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. [16, 20] 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. [6] 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.
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. [21]
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.
Dento-osseous protrusion associated with microgenia can cause pseudomacrocheilia. [19] 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. [19] 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. [19] Surgical-orthodontic therapy may eliminate the pseudomacrocheilia.
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.
-
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.
