When to Perform a Lip Lift and When Not To

Let me just get this out of the way: I hate lip lifts. Well not always. I just think they are too often performed creating lips that look unnatural. There are exceptions to this rule but there are very few, which I shall try to elaborate in this blog article. Let’s begin with why do people want lip lifts? The number one reason is a distorted sense of importance imparted to the upper lip for its sign of femininity and youth when in fact the bottom lip can create a much more desirable look without the risk of looking artificial. As I have enumerated in other articles, the upper lip should almost always remain smaller in size relative to the lower lip. When this lip principle is violated, the upper lip can look unnatural. In addition, the upper lip tends to diminish in size as one ages so overlifting the upper lip can look artificial, especially when one is older, which is precisely when someone wants to have a lip lift performed. Again, there is an exception to this rule upon which I shall elaborate.

Donatella Versace looks as if she is a bad victim of unnecessary lip lift surgery

Let’s also clarify what I am defining as a lip lift:  the incision is made underneath the nose along the border of the nose to the face, and tissue is removed so that the lip can be brought upward and rolled out.  This technique is very effective in lifting the lip but sometimes too effective.  When one takes two fingers and gently rolls the lip upward just a little bit the surgical modification is almost always more than what a finger lift demonstrates.  Therefore, caution should truly be exercised when considering a lip lift.  In addition, there will be a scar:  something a prospective patient must know.  Although with a careful plastic surgery 3-layer closure performed with meticulous precision, this incision should be rarely seen, a patient must know that a scar can be visible close up and that makeup may be needed to camouflage it to an ideal level.  In addition, there can be rarely but still possibly slight distortion to the nasal shape due to some pull on the bottom of the nose but again this is unlikely.  What this article is not talking about is a lip advancement in which the incision is made at the border of the lip and white tissue removed to allow for advancing the red lip upward.  In my opinion this procedure is so fraught with complications including an unnatural shaped lip and visible scar not to mention an overinflated look that there is almost no indication to perform a lip advancement.

Now, when would a lip lift be indicated in a patient then?  Let’s first discuss the aging of the upper lip to have you understand that a lip lift is actually the most intuitive surgical maneuver to correct moderate aging of the upper lip but still may not be ideal in many cases.  The white portion of the upper lip begins to lengthen over time and the red lip begins to become thinner.  This causes the upper lip to hang over the front white teeth with and without smiling, which can be a sign of aging.  The lip lift is actually a very targeted procedure that can correct all three problems:  shorten the white lip, increase red lip show, and show teeth better in smiling and in non-smiling positions.  Intuitively attractive right?  Well yes.  But that does not mean in practicality it always looks good, as it seldom does.

Here is who I have found to be the perfect candidate for a lip lift:  an older woman who has absolutely no upper red lip at all, has a very long white lip, has no upper teeth show when she opens her mouth and when she smiles, has bad surface skin that can hide the scar, and does not mind wearing makeup to cover the scar if necessary.  That is the ideal patient for a lip lift.  The least ideal patient is a young 30-something year old man (or woman) with flawless skin, who has a relatively full upper red lip and relatively short white lip, has good or too much teeth showing when smiling and when not smiling but only wants a little bit more red lip to show.  Unfortunately, most people who want lip lifts fall into the latter category or at least towards the latter category and are truly bad candidates for this procedure because of the risk of visible scarring and an unnatural looking upper lip.  Next time you gently pull up on your upper lip and say that is what you want the physician to do, please heed the cautions enumerated above and think twice.

Sam M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas, specializing in lip augmentation and lip reduction procedures. To schedule a consultation please call (972) 312-8188. To Learn more about Dr Lams’ facial plastic surgery procedures or to ask Dr Lam a question please visit his plastic surgery forums.

Understanding The Importance of Lip Transitions When Creating Natural Looking Lips

I have been thinking about transitions from the red lip to the non-red lip because of two women that I saw in the past few days.  First, there was a woman who came from Oklahoma that had these hanging red lips towards the corners of her mouth that looked like a fish.  She had only those side areas injected with silicone because she wanted to make them look fuller.  But a natural lip should taper gently to nothing as it reaches the corners of the mouth.  Instead, hers bulged as it reached the corner of the mouth.  I performed a lip reduction to correct her problem.  The second lady that I saw insisted on having fillers placed into the sides of her lips because she said she drooled at night.  I explained that functionally I do not think filling those sides would help her not drool but more importantly it would look terribly unnatural.  Remember that I truly understand how lips should naturally look, and I ask you to defer to my better judgment when designing your lips so that they stay natural in appearance to all passersby.

Lips that fail to taper to the corners of the mouth look unnatural, which has been corrected through surgical lip reduction.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon, specializing in lip reduction and lip enhancement procedures . For more info, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our lip surgery forum.

Concerns After Lip Reduction: Revisited

Since I perform a very large number of lip reductions, I have worked hard to discuss with individuals all of the risks, complications, and recovery issues that I can imagine and that I have experienced over the years.  This blog article will discuss what I have encountered so that hopefully as many of your answers to your questions can be found before having a procedure done with me.

