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Aesthetic Lip Surgery: Cheiloplasty

4276_paginaOne of the most frequently used procedures in a cervicofacial lifting is placing grafts of the patient’s own tissue (aponeurotic-muscle tissue or SMAS) to increase the volume of those face areas that require it; to achieve an enhancement of the lip, as in this case. Fine wrinkles on the upper lip can be treated with fillings, but deep upper lip wrinkles require regeneration of the skin (Dermoabrasion).

The upper lip is made up by the following: vermilion or red portion itself and the area formed between the upper vermilion, nose base and nasogenian grooves. The lower lip is also built up by vermilion and the skin area going from the continuation of the nasogenian grooves to the beginning of the chin.

Lips can suffer a series of aesthetic alterations which can be corrected: size disparity, depressions and wrinkles. The current facial image model gives great importance to lip shape and size that denotes certain exotic tendency.

Not all faces allow this kind of aesthetics, it is facial harmony what determines lips in balance with other facial features. We are, so as to say, conditioned by the other facial measures, that is, the vertical length of the upper lip (skin not mucous) is related to the projection of the nose base. The upper lip must overhang the lower lip and be slightly thinner, etc.
For this reason, we include these operations in “Facial modeling”. We just have to remember the good taste aberrations of deformed lips the yellow press shows us and which some of our famous personalities have.

Use the following to increase lip volume:

  • Plasty: own lip tissue is taken from one area to another: VY plasty is the most frequently used method; muscle and mucous are turned outward. Vermilion is increased in volume and height: good results.
  • Grafts: only used when operating simultaneously on other areas that serve as donors, mainly in face lifts. Tissue called “smas” (Superficial Musculoaponeurotic System) or temporalis muscle aponeurosis is used: it’s absorbed slightly, but can cause other irregularities due to scar contracture. Other tissues can be used, although we currently advise against fat grafts, because the edema in this region is too large and there is practically total reabsorption.
  • Implants:
  1. Artecol (Methacrylate): current equivalent to silicone. Patient must undergo allergy test due to collagen composition. The filling method used is not only due to the volume introduced but also because of the fibrosis it causes: it’s better to be cautious and not to desire a quick augmentation so that fibrosis might form. For this reason it is necessary to implant it in several procedures. Inexact and individual duration: 1-2 years, permanent?
  2. Gore-tex: permanent and useful to outline vermilion, some strands might extrude although this is usually not the problem.
  3. Bovine-derived collagen is one of the most frequently used organic compositions. It has short-term effects and can cause allergic reactions that require the patient to undergo an allergy test. A negative result does not exempt from possible allergic reaction during insertion procedure.
  4. Hyaluric acid: non-animal origin, lasts 6-12 months.

If, aside from having a thin upper lip, the distance from upper vermilion to base of the nose is very long, tissue resection might be necessary near vermilion or nose base, so as to recover natural proportions and diminish wrinkles caused by sagging skin. Superficial wrinkles respond very well to dermabrasion.

bibliografia

  • Cardoso, A.D., And Sperli, A.E.: rhytidoplasty of the upper lip, Fifth International Congress of Plastic And Reconstructive Surgery, Melbourne, 1971, Butterworth & Co., Ltd.
  • Delerm, A., And Elbaz, J.S. Cheiloplastie des levres minces: proposition d’une tecchnique, Ann. Chir. Plast. 20:243, 1975.
  • Hinderer, U.T.: Tratamiento de las arrugas profundas del labio superior mediante implantación subcutánea temporal del folio de Silicona. “Rev.Esp.Cir.Plast.”, 3. 2: 151 (1970)