Patients often asked me what are the differences between a skin-only lip lift and my muscle hemming technique. To put it simply, longevity, scarring and nasal distortion.
Skin Only Lip Lift
Until the late 90’s, the only lip lift I knew how to do was the skin only type. I would perform this by excising a certain amount of skin below the nasal base and sewing the lower edge of the excision to the upper edge which happens to be the skin of the nose. The only thing now supporting this entire weight of the upper lip (which happens to move millions of times a day, eating, kissing, expressing and speaking) is the freshly closed incision at the skin level. One can imagine that this provides little support for all the action occurring around the upper mouth area. Consequently, the longevity of the lip lift itself is lessened, the nostrils are more likely to be pulled downwards while the resulting scar is more likely to stretch and thicken.
Muscle Hemming Lip Lift
After many years of observing the long-term results of skin-only lip lifts, I developed the muscle hemming technique. By employing moderate principles of plastic surgery in which nip and tucks (such as a facelift) are improved by lifting and tightening the layers below the skin including muscle I have noted a significant benefit to my lip lifts in terms of scarring, longevity and less nasal distortion. However, the recovery period was notably increased. The muscle hemming technique involves placing slowly dissolvable sutures into the muscle layer below the skin and intern suturing that to the periosteum (lining) of the bone deep to the nose itself. The lip lift is thus a solid one without relying on skin closure to achieve its superior long-term results while lessening the chance of undesirable scarring and pulling around the nostrils.
Skin Flap Lip Lift
Which brings me to today. For the last 3 years I have been employing a skin-flap technique which provides all the benefits of the muscle hemming technique but with half the recovery. Suturing of the muscle is minimized in this technique but none of the longevity and superior scarring is sacrificed. The period of significant distortion and swelling has been halved from 2 weeks to less than 1. Additionally, the results are “softer” in appearance with minimal to no distortion of the nostril area.
Performing the modern lip lift with minimal-to-no-scarring and achieving a permanent beautiful result is challenging . It requires attention to minute detail and appreciation of how the oral region plays a central role in facial harmony. The vast majority of patients are thrilled with the subtle yet powerful results of this operation, but it has taken over 2 decades of unwavering dedication and imagination to get this far.
While many surgeons feel uncomfortable with performing an upper lip lift, let alone one simultaneously with a rhinoplasty, it can be safely done. The concern revolves around the fear of losing vital blood supply to the columella (the fleshy straight partition that exists between the nostrils), because if the blood flow is compromised to this area then necrosis or loss of the columellar skin can result. This, in turn, can lead to a possible unsightly scar. If the nose job is performed through an endonasal or closed approach ( whereby all incisions are strictly confined to within the nose itself) there should be little concern for this. However, caution must be exerted when the rhinoplasty is performed with an open technique- one that involves making a scar across the columella in order to gain better access and therefore better visualization and control of the operation. In a normal open technique the incision is placed about halfway up on the columella. Since an upper lip lift necessitates making an incision at the base of the columella (where it joins with the upper lip), the incision needed for the open rhinoplasty can also be the same one- so the incision will be used for two different purposes.
Scar placement for rhinoplasty alone and in combination with an upper lip lift
The situation becomes more complicated, however, when a persisting scar stemming from a previous open nose job is present. In this situation, the plastic surgeon must carefully plan his incisions so as not to compromise the blood supply. More often than not it is safer to keep the upper lip lift incision separate from the rhinoplasty’s in these revision cases.
The planning becomes even more critical when the nostrils need to be narrowed during the nasal aesthetic surgery ( Weir excisions). Not only does the upper lip lift need to be blended well onto the columella, but it also needs to be conformed to a freshly narrowed nasal base, with minimal undesired tension across the final scar ( which can increase the chance of it being noticeable). Intricate surgery along with an intimate knowledge of the regional anatomy and the biophysics of an upper lip lift are key ingredients to a beautiful outcome in this combination surgery. Following are two examples of before and afters of this combo surgery.