral defects, a myriad of reconstructive options are available, ranging from primary closure, cross-lip flaps, and local tissue transfer, to free tissue transfers such as radial forearm free flaps, innervated gracilis free flaps, anterolateral thigh free flaps, and osteocutaneous free flaps.     

Technique for Correction of the Retracted Columella, Acute Columellar-Labial Angle, and Long Upper Lip

The excess tissue from upper lip vertical length reduction provides bulk for opening the columella–labial angle and increasing the visibility of the columella and upper lip vermillion. Decorticated centrally based transverse flaps from the lip and nostril floor, when transposed into a columellar pocket, correct commonly combined degenerative or developmental deformities. The technique delivers premaxilla, columella, and columella–labial angle mass, which simultaneously corrects the retracted columella, opens the columella-labial angle, shortens the upper lip length, and enhances vermillion visibility.     

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

BACKGROUND:

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome.

METHODS:

The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors’ knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction.

RESULTS:

The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required.

CONCLUSIONS:

This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.     

Unfavourable results in the repair of the cleft lip

Introduction:

Unfavorable results in unilateral and bilateral cleft lip repair are often easy to spot but not always easy to prevent as to treat. We have tried to deal with the more common problems and explain possible causes and the best possible management options from our experience.

Unilateral cleft lip repair:

Unfavorable results immediately after repair involve Dehiscence and Scaring. Delayed blemishes include vermillion notching, a short lip, deficiency in the height of the lateral vermillion on the cleft side, white roll malalignment, oro-vestibular fistula, the cleft lip nose deformity, a narrow nostril and a “high-riding” nostril. We analyze the causes of these blemishes and outline our views regarding the treatment of these.

Bilateral cleft lip:

Immediate problems again include dehiscence as also loss of prolabium or premaxilla. Delayed unfavorable results are central vermillion deficiency, a lip that is too tight, bilateral cleft lip nose deformity, problems with the premaxilla and maxillary growth disturbances. Here again we discuss the causation of these problems and our preferred methods of treatment.

Conclusion:

We have detailed the significant unfavorable results after unilateral and bilateral cleft lip surgery. The methods of treatment advocated have been layer from our own experience.KEY WORDS: Cleft lip nose, contractures, high riding nostrils, scarring, unfavourable results, vermillion deficiency     

Gracilis free muscle transfer for morpho-functional reconstruction of the lower lip

BACKGROUND: Large full-thickness defects of the lower lip need free tissue transfer. The free forearm flap is the more widespread technique for free flap lower lip reconstruction, but it results in a static lip. The authors describe a technique of morphodynamic sensate reconstruction of the lower lip with a free gracilis flap and a musculomucosal flap. METHODS: Three patients underwent reconstruction with an innervated free muscular gracilis flap, an innervated musculo-mucosal flap for the vermillion (2 cases), and a full-thickness skin graft. RESULTS: No significant complications were observed. Static function and vermillion sensitivity were immediately restored. The skin color match was excellent. After 9 months, contraction of the transferred muscle was evident. CONCLUSION: The lip is a dynamic unit. The innervated gracilis muscle seems ideal for lip reconstruction in that it correctly replaces all the lip layers and compensates for the lost function much better than a static technique.     

The ��bikini lip reduction��: A detailed approach to hypertrophic lips

Excessively large lips represent an occasional but significant challenge in aesthetic surgery. Previously described techniques focus largely on the simple excision of a strip of tissue to reduce the lips, without specific attention to the resultant lip contour or to the volume relationship between the lips. The present paper describes a new technique for lip reduction, called the ‘bikini lip reduction’. This technique not only reduces the volume of the lips, but also restores an attractive labial contour, as well as an ideal volume relationship between the upper and lower lips. Because it is based on aesthetic analysis, this technique consistently yields both smaller and more aesthetically appealing lips. Simply stated, the bikini lip reduction consists of excision of a ‘bikini top’ (two cups and a middle strap) from the upper lip and a ‘bikini bottom’ (a triangle) from the lower lip. The aesthetic results and the patient satisfaction achieved through the bikini lip reduction technique have been very satisfactory.     

3D Stereophotogrammetry Quantitative Lip Analysis

Background  Reduction in lip volume is a stigmata of the aging face. There are many lip augmentation techniques but very few studies analyzing how these techniques change the three-dimensional structure of the lips. Furthermore, there is no consensus about whether the lip position should be standardized to either the lips closed or parted. The aim of this study was first to obtain a three-dimensional quantitative analysis of the lips in adults and to look for sexual dimorphism and, second, to compare whether more consistent measurements of the oral region can be obtained with the mouth open compared with it closed. Methods  Seventy young Caucasian volunteers underwent lip dimension analysis using 3D stereophotogrammetry with lips parted and closed. Parameters measured for consistency of results were linear distances (e.g., mouth width, total lip height, upper lip height), surface distances (e.g., upper vermilion), areas (e.g., vermilion upper and lower lip, total vermilion), and volumes (upper and lower lip volume, total lip volume). Analysis also compared lip dimensions between male and female subjects. Results  Consistent and reproducible results were seen with the lips closed compared with lips apart. All lip parameters (distances, areas, and volumes) were larger in men than in women. The following measurements had significant differences between males and females: mouth width, upper lip height median, upper white lip height median, upper white lip height lateral, lower vermilion surface distance, and area of vermilion (p < 0.05). Conclusion  We present a novel technique for aesthetic assessment of the lips that is objective and achieves consistency with the lips in the closed position. Males have greater lip dimensions compared with females.     

