Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Mohs micrographic surgery is the gold standard for removing skin cancers on the face, particularly basal cell and squamous cell carcinomas. While this technique spares as much healthy tissue as possible, it often leaves a deep, circular defect that crosses the vermilion border and involves the muscle.
Reconstruction of these defects is the most common indication for lip surgery. The surgeon must plan a repair that fills the deep divot left by the cancer removal while preventing the lip from being pulled up or down (distortion). Immediate reconstruction is typically performed once the cancer is confirmed clear.
Trauma from dog bites, car accidents, or falls can result in the tearing or complete loss of lip tissue (avulsion). These injuries are often jagged and contaminated, requiring careful cleaning before reconstruction. Dog bites, in particular, frequently involve the loss of the “cupid’s bow” or the corner of the mouth.
Reconstruction in the acute setting focuses on salvaging viable tissue and re-aligning the landmarks. In cases of significant tissue loss, delayed reconstruction or the use of distant flaps may be necessary. The goal is to maximize the retention of original tissue to maintain the natural color and texture match.
While primary cleft lip repair is performed in infancy, many patients require secondary reconstruction in adulthood. This may be to correct a whistle deformity (a notch in the lip), asymmetry of the cupid’s bow, or tight scarring that restricts movement.
Adult reconstruction for cleft lip focuses on refining the aesthetic result and improving muscle continuity. It often involves scar revision, muscle re-approximation, and adding volume to the thin side of the lip using dermal grafts or fillers. It is a refinement process to erase the stigma of the congenital deformity.
Vascular anomalies, such as venous lakes or hemangiomas, can cause significant distortion and enlargement of the lip (macrocheilia). These lesions are composed of abnormal blood vessels that can bleed or cause pain. They often create a purple or red discoloration and a bulky, compressible mass.
Surgical excision involves removing the vascular mass while preserving the overlying skin and lining, if possible. Because these lesions are prone to bleeding, advanced hemostatic tools are used. The reconstruction focuses on reducing the bulk of the lip to match the unaffected side.
Microstomia is a functional deformity characterized by an abnormally small mouth opening. This is often a result of scarring from burns, severe trauma, or connective tissue diseases like scleroderma. It restricts the patient’s ability to eat, brush their teeth, and speak clearly.
Reconstruction involves a commissuroplasty, a procedure to widen the corners of the mouth. The surgeon excises the scar tissue at the corners and advances the inner cheek lining to create new lip corners. This functional release dramatically improves the quality of life and access to oral hygiene.
Ectropion, or eclabium, is a condition where the lip rolls outward, exposing the wet inner mucosa to the air. This is typically caused by burn scars or trauma scars on the chin or cheek that pull the lip down. It results in constant drooling, chapping, and a visible deformity.
Reconstruction requires releasing the scar tissue that is pulling the lip. Often, a skin graft or a local flap is needed to add extra skin to the chin or cheek area, relieving the tension and allowing the lip to roll back into its natural, closed position.
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With advanced age, the lips undergo biological atrophy. The muscle thins, the fat dissolves, and the lip lengthens vertically, covering the upper teeth. This results in a thin, inverted appearance. While often cosmetic, severe atrophy can lead to functional issues with seal and speech.
Reconstructive techniques, such as a lip lift, shorten the distance