Can A Double Lip Be Corrected In A Young Child?

Q: Dr. Eppley, I have a 4 year old son born Jan 2021 who appears to have a “double lip”. He had a tongue and lip tie release at 8 months old in Sep 2021. I am including a zip folder with photos before the surgery and after along with videos to see how his smile was/is. 

I need an opinion of someone who is an actual surgeon who understands facial muscles etc and not just a dentist with a knife. Hence why I am hoping you can just tell me if we are making a possible good next move or not. I really value your opinion after seeing some feedback you had previously put online about double lips and understanding the mechanics, cosmetics etc.

After the lip release at 1 year, the lip tigh looks high with a lot of thick tissue. He also has very tight buccal cheek ties that were never released at all. They are hard to picture, but were very thick, low, attaching right above where his teeth meet his gum. He won’t let us pull his cheek open to look so I imagine it is still present.

My concern is his smile now. He has an apparent crease across his upper lip when he smiles. It’s not obvious at all when resting – the smiling “big” creates it. The crease runs the full length of his upper lip. Is this a double lip? I’ve read that can be caused by trauma – did the release cause this? Double lips usually involve removing the redundant tissue but that would leave him with barely any upper lip. I can’t tell if the “double lip area” is outer or inner lip tissue that should even be resected. Before surgery, when smiling, did he have much of an upper lip? It was almost cliff-like if that makes any sense.

We are now faced with what to do next. We are exploring the option to re-release what’s left of his upper lip tie, and maybe ask for the buccal ties to be released too. With your knowledge of anatomy and the cosmetic side of things, would this potentially resolve the distortion in his upper lip? Or could it release the tension (particularly if the buccal is still strong + reattached upper lip). 

We are beside ourselves wondering what the right thing is to do. I really appreciate anything you can offer.

A:Unless the upper double lip is causing a functional problem, which I am sure it isn’t, you need to leave it alone for now in a young growing child. I am not sure this was not caused by the maxillary frenulectomy…of which what the compelling need to do so was at such a young age. The upper lip may or may not have been caiued by the frenulectomy. This may be the ‘rabbit hole’ effect…you do one thing to fix one problem and then you develop a new problem. The goal is to get out of that cycle which in surgery is easy….stop doing surgery unless there is a compelling medical need to do so.

Double lip correction is an effective and straight forward procedure and can be done at any time. But I would let him grow some more and let his facial tissues develop further. I would only correct the double lip or any of the other associated issues when he is older and he finds it to be an issue.

Dr. Barry Eppley

World Renowned Plastic Surgeon