First we will address recovery issues that I think are helpful for a prospective patient to be aware of.  The number one concern that individuals have is how long will they be swollen.  This is a hard one for me to answer because swelling is variable.  I have seen as little as a few days and as great as a few months.  However, in general it is about 1 to 2 weeks of unfavorable swelling with the worst being the first several days.  In fact, the lips can swell after the first few days to be much larger than they were even before the surgery, a fact that can be alarming.  This is normal.  I repeat this is normal.  Most people take only a week off from work for practical reasons but must understand that there can be ongoing swelling into the second week.  For ethnic lip reductions, the worst that I have seen for duration of swelling was 5 weeks but this was in a woman who had a very very large lip reduced and I have yet to encounter that long a time for swelling in another ethnic individual.  For correction of previous bad silicone I have see up to 5 months of mild fluctuating swelling but that one woman had swelling that was already present before I performed her lip reductions so I believe this is an atypical case.

Corrective Lip Reduction for Aquamid

Another concern is how long will the lips have visible sutures.  Typically again this is for 1 to 2 weeks.  It is imperative that the sutures not be trimmed during the first week and only sutures that are hanging loose be trimmed after the first week.  Allowing sutures to dissolve by themselves is the key.  Also the incision for the first several weeks can be hanging outward more until the swelling starts to dissipate.  This is normal.   If the lip has some bleeding in the first week or two, that is normal.  All you have to do is hold pressure.  It will stop.  If a suture becomes unraveled early and even if the wound slightly opens, it should still heal fine.  This happens in a few cases.  The lips can also feel very numb afterward and even stay relatively numb for a few weeks to months, which should not raise alarm.  The lips can also feel tight, especially when opening one’s mouth or smiling and this can last for several weeks and at times even somewhat for several months.

Risks of a lip reduction include but are not limited to over or under reduction, scarring, and asymmetry.  I always tell my patients that it is very important for them to trust me on how much lip I can reduce because any more or any less may be a problem for them.  Too much lip reduced and the person could have a gummy smile, lip incompetence, a tight feeling or look unnatural.  Too little lip reduced and no result could be visible.  Given these limitations I always suggest that if one would need a further lip reduction that he or she wait for at least 6 months before contemplating any further reduction (for which I would not charge for the added procedure) because healing may be delayed with too quick another reduction and the risk of overreduction is then possible with all of the attendant problems enumerated above.  I only need to perform a further reduction in less than 5% of those who undergo lip reduction with me.  However, it is fully in my discretion to decline an individual in whom I think the risk is too great to undergo another reduction.

I have had two patients with scarring, and they were both African-Americans.  The scarring was only about 1 mm of thickness at the incision line and was easily handled with 1 to 2 rounds of 5-flourouracil injections.  Unfortunately, I am one of the few people who know how to do this procedure so you may have to fly back for me to do this, which you would be responsible for any incidental and travel expenses but I would not charge you for my services.  Fortunately, I have only had 2 cases of this out of several hundred so the odds are favorable that there will be no scarring.  As a reminder, an actual keloid is near impossible on the face even if you have a history of them on your ears, neck, scalp, or body so I am not concerned about that.  Asymmetry is very unlikely, and I do not remember having a case of this occur but obviously it is always a risk.  More often than not if you see asymmetry it is either something you had before (so please look at your lips carefully before having a procedure with me) or is very slight and should not be noticeable on normal social or professional distances.  I hope this extensive catalog of the risks. limitations, and recovery issues following a lip reduction procedure with me was helpful for you.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon, specializing in lip reduction and lip enhancement procedures . For more info, or to schedule a consultation please call (972) 312-8188. If you would like to ask Dr Lam a question please visit our lip surgery forum.

Nicole Kidman’s Lips: The Non-Disappearing Lip

Celebrities all are subject to bad plastic surgery like the rest of us. They just so happen to have their mugs plastered across magazines and television appearances, making their mistakes ever so more glaring. Nicole Kidman’s lips are no exception to this problem.

Nicole Kidman’s Fake Lips

The overly enlarged upper lip and the shapelessness of it resembling a bloated sausage are definitely hallmarks of bad lip enhancement work.  However, these unaesthetic attributes that are present when the lip is in repose are also present when the lip is fully smiling.  Normal lips tend to flatten out and at times almost disappear when one smiles.  However, her lips remain round when smiling which is a dead giveaway product was overfilled in the upper lip.  I have had numerous patients come asking for fillers because their upper lip disappears when they smile.  I use Nicole Kidman’s lips as an example that in fact one’s lips should almost disappear when smiling otherwise this can be a sign of unnaturalness.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon in Dallas, Texas. To learn more about Dr Lam’s lip surgery procedures please call (972) 312-8188 to schedule a consultation. If you would like to ask Dr Lam a question about lip surgery please visit our lip surgery forum.

Jody, Dr. Lam’s patient, gives her testimonial 1 year after her upper and lower lip reduction procedure and talks about how it has changed her life.