Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Lip reconstruction can be performed under local anesthesia with sedation or general anesthesia, depending on the complexity of the flap and the patient’s comfort level. The airway is secured, often with a nasal tube or a specialized oral tube, which is placed away from the surgical field to give the surgeon unobstructed access to the lips.
The anesthesia team continuously monitors vital signs. The patient’s eyes are protected, and the face is prepped with sterile solution. Local anesthetic with epinephrine is injected into the lip to numb the area and constrict blood vessels, minimizing bleeding and allowing for precise visualization of the anatomy.
The surgery begins with a critical analysis of the defect. If the surgery is for cancer, the tumor is removed, and margins are checked (often via frozen section pathology) to ensure no cancer cells remain.
Once clear, the wound edges are “freshened” or debrided. The surgeon cuts back the tissue until healthy, bleeding muscle and skin are reached. The defect is then measured again to determine the exact dimensions required for the flap.
Based on the measurements, the flap is marked on the donor site (the cheek or the opposing lip). The surgeon incises the skin and carefully dissects the tissue. For Abbe or Estlander flaps, the dissection is meticulous to locate and preserve the labial artery pedicle.
The flap is elevated, meaning it is lifted from its bed while remaining attached to its blood supply. The surgeon checks the color and capillary refill of the flap to ensure it is well-perfused before moving it into the defect.
If significant nerves were cut during the injury or resection, the surgeon may perform a neurorrhaphy (nerve repair). Using a microscope and sutures thinner than a human hair, the ends of the nerve are reconnected.
This step is crucial for restoring sensation and muscle tone. While nerve regrowth is slow, performing this repair gives the best chance of regaining feeling and preventing the droop associated with paralysis.
The core of the reconstruction is the repair of the orbicularis oris muscle. The surgeon dissects the muscle edges from the skin and mucosa to mobilize them. The muscle ends are then brought together and sutured with durable, long-lasting absorbable sutures.
This creates a continuous ring of muscle, restoring the oral sphincter. The tension of this repair is critical; it must be tight enough to provide a seal but not so tight as to prevent the mouth from opening.
The internal lining of the lip is closed first. The surgeon uses absorbable sutures to approximate the mucosal edges. This closure must be watertight to prevent saliva from leaking into the muscle repair, which could cause infection or a fistula.
If there is a shortage of lining, a mucosal flap from the cheek or tongue may be used. Providing a healthy, sealed internal environment is the foundation for the rest of the repair.
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The most aesthetically critical step is aligning the vermilion border. The surgeon uses magnifying loupes to precisely align the “white roll” of the lip. Even a millimeter of step-off is visible.
Key sutures are placed at the border first to lock it in position. The rest of the vermilion is then repaired. This precise alignment ensures the continuous, natural curve of the lip line is restored.
For Abbe or Estlander flaps, the tissue is rotated from one lip to the other. The flap acts as a bridge across the mouth. The surgeon sutures the flap into the defect in layers (mucosa, muscle, skin).
The pedicle (the bridge containing the artery) is left intact, crossing the mouth opening. This means the patient’s mouth will be partially sewn shut on one side. This is a temporary state necessary to keep the flap alive until it grows its own blood supply from the new location.
Once closed, the incisions are covered with antibiotic ointment. Bandages on the lip are challenging to maintain due to movement and moisture, so the repairs are often left open or covered with specialized glue.
For severe injuries, a splint or steroid injection may be used to reduce swelling. Steri-strips may be applied to support the skin sutures and minimize tension on the wound edges.
In the recovery room, the airway is monitored closely. Swelling of the lips and tongue can be significant. The head is kept elevated to reduce edema.
The flap is monitored for venous congestion (turning purple) or arterial insufficiency (turning pale). Any color change is a surgical emergency. Nurses monitor oxygen saturation and ensure the patient can swallow safely.
Pain is managed with a combination of medications. Nerve blocks performed during surgery provide relief for several hours. Post-operatively, oral pain medication and anti-inflammatories are used.
Ice packs are applied to the cheeks (not directly on the flap) to reduce swelling and pain. Keeping the pain under control helps keep blood pressure down, which reduces the risk of bleeding.
Patients are placed on a strict liquid or soft diet immediately after surgery. Chewing can pull on the sutures and disrupt the muscle repair. Straws are strictly forbidden as the suction creates negative pressure that can stress the wound.
Patients must feed themselves using a syringe, spoon, or cup, with the device carefully placed in the corner of the mouth away from the repair. This protects the integrity of the surgery during the critical initial healing phase.
If you have general anesthesia, a breathing tube is used. Often, we use a nasal tube (down the nose) instead of the mouth, so the tube doesn’t get in the way of the lip repair. It is removed before you fully wake up.
If you have an Abbe flap (cross-lip flap), your mouth will be tethered on one side. You can still open the other side enough to drink liquids, soups, and smoothies through a straw or from a cup. It requires patience, but you will get enough nutrition.
The lips are very sensitive, so there is some discomfort, swelling, and throbbing for the first few days. However, prescribed pain medication and keeping your head elevated make it very manageable. The worst part is usually the inconvenience of eating, not the pain.
The lips swell significantly after surgery. The peak is usually on day 2 or 3. Most of the swelling resolves after 2 weeks, but residual firmness and puffiness can take several months to resolve fully.
The surgery disrupts the small sensory nerves in the skin. Numbness across the chest and nipples is widespread. Sensation typically returns gradually over several months as the nerves regenerate, often accompanied by little “zaps” or tingles.
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