45. Lifting the upper lip with two elastic threads
KEYWORDS: upper lip lift, Lip Augmentation, vermilion augmentation, elastic threads
A long upper lip is an esthetic defect of familial origin. If the lip is not excessively long, it can be lifted by means of two elastic threads.
The preoperative design is drawn from the wing of the nose to the contralateral margin of the columella. From here, it descends obliquely to the extremity of cupid's bow, follows the edge of the vermilion border and then travels back up to the wing of the nose. Anesthesia is loco-regional.
In this Elastic Plastic Surgery procedure, implanting elastic threads increases the vermilion border, reduces the height of the cutaneous portion of the lip and prevents it from lengthening.
A tiny skin incision is made. The operator uses a fine Klemmer to create a space to house the knot at the level of the canine fossa. The Jano needle enters the small incision and travels along a superficial pathway until it partially emerges from the mucosa of the vermilion border. Next, it follows the edge of the vermilion border at a depth of 5 mm. It then rotates and travels back towards the columella at a greater depth. Finally, after travelling along the last stretch of its pathway, the two-tipped needle emerges from the small entry incision and anchors the elastic thread to the deep tissues of the lip. Once implantation is complete, the elastic threads are placed under tension and knotted. The vermilion border rotates outwards and rises and the lip shortens. The small incisions are sutured.
Capurro S. (2019): Lifting the upper lip with two elastic threads. CRPUB Medical Video Journal. Elastic Plastic Surgery section, www.crpub.org.
What other approaches can be adopted if the lip is long?
A third elastic thread can be implanted. This is fixed in depth immediately below the nostrils; it then travels along a superficial pathway in order to create a triangle extending about halfway down the lip. If the lip is very long, an appropriate amount of skin is removed from beneath, and to the sides of, the columella, without going beyond the nostrils. The two threads are then implanted. Once the threads have been knotted, the operator decides whether further skin needs to be removed. This procedure does not leave the visible scars that are typical of traditional lip-lifting techniques.
What should the patient do after the procedure?
The patient must cleanse the small sutured incisions and apply an antibiotic cream for at least 20 days. Old cosmetics must be avoided, as they may be polluted.
At what age is this procedure performed?
It is performed when the patient has a long lip. Naturally, implanting the elastic threads has an efficacious preventive effect; the procedure is therefore particularly indicated for patients whose parents have a long upper lip, in order to prevent this esthetic defect. It is also indicated for those who wish to enhance the size of a thin vermilion border in a natural way, without using fillers.
How do you get the vermilion border to turn upwards correctly?
The Jano needle must penetrate 5 mm into the vermilion border; it is then extracted until 5 mm of the tip remains in the muscle tissue. The two-tipped needle then rotates and partially emerges at the extremity of cupid's bow. Its pathway must always be 5 mm inside the vermilion border. The pathway must be superficial, but the threads must have a good grip on the vermilion border. In this way, the vermilion border turns upwards.
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