Your Questions
Your Questions
Q: Dr. Eppley, I am interested in lip reconstruction. Attached are photos of my lips. Two years ago, I had a vermillion lip advancement. However, the surgeon did a v/y to the central portion of my upper lip…something that was never discussed beforehand. I’m left with no cupid’s bow and no philtrum. My lower lip hangs down and there are ‘pouches’ just below the lower lip. What can you do to make my mouth look better, and most of important, what can be done to lift my lower lip so that my teeth don’t show and those pouches diminished. Thank you so much in advance.
A: Thank you for sending your lip pictures. Lip reconstruction efforts can be done on both the upper and lower lips. Certainly the upper lip vermilion advancement can be improved because that is straightforward redesign of the shape of the upper lip and advancing the vermilion edges according to the new pattern cut out. This is very predictable and will make a positive improvement. Raising the lower lip, however, is considerably more challenging, not easy, and very unpredictable. Regardless of the dubious success of raising the lower lip, the pooches that lie below and beyond the vermilion of the lower lip can not be improved. Techniques to try and raise the lower lip usually require a sling or suspension of tissue placed across the lower lip from one mouth corner to the other. (technically from a small incision at the end of each nasolabial fold crease to the sling can be threaded through) This sling could be comprised of your own tissue (abdominal fascia) or an allogeneic (cadaveric) sling of dermis can be used. (e.g., Alloderm)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am in need of lip and earlobe reconstruction. A middle piece of my upper lip and my entire left earlobe were bitten off by a dog last year. Both my lip and ear have fully healed but I need reconstruction to get them to look better. I have attached some pictures of my lip and ear for your thoughts on best to reconstruct them.
A: Thank you for sending your excellent pictures. They show both the upper lip and left ear deformities well. Both of these pose some of the most difficult challenges in reconstruction of these areas. The upper lip lacks volume and also has a color mismatch of the vermilion of the surrounding lip. While the color and volume problem could be improved by excision of the defect and bringing good tissue in from the sides, that will result in a vertical scar extending up into the currently unscarred upper lip skin. Therefore I would prefer to build up the volume with a dermal-fat graft and then add color by micro pigmentation (tattooing) That would be [referable to me than a vertical upper lip scar. From an ear standpoint, earlobe reconstruction would need to be done by a two-stage procedure. The first stage would be the transfer of a skin flap from the tissue next to the earlobe and post auricular crease. The second stage would be the release of the skin flap and wrapping it around an ear cartilage graft to form the lobule.
Both upper lip and left earlobe reconstruction could be done at the same time under local or sedation anesthesia.
Dr. Barry Eppley
Indianapolis, Indiana