| One 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.
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?
- Gore-tex: permanent and useful to outline
vermilion, some strands might extrude although this is usually not the problem.
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.
- 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.
• 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.
• 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)