Lips

Lip surgery is one of Dr Haworth's specialties. In fact, he is one of the premier pioneers of lip shaping procedures, having performed his techniques on thousands of patients around the world.

As our faces age, so do our lips. The oral region tends to droop and sag just as faces and breasts do. Volume loss is only part of the explanation for this phenomenon; the main culprit is a degradement of the structure of the skin and its supporting tissue. Learn more about the characteristics of youthful lips at our site dedicated to lip beautification.

The ideal youthful lip displays the following characteristics:

• Plump contour with 4-5mm teeth showing when the mouth is at rest
• Width of the lips as measured from corner-to-corner is no more than double the width of the nostrils
• The thickness or height of the middle aspects of the lower lip is twice to thrice of the corresponding area of the upper lip
• Proportional distance between upper lip and nostrils
• Corners that slightly turn up naturally
• Firm lower lip with plump pout confined to the center third to half of the lip only
• Precise definition between vermillion border and the smooth surrounding skin around the mouth ("white roll" or labial ledge)

Lips undergo the following changes with age:

• Inversion where the lips turn in so that no teeth are visible when the mouth is at rest
• Elongation where the width from left to right widens
• Upper cutaneous lip elongation where the distance between the bottom of the nostrils and the upper vermillion border increases imparting a 'horsey' appearance
• Drooping of the corners
• Lower lip hanging or redundancy
• Wrinkling in the skin around the lips (and the cause of lipstick "bleed')

In order to have youthful, sensual lips, we now know that shape is far more important than volume. Rather than simply requesting their lips be made bigger with fillers, increasing numbers of our patients are seeking beautification through reshaping.

Lip reshaping is customized for the patient based on her facial structure, tissue characteristics and aesthetic expectations. Lip reshaping can involve one or a combination of procedures done either at the same time or in sequence. It also offers the distinct advantage of being a permanent solution. Learn more about Dr. Haworth's philosophy on aesthectic plastic surgery at our site dedicated to lip beautification.

The most appropriate candidates for lip reshaping and fat transfer are patients who have:

• A desire for more permanent results than temporary injectable fillers (which only address volume anyway)
• Lips that have become thin, inverted, shapeless or sagging with age
• Had other facial rejuvenation surgeries and want their lips to sync up with the rest of their face
• Had a rhinoplasty and find that their upper lip is too long
• Naturally unbalanced lips
• Naturally thin, inverted or flat lips that are nearly invisible, imparting an angry expression

Those who already possess ideally shaped lips but desire a bit more plumpness may only need added lip volume. Our practice offers both temporary (injectable filler) and permanent (fat transfer) augmentation.

FAT TRANSFER

Fat transfer is an excellent way to permanently and naturally add volume to the lips. Read more.

CORNER LIP LIFTS

Corner Lip Lifts are designed in order to elevate an otherwise drooping outer corner of the mouth. Patients often complain of constantly looking angry or sad compounding their aging appearance. However, young patients can also have downward turning corners of their mouth that they may have had ever since they can remember. Dr. Haworth performs 3 versions of the permanent lip lift:

1. TRADITIONAL OUTER CORNER LIP LIFT with a near invisible outer scar located inconspicuously along the outer most corner of the red border of the upper lip. This surgery can be done under local anesthesia and involves 2 layers of stitches placed with the aid of magnification to minimize any scar. A singular outer stitch is removed in 5 days at which point makeup can be worn. Recovery from this surgery is minimal at worst.

BEFORE	AFTER

SURGERY SPECIFICS

2. MEDIALIZED EXTERNAL LIP LIFT again with a near invisible scar which can be performed under local anesthesia. This surgery not only elevates the corners of the mouth, but increases the red lip visible on either end of the upper lip. It also decreases any displeasing downward slope the upper lip takes as measured from its center. In other words, it is quite powerful in its ability to change the shape of the upper lip, giving unprecedented control to the surgeon. Despite its apparent simplicity, this surgery can be very challenging to even an experienced surgeon since it requires extraordinary detail to execute symmetrically and with pleasing results.

BEFORE	AFTER

SURGERY SPECIFICS

3. AN INNER ONE (DEPRESSOR ANGULI ORIS-DAO RELEASE) is reserved for younger patients or for those with drooping outer lip corners but no folding, wrinkling or skin sagging below the corner of the mouth. The surgery divides a small muscle through an incision just inside the cheek. All sutures are dissolvable therefore none need be removed.

