Lip Reduction Workup

  • Author: Vipul R Dev, MD; Chief Editor: Jorge I de la Torre, MD, FACS   more...
 
Updated: Dec 5, 2011
 

Laboratory Studies

The lip and its relationship to other facial structures are evaluated by frontal and profile aesthetic views as well as possible cephalometric radiograph to assess the underlying dento-alveolus and facial skeleton. The lips must be assessed, as must the relationship of the lips to the nose and chin.[5, 9] Physical examination of the lip is conducted from the face-on view to evaluate the visible vermilion (vertical height) and the transverse lip excess.

From the profile view, the upper to lower lip relationship as well as the degree of lip eversion is also noted. Prominent lips may be the result not of lip volume but of lip ectropion or labial eversion.[3] Furthermore, the orbicularis musculature is assessed for its tone and the muscular ring for its competence. Once again, the nose-lip-chin relationship is critically evaluated. If needed, a lateral cephalogram is obtained to assess the underlying dento-alveolus and facial skeletal contribution to the lip deformity.

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Imaging Studies

Lateral cephalometric evaluation is indicated to rule out dento-osseous causes of lip protrusion. It is used to assess osseous lip support, soft tissue thickness, and lip posture. For instance, maxillary retrusion with vertical deficiency and mandibular prognathism produces a pseudomacrocheilia of the lower lips, as shown below.[10]

A. Female (age 13 years) with midface deficiency sA. Female (age 13 years) with midface deficiency secondary to cleft lip and palate. The maxilla is hypoplastic and mandible is relatively prognathic with over closure. She has upper lip deficiency and lower lip prominence. B. After maxillary LeFort I advancement, the upper lip remains deficient and lower lip prominent. C. She underwent upper lip augmentation and lower lip reduction twice to achieve a harmonious facial profile.

Dento-osseous protrusion associated with microgenia can cause pseudomacrocheilia.[8] A useful cephalometric analysis consists of evaluating the linear distance from the lower incisor tip nasion B (NB) line, which is the same distance as the line from pogonion to NB line.[8] Alteration in this relationship suggests mandibular protrusion or microgenia. The normal chin and lip soft tissue thickness is approximately 12 mm in Caucasians and 15 mm in African Americans. Excessive lip incompetence could be the result of long face syndrome, open bite deformity, or muscular hypotonia.[8] Surgical-orthodontic therapy may eliminate the pseudomacrocheilia.

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Other Tests

Preoperative evaluation of lip reduction surgery should include a psychological screening of the patient's expectations of the outcome of the surgery. Patients should be counseled in advance that additional touch-up surgery may be necessary.

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Contributor Information and Disclosures
Author

Vipul R Dev, MD  Chief Medical Director, Regional Wound Care Center; Chief Executive Officer, California Institute of Cosmetic and Reconstructive Surgery; Director, HealtheUniverse, Inc

Vipul R Dev, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Surgeons, American Medical Association, American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons, Association for Academic Surgery, California Medical Association, National Medical Association, Sigma Xi, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: lifecell Honoraria Speaking and teaching; pfizer Honoraria Speaking and teaching

Coauthor(s)

Peter Wang, MD  Director of South Texas Cleft Palate and Craniofacial Team; Chief, Department of Craniomaxillofacial Surgery, Section of Plastic Surgery, Assistant Professor of Plastic Surgery, University of Texas Health Science Center at San Antonio

Peter Wang, MD is a member of the following medical societies: American Cleft Palate/Craniofacial Association, American Society of Plastic Surgeons, and Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Lawrence Ketch, MD, FAAP, FACS  Head, Program Director, Associate Professor, Department of Surgery, Division of Plastic Surgery, University of Colorado Health Sciences Center; Chief, Pediatric Plastic, The Children's Hospital of Denver

Lawrence Ketch, MD, FAAP, FACS is a member of the following medical societies: American Academy of Pediatrics, American Association for Hand Surgery, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Society for Surgery of the Hand, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Plastic Surgery Research Council

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jaime R Garza, MD, DDS, FACS  Consulting Staff, Private Practice

Jaime R Garza, MD, DDS, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Society for Aesthetic Plastic Surgery, American Society of Maxillofacial Surgeons, Texas Medical Association, and Texas Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Nicolas (Nick) G Slenkovich, MD  Director, Colorado Plastic Surgery Center

Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Jorge I de la Torre, MD, FACS  Professor of Surgery and Physical Medicine and Rehabilitation, Chief, Division of Plastic Surgery, Residency Program Director, University of Alabama at Birmingham School of Medicine; Director, Center for Advanced Surgical Aesthetics

Jorge I de la Torre, MD, FACS is a member of the following medical societies: American Association of Plastic Surgeons, American Burn Association, American College of Surgeons, American Medical Association, American Society for Laser Medicine and Surgery, American Society for Reconstructive Microsurgery, American Society of Maxillofacial Surgeons, American Society of Plastic Surgeons, Association for Academic Surgery, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

References

  1. Oliver DW, Scott MJ. Lip reduction cheiloplasty for Miescher's granulomatous macrocheilitis (Cheilitis granulomatosa) in childhood. Clin Exp Dermatol. Mar 2002;27(2):129-31. [Medline].

