Dr. Karen Leong | 10/13/2020
Good morning! I’m Dr. Karen Leong, Newport Beach, CA and I wanted to do a segment today on lip rejuvenation. Because I’m a surgeon, the focus is on a surgical lip lift. Now, I just wanted to go over the anatomy of the upper lip a little bit.
So obviously, whenever we’re talking about anatomy, there is the foundation, which is bony, and that is the maxilla, which is the bone that supports the upper teeth and upper jaw. The cutaneous — or skin and soft tissue portion of the upper lip — is comprised of the cutaneous, which means skin, and then also the actual red lip. Looking more closely, you can see that this is a Cupid’s bow, and you can see there are two columns here, which we call philtral columns, which also give you that Cupid’s bow. This is the central segment of the upper lip, and then there’s the right and left lateral segments.
Now, when we’re young — and unfortunately not all of us have this — but our upper lip tends to be fuller and you want a one-third, two-third ratio of the upper lip to lower lip. Now, obviously for me, that’s not exactly the case and this differs person by person, but when we’re looking at lip aesthetics, that’s typically what people want. You want a juicer bottom lip than you have an upper lip.
I wanted to focus on the upper lip itself. Now, as we age — and you will notice this looking back at your pictures — the bone starts to shrink, and as it shrinks, the soft tissues fall into the space where that bony support used to be, and what you’ll notice is, as we’re young, we have dental show. That means that when my mouth is at rest, you can see a couple millimeters of teeth. The goal is about two millimeters. I’ve had braces so mine’s a little bit more, but the goal is about two millimeters of teeth showing when your mouth is at rest. Now, as the bone shrinks and the tissues fall, you’ll notice that the lip elongates, and for lot of older people, the lips gets quite long and then it gets thin. So then now you no longer see teeth at rest or when you’re speaking, and you also feel like you’ve lost the red lip itself.
Now, people will go and have fillers done into the lip itself, into the vermilion border — or where you would put your lip liner — and these things can help to volumize the lip and to also redefine the lip line so that you don’t have so much of the bleeding lipstick, and you have a little bit more definition of the lip itself. I like to put filler also here in the pyriform aperture, where I find that a lot of the bony resorption happens. When I do that, it restores some of that bony structure to the upper lip and gives the illusion of a lift. However, once you’ve gotten to the point where, you know, either you’re not really in line with having fillers, you don’t like the look or the feel, or you’re just tired of having to have them done every single year in order to maintain your still-long-and-thin-lipped look, what we can offer is a surgical lip lift.
Now, I know it’s a little bit nerve-racking to consider a surgical lip lift because when you’re thinking about it, you say, “Oh my goodness! Scars across my face. Who wants that?” Now, the wonderful thing about this procedure is that all of the incisions are hidden in your natural creases. So, they go around the edges of the nose — in what we call the alar crease — and then you have a small incision right across the base of the columella, the base of the nose here. The rest of the sutures are placed inside the nose, and I perform what is called an endonasal lip lift, which means that I create skin flaps after you determine how much of a lip lift to perform, and they are secured inside the nose so that you won’t see a scar that cuts right across the upper lip.
So, how do we determine how much of this tissue to take? Now, this is the longest portion of the case is the marking. So, when you are at rest, I have you sitting straight up. I want everything to hang as much as possible. I have you rest your lips and then we sequentially lip lift — using this type of maneuver — until we get the amount of lift and the amount of dental show that is ideal for you. Now, this can be anywhere up to seven or eight millimeters, depending on how long your lip is. And once that’s done, I make that marking. I’m very careful. I make lots of measurements, and I design the tissue that’s going to be excised. Following that, this procedure is done in the office under local analgesia, which means that we’re just doing numbing medication. I don’t do nerve blocks, so your mouth isn’t all funny, like it is after going to the dentist. It’s just numbing medicine right around the area where I’m going to be removing tissue.
Now, once the numbing is in, that’s the worst of the case over. The rest of it is just me working, and I feel that this procedure, compared to pretty much everything else I do, is the most puzzle-like. It’s actually a lot of fun because I have to piece together what I’ve created to what is anatomically there. And a couple of things to consider when I’m doing this are the nasal sills — please excuse my very crooked nostrils — but this area should be preserved as best as possible because you don’t want a very obvious, flattened nasal sill. So, the dissection that I do, and the lift that I do, takes that into account is very careful. Now, once I have that tissue removed, I lift and secure it up into the nose and the vestibular mucosa, which is not very mobile, which means that I have good fixation without pulling on my scar. And then it’s just closing the skin on the outside and the inside.
After one week, I remove those sutures, and even at one week, the scar is amazing. Even for skin types like me, it disappears beautifully right into the alar creases and along the edge of the nose. I do provide a scar gel, and for that week, I ask that you refrain from eating hard, crunchy crusty foods, like pizza or burgers or big steaks – anything that will pull and tug at that upper lip as it’s healing. I request that you keep the area clean, just a little hydrogen peroxide and then apply Aquaphor. I do put you on prophylactic antibiotics, and if you have a history of cold sores, I will put you on an antiviral medication just to prevent that from happening. Typically, my patients don’t need any pain medication. It feels a little numb and a little bit sore from the procedure, but Tylenol or a little bit of Motrin is more than enough. I haven’t had any issues with bruising, and like I mentioned, it’s very well tolerated with just a local numbing medicine.
Once the stitches are out, I do ask that you be very careful with using sunscreen to make sure that those scars fade as well as possible. Scars always take up to a full year to fully mature. I do recommend a scar gel. I personally like BIOCORNEUM because it’s a nice, clear gel, it’s silicone-based, and it has SPF in it so that when you’re out and about, you are protected from the sun. As long as the scars are still a little bit pink, that means they are still fresh and healing. We do have a VBeam laser that is included in your package. So, if we do need to do anything to treat the scar, that is readily available.
So, that is lip lift in a nutshell. Again, as we age, the bone resorbs, the tissues fall, so our lip becomes longer and longer, there is no longer dental show or teeth showing at rest, and your lips become thin because now it’s rolling into itself. A surgical lip lift restores the position of the lip. It gives you more fullness because it’s everting — or turning out the lip — so that you have more of a pout. It doesn’t have any of that ducky look from having fillers because there’s nothing we’re actually putting into the lip. We’re just restoring the lip back to where it used to be when you had good support from the bone and from the tissues.