With advancing age, the upper lip tends to present an aesthetic aging that many patients want to avoid. For this reason, upper lip lift techniques are a common practice in plastic, cosmetic and reconstructive surgery.
The aging of the upper lip has received less attention from surgeons, due to lack of effective techniques. For example, Rhytidectomy is performed to lift the face, but does not improve the appearance of the upper lip. Therefore, attempts to improve the appearance of the lip are usually limited to abrasion or chemical peel.
Aging of the skin of the upper lip
Aging of the lip has well-defined characteristics, which are responsible for the sagging and deteriorated appearance:
- Increased distance between the nose and vermilion.
- Thinning of the vermilion
- Radial folds
- Accentuated nasolabial fold, which is the small depression between the nose and the upper lip.
- Flattening of the nasolabial fold
The surgeries employed so far have been limited to excision of a short strip of skin, either in the transition zone of the upper lip and nose, at the junction of the vermilion of the lips with the cutis. A more extensive resection of a strip of skin along the nasolabial folds and nasolabial junction is presented, and some improvements have now been added to this technique to achieve better results.
Lip lift procedure
The procedure involves excision of a strip of skin. If the nasolabial fold is excessively prominent, the resection can be extended. The skin of the upper lip is carefully removed from the subcutaneous tissue at the edges of the incisions. Then, two layers of nylon are used in the closure, one in the deep part of the dermis to approximate the wound edges and a superficial layer to put on the edges perfectly. The external stitches are removed on the second postoperative day.
Lip lift operation in severe cases
In patients with more severe aging changes, a more radical technique is used: this procedure also involves resection of a strip of skin. The stained areas are then closed again, and the edges of the skin are sutured over these areas, to create a projection of the simulation of the ridges of the nasolabial fold. The skin of the upper lip is indented medially to smooth the radial wrinkles.
Depending on the patient’s needs and characteristics, the surgical approach is chosen. If a patient has only a noticeable upper lip wrinkle, a small strip of skin can be resected along the nasolabial junction. If there is a prominent ptosis or sloughing of the commissures and nasolabial folds, the resection can be extended to include these areas. When radial wrinkles are prominent, undermining of the resultant skin is recommended.
If the nasolabial fold is flattened, a projection of the nasolabial ridge can be created by re-epithelializing two strips of skin and suturing the edges of the incision over them. In these cases, the central part of the skin should not be undermined, in order to maintain the central depression and thus a more natural appearance.
In those patients without a marked nasolabial fold, the approach can be modified, where all the aging features of the skin will be treated without creating an extensive scar. This procedure is particularly useful in those patients who have undergone rhytidectomy with sufficient improvement in the nasolabial fold, but not in the upper lip.
Postoperative upper lip elevation
After the upper lip operation, patients are advised to avoid even slight traction on the suture lines for 3 months: they should be very careful when brushing their teeth, use small cutlery to eat, and avoid opening their mouth too wide. It is also discouraged to sleep face down on a pillow for the next 3 months after the operation. It is also recommended to avoid direct sun exposure for 6 months.
The plastic surgeon must be very careful in suturing and making incisions, as well as advising patients to avoid any traction on the scars. Good results have been obtained in patients with fair skin, but upper lip elevation cannot be recommended in patients with darker skin due to the risk of scar hyperpigmentation in and around that area.