BEFORE	AFTER

SURGERY SPECIFICS

UPPER LIP LIFT

UPPER LIP LIFTS ACHIEVE 3 GOALS:

1. They shorten the distance between the nose and upper lip. The upper lip grows longer with age, so oftentimes an upper lip lift is performed along with a facelift at the same time. Patients who have had previous rhinoplasties occasionally complain that their upper lip appears longer after the nasal surgery so an upper lip lift can be appropriate for these individuals as well.
2. They allow more upper tooth exposure. One need not go further than any common fashion magazine and realize that all the young models seem to have one thing in common with their lips and oral area- their upper teeth are nice and are visible (about 4-5 mm) with their lips slightly parted in natural repose (i.e., not smiling).
3. They roll out the upper lip that is otherwise inverted. What this means is that the red portion of the upper lip will be more visible, therefore enhanced. This effect is subtle and will not create exaggerated Angelina Jolie's lips alone.

BEFORE (with markings)	Stylized rendering after excision.	AFTER

Dr. Haworth has altered his upper lip lift technique 3 times over the last 14 years. The first version involved skin-only lip lifting, but he realized that results were not as lasting and the scars not as good. Additionally, there was a higher frequency of collateral distortion around the nose in which the nostrils were displaced downwards by a millimeter or two. Therefore, he exclusively started incorporating lifting the orbicularis oris muscle (below the skin) as well. Contrary to common myth, this does not involve cutting the muscle out, but is simply a shortening or hemming of the muscle via a folding technique onto the periosteum (lining) of the bones beneath the nose. This tended to not only improve the scarring (to near invisibility) with minimal-to-no nasal distortion, but also provide far longer-lasting results. Recovery is slightly longer with some subjective stiffness and numbness of the upper lip lasting for about 2-4 months. Rarely does numbness last longer since only microscopic nerve branches exist within the area the actual cutting and sewing is performed. It is analogous to the tempoarary numbness one may experience after a breast augmentation, tummy tuck or, indeed, any type of surgery.

BEFORE	AFTER (Skin-only ULL and Lower V-Y plasty)

Along with rhinoplasty, an Upper Lip Lift in the properly selected patient, produces some of the most dramatic improvements seen in plastic surgery today. It is one of those surgeries that can also make you look younger even if performed alone and despite its often times dramatic effect, no one can pinpoint exactly why you look better.

SURGERY SPECIFICS

F. A. T. M. A.

FATMA (fat transfer & mucosal advancement) are actually 2 procedures rolled into one. This surgery produces permanently fuller lips with your own tissue, combining rearrangement of the tissue just inside your mouth with fat transfer. These procedures act by working synergistically to create fuller lips that either technique cannot produce on their own. As we age, many people will notice that their lips tend to thin out. However, the situation is actually more complex than simple attenuation of lip tissue. The lips loose support from the teeth (since the actual bony skull retracts in shape pulling in the teeth along with it), invert or roll inwards in the process while the actual width of the mouth gets wider. FATMA directly addresses these very pathophysiological issues by rolling out the lips while narrowing the oral aperture.

Markings of the upper lip lift.	Stylized rendering after excision. Lift vectors are shown.

Dr. Haworth reserves FATMA for those patients with very thin lips that tend to be inverted or roll inwards towards the teeth. No amount of filler in these types of lips can produce significantly fuller lips that appear natural. FATMA is performed under sedative anesthesia and takes about 1.5 hours to perform on both the upper and lower lips. "V" shaped flaps are first strategically planned on the outside of the upper and lower lip and their design then transposed to their mirrored position on the inside of the lips.

These are then delicately elevated as tissue flaps and rearranged from a "V" shape to a "Y " shape to roll out the lip itself. The surgery does result in obvious swelling for 2-6 weeks, so patients choosing to undergo this must plan their schedule accordingly.

BEFORE	AFTER (Dental reconstruction, F.A.T.M.A. and corner lip lift)

SURGERY SPECIFICS

To read more about Dr. Haworth's FATMA technique, CLICK HERE for the published article.

LOWER LIP V-Y PLASTY

A Lower Lip lift incorporating V-Y plasties or other tissue rearrangements helps solve the difficult problem of the aging lower lip. An aging lower lip manifests itself as a lip that flattens in shape, thins while turning inward towards the teeth (except in times if a weak, underdeveloped chin is present as well) and drops downward to expose the lower teeth (the opposite effect of a dropping upper lip).

Through a simple operation involving minor muscle tightening and rearrangement of the tissue located just inside of the lower lip, the above effects can be significantly lessened. However, complete correction with any current technique is heretofore near impossible.

BEFORE	AFTER

SURGERY SPECIFICS