47. Elastic Lifting of the Upper Lip with three threads
KEYWORDS: lip lift, elastic lip lift, upper lip suspension, Elasticum EP4
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 or three elastic threads in order to reduce its length.
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. This design is reproduced on the contralateral portion of the lip. The pathway of a third elastic thread, extending halfway down the lip, is then drawn. Regional anesthesia is carried out.
Local anesthesia is carried out along the pathway of the two-tipped needle.
This Elastic Plastic Surgery procedure increases the vermilion border, reduces the height of the cutaneous portion of the lip and prevents it from lengthening.
A microsurgery scalpel is used to make a 2 mm incision in the fold of the wing of the nose at the level of the canine fossa. The operator uses a fine Klemmer to create a cavity to house the knots. The tip of the Jano needle is inserted into the small incision. The two-tipped needle is directed towards the surface and travels along a superficial pathway until it partially emerges from the mucosa of the vermilion border. The elastic thread is pulled through. The two-tipped needle is extracted until 5 mm of the posterior tip remains in the tissues. It then rotates and follows the edge of the vermilion border, partially emerging at the extremity of cupid's bow. The elastic thread is pulled through. The two-tipped needle is extracted until 5 mm of the posterior tip remains in the tissues. It then rotates and travels along a deeper pathway towards the right-hand edge of the columella. The elastic thread is pulled through. The Jano needle is extracted until about 8 mm of the posterior tip remains in the tissues. It then rotates, anchors the elastic thread to the deep tissues of the lip, and emerges from the small entry incision in the fold of the wing of the nose.
The second elastic thread is now implanted. Having made an incision with a microsurgery scalpel, the operator uses a fine Klemmer to create a cavity. As the Jano needle travels through the lip, its pathway becomes more superficial. When the needle emerges from the vermilion border, the elastic thread is pulled through. The needle is extracted until 5 mm of the tip remains in the tissues. It is then rotated and follows the edge of the vermilion border, partially emerging from the extremity of cupid's bow. From here, the Jano needle follows a deeper pathway, partially emerging from the left-hand edge of the columella. The two-tipped needle rotates and anchors the elastic thread in depth before emerging from the small incision. The two threads are now placed under tension and knotted under the guidance of the tip of a Klemmer.
The third thread is now implanted. The two-tipped needle travels through the deep tissues of the lip, partially emerging from the contralateral incision. The needle creates a half-loop immediately beneath the skin, halfway down the lip. It then follows a deeper pathway, emerging from the entry incision.
The small incisions are sutured with absorbable threads.
The increase in vermilion and the reduction of the white part of the lip are clearly visible.
Capurro S. (2020): Elastic Lifting of the Upper Lip with three threads. CRPUB Medical Video Journal. Elastic Plastic Surgery section, www.crpub.org.
What other approaches can be adopted if the lip is long?
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. This procedure does not leave visible scars.
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.
What effect has the third elastic thread?
In addition to further stabilizing the lengthening of the lip, pull the skin of the lip in depth, avoiding swelling.
Has the patient already undergone a surgical shortening of the lip?
Yes, and the lip has lengthened again. The elastic threads prevent the lip from continuing to stretch.
What warnings in the post-operative period?
Small surgical incisions should be medicated with an antibiotic ointment. Locally the patient should only use new cosmetic products.
Is there also a suspension of the lower lip?
Yes, it is mostly performed in the rare facial nerve agenesis and is published on CRPUB.
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