  2. Pitanguy I, Gonzalez R, Brentano J, et al. Surgical treatment of macrocheilia. Head Neck Surg. May-Jun 1988;10(5):309-18. [Medline].

  3. Habel G, O'Regan B. Surgical management of macrocheilia of the lower lip. Br J Oral Maxillofac Surg. Oct 1990;28(5):295-8. [Medline].

  4. Stucker FJ Jr. Reduction cheiloplasty. An adjunctive procedure in the black rhinoplasty patient. Arch Otolaryngol Head Neck Surg. Jul 1988;114(7):779-80. [Medline].

  5. Ellis DA, Rubin AM, Shemen LJ. University of Toronto teaching rounds. Esthetic evaluation of the lips and cosmetic reconstructions. J Otolaryngol. Jun 1982;11(3):221-5. [Medline].

  6. Farkas LG. Anthropometry of the Head and Face in Medicine. NY: Elsevier Science; 1981.

  7. Gunter PJ. Facial analysis for the rhinoplasty patient. Presented at: Dallas Rhinoplasty Symposium. 1999:17-28.

  8. Epker BN, Wolford LM. Reduction cheiloplasty: its role in the correction of dentofacial deformities. J Maxillofac Surg. Jun 1977;5(2):134-41. [Medline].

  9. Stucker FJ Jr. Profile contouring including cheiloplasty. Arch Otolaryngol. Nov 1979;105(11):680-3. [Medline].

  10. Pensler JM, Mulliken JB. The cleft lip lower-lip deformity. Plast Reconstr Surg. Oct 1988;82(4):602-10. [Medline].

  11. Cederna PS, Fiala TGS, Smith DJ Jr, et al. Melkersson-Rosenthal syndrome: reduction cheiloplasty utilizing a transmodiolar labial suspension suture. Aesthetic Plast Surg. Mar-Apr 1998;22(2):102-5. [Medline].

  12. Field LM. Macrocheiloplasty. Principles and techniques. J Dermatol Surg Oncol. Jun 1992;18(6):503-7. [Medline].

  13. Niechajev I. Lip enhancement: surgical alternatives and histologic aspects. Plast Reconstr Surg. Mar 2000;105(3):1173-83; discussion 1184-7. [Medline].

  14. Niamtu J 3rd. Lip reduction surgery (reduction cheiloplasty). Facial Plast Surg Clin North Am. Feb 2010;18(1):79-97. [Medline].

  15. Dedic A, Masic I, Pasalic A, et al. [Therapy of the Melkersson-Rosenthal syndrome with kenalog]. Med Arh. 2000;54(2):119-20. [Medline].

  16. Matory EW. Lip thinning. In: E Courtiss, ed. Male Aesthetic Surgery. 2nd ed. St. Louis: Mosby; 1991:180-1.

  17. Puri N, Pradhan KL, Chandna A, et al. Biometric study of tooth size in normal, crowded, and spaced permanent dentitions. Am J Orthod Dentofacial Orthop. Sep 2007;132(3):279.e7-14. [Medline].

  18. Trussler AP, Kawamoto HK, Wasson KL, et al. Upper lip augmentation: palmaris longus tendon as an autologous filler. Plast Reconstr Surg. Mar 2008;121(3):1024-32. [Medline].

 
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Frontal and profile view of a 45-year-old African American woman seeking reduction of her upper lip.
Design of the wedge-shaped excision. Lateral extensions are necessary to eliminate dog ears.
Frontal and profile views 2 months postoperatively. Note the better result seen in frontal view compared to profile view.
A. Face-on view of a 25-year-old male who sustained facial trauma 1 year ago. He presents with persistent upper lip enlargement after all other facial edema subsided. B. Pursing of lips shows exaggerated eversion. C. Profile view.
A. Intraoperative view demonstrating clamping down on the vermilion with a side cutting bone cutter. B. Intraoperative result.
A. 4 months postoperative view. B. Profile view.
A. Female (age 13 years) with midface deficiency secondary to cleft lip and palate. The maxilla is hypoplastic and mandible is relatively prognathic with over closure. She has upper lip deficiency and lower lip prominence. B. After maxillary LeFort I advancement, the upper lip remains deficient and lower lip prominent. C. She underwent upper lip augmentation and lower lip reduction twice to achieve a harmonious facial profile.
A. Child (age 6 years) with cerebral palsy who has hypotonic upper and lower lips presents with lip incompetence and uncontrollable drool. B. Design of the lower lip full-thickness excision.
Lip reduction. Image from: Rees, T. Mentoplasty, prognathism and cheiloplasty. In Rees, Cosmetic Facial Surgery, 1st ed. Philadelphia, Pa: WB Saunders, 1973:550.
 
 
 
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