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59. Elastic lifting of the lower lip

KEYWORDS:elastic lifting of lower lip, Elasticum, elastic thread, Jano needle

This patient asked us to correct the detachment and drooping of her lower lip, the outcome of maxillofacial surgery performed years earlier to reduce the length of her face. During the maxillofacial operation, her chin was reduced and reinforced with a metallic plate, which caused the tissues of the chin to lose their adherence. This loss of adherence caused the lip to sag and droop. This can easily be corrected by implanting an elastic thread (Elasticum EP4), to suspend the lower lip to the two fasciae of Loré.
To explain to the patient how this procedure is carried out, and to familiarise her with this particular lifting technique, we simulated the suspension of the lower lip with an elastic sticking plaster, which remained in place for a few hours.
Once local anesthesia has been carried out along the lines of the preoperative design, the procedure begins. An 8 mm incision is made behind the lobe of one ear, and the tissues immediately above the fascia of Loré are dissected with scissors. A spreader is used to extend the access of the two-tipped Jano needle slightly beyond the ear. The operator now inserts the Jano needle at a slight angle and anchors the elastic thread to a small superficial portion of the fascia of Loré. The needle now partially emerges from the skin of the cheek and the elastic thread is pulled through. A Klemmer is always attached to the end of the elastic thread.
The two-tipped Jano needle is extracted until 10 mm of its posterior tip remains in the tissues. It is then rotated and follows the preoperative design.
The assistant keeps the elastic thread under slight tension, to allow the needle to pass more easily through the tissues, which have been injected with silicone. This patient has already undergone two sessions of Adipofilling with adipose and stromal cells, to correct the deleterious effects of the liquid silicone on the skin.
The Jano needle partially emerges from the skin and the elastic thread is pulled through. When 5 mm of the posterior tip remains in the tissues, the two-tipped needle rotates and continues along its pathway, following the preoperative design.
Once beyond the tragus in the region of the contralateral cheek, the Jano needle is partially extracted. The elastic thread is pulled through and placed under tension. When 1 cm of the posterior tip remains in the tissues, the Jano needle is rotated and penetrates to a greater depth, first vertically and then tangentially. At this point, the operator can no longer move the tissues by moving the needle sideways. This is because the tip of the needle has penetrated into the fascia. The Jano needle pinches the fascia of Loré and then immediately moves upwards into the subcutaneous tissue, partially emerging along the line of the preoperative design. The assistant maintains slight traction on the thread, to allow the needle to pass through the tissues more easily. The elastic thread is pulled through. The operator tugs the thread slightly a few times, to ensure that it is properly anchored to the fascia of Loré. The two-tipped needle then rotates and passes close to the vermilion border. The needle continues along its pre-established pathway. The operator uses his fingers to check that the elastic thread has passed through the lip correctly. As this patient has already undergone several operations and injections of liquid silicone, a needle-holder must be used to facilitate the passage of the needle. The Jano needle partially emerges from the skin in front of the tragus and, with the aid of a spreader, is extracted from the small incision behind the earlobe. The two ends of the elastic thread are placed under tension and knotted. The small incision is sutured.
Elastic lifting of the lower lip can also be carried out to reduce the visibility of the lower teeth. As is known, the elastic thread is impalpable and, once colonised by connective cells, is transformed into a natural “ligament” that becomes integrated into the subcutaneous and muscle tissue.

Capurro S. (2023). Elastic lifting of the lower lip. CRPUB Medical Video Journal. Elastic Plastic Surgery section. www.crpub.org.

FAQ

Can elastic lifting of the lower lip also be carried out for neurological reasons or to treat scarring?

Yes, it can also be carried out to make the lower teeth less visible.

What can be done to treat the outcome of liquid silicone injection?

Adipofilling improves the quality of the skin and the irregularities of the skin surface and reduces the effects of reactions to silicone. We frequently remove the liquid silicone injected into the vermilion. We use the pulsed timedsurgical cut which leaves almost invisible scars.

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