Pronounced nasolabial fold: A surgical correction

A surgical treatment for pronounced nasolabial fold correction through aponeurotic galea, fatty dermic, and dermic autogenous grafts by intraoral access is presented. The results obtained with 20 patients, with up to five years of postoperative observation, are discussed.Presented at the 24th Brazilian Plastic Surgery Congress, São Paulo, Brazil, November 1987     

口轮匝肌重建联合黏膜V—Y成形修复双唇裂术后红唇凹陷畸形

目的探讨口轮匝肌解剖重建联合前唇黏膜“V—Y”成形术修复双唇裂术后中央部红唇凹陷畸形的手术方法。方法对16例双唇裂术后前唇凹陷畸形者行前唇部红唇“V”形切口，解剖分离出红唇两侧口轮匝肌并缝合，将前唇黏膜瓣“Y”形缝合，使前唇丰满。结果患者红唇凹陷畸形得到矫正，红唇形态良好，静态与动态畸形矫正效果满意。随访2个月至2年，远期疗效稳定。结论红唇部口轮匝肌解剖重建联合前唇黏膜“V—Y”成形术，是一种操作简单、效果稳定的功能性修复双唇裂红唇凹陷畸形的较好方法。     

Restoration of the Lip Roll with Gore-Tex

Gore-Tex has been used by the author for the past 2 years to enhance the vermillion border of the lips by emphasizing that a natural pocket exists between the skin and the orbicularis muscle all along the white roll where a Gore-Tex implant can be easily placed. The overlying skin is thick providing a good protection of this material, and such a thickness necessitates that this protection is provided. If a complication occurs from its use, then the implant can be easily removed without any damage to the adjacent tissues.     

叉形瓣法功能性修复重度双侧唇裂

探讨并改进重度双侧唇裂的修复方法。方法：根据Black设计的叉形瓣并作适当的改进。深达骨膜的绕鼻翼切口使鼻翼基部及口轮匝肌充分游离，重建鼻底及正常的口轮匝肌环；前唇粘膜瓣用于加深唇沟；侧唇唇红瓣修复前唇唇红和唇珠。应用本方法修复重度双侧唇裂57例。结果：53例创口I期愈合，鼻底宽度及丰满度较满意，上唇在静态和动态时的外形均较好，但有不同程度的上唇过紧，鼻翼、鼻尖有不同程度的塌陷。2例感染、1例抓伤、1例摔伤导致伤口部分裂开。结论：叉形瓣法功能性修复重度双侧唇裂能获得较好的鼻唇外形和唇部功能，并为Ⅱ期修复创造了条件，可作为修复重度双侧唇裂的重要方法。     

Direct upper-lip lifting: A safe procedure

Thin lips and an aging lower third of the face are increasingly the focus for surgical improvement. Thin and tightly pursed lips imply a certain resignation or even bitterness, especially in older women. Excessive application of lipstick to enhance the shape and color of thin lips was a solution but a poor camouflage. The desire for well-defined and full lips, as seen today on many models and actresses, is the motivation behind the increasing demand of women with relatively normal looking lips to turn to cosmetic surgery. They often present the surgeon with photographs of the shape and fullness of lips they desire to achieve. In this article the author recommends the use of the direct upper-lip lifting method as a more effective and successful approach to enhancing the shape of the upper lip. For plumping the lower and upper lip, the author recommends using autologous collagen augmentation.     

Mucous-flap method for cleft-lip revision using transverse everted full-length lower-lip flap

In patients who had undergone the first surgery for cleft lip and in whom the volume of tissue was smaller for the upper lip than for the lower lip, transfer of tissue from the lower lip using a full-length mucous flap allowed the tissue volume of the upper lip to be increased and external appearance of the lips to be improved. The subjects of this study were 6 patients who underwent this surgery between February and September 2001 and were followed for up to 3 years postoperatively. This surgery can be performed under topical anesthesia, without necessitating restriction on mouth opening and oral ingestion. Furthermore, it allows easy adjustment of the tissue volume in both upper and lower lips. This operative procedure is recommended for cases of cleft lip where surgical treatment has been performed before and the tissue volume is smaller in the upper prolabium than in the vermilion.     

广东成年女性安氏Ⅰ类开唇露齿拔牙矫正前后软组织侧位变化的比较

目的了解广东成年女性安氏Ⅰ类开唇露齿患者拔除4个第1双尖牙矫正后软组织侧貌变化情况，评价该类患者矫正后软组织变化的意义。方法回顾性研究15例广东成年女性安氏Ⅰ类开唇露齿患者，用头颅侧位分析法分析拔牙矫正前后软组织X线片，再将同一测量值于矫正前后做配对t检验，了解有无显著性差异，分析判断矫正后唇组织变化的意义。结果在角度方面：鼻唇角、上下唇角、Z角增加；线距方面：上下唇长和上下唇厚加大，而上下唇审美平面距和上下唇突距皆缩小，且变化有统计学意义；面凸角、面角、上下唇基角和颏厚等变化无统计学意义。结论该类患者拔除4个第1双尖牙的矫正可以使患者面部严重不协调关系有明显改善；但唇厚较治疗前加大，唇间距仅部分缩小，上前牙仍有部分外露，患者仍然有开唇露齿的面像，其进一步好转依赖于患者唇肌功能的改善。     

上唇红唇修薄手术方法的改进

传统的上唇红唇修薄手术，切口设计很容易破坏上唇结节（唇珠），术后外形不美。为了在修薄上唇唇红的同时，完整地保存上唇结节，使术后上唇外形更加自然提供一种新的术式。方法是在上唇结节下方与两侧将切口设计成“Ｖ”形，将传统的弧形切口改为曲线切口。并根据唇结节的丰满程度，利用双侧带蒂唇红下组织瓣加高唇结节。临床应用２１例，术后显示美容效果满意。本方法不破坏结节组织。如唇结节不丰满，可利用多余唇红下组织来加高唇结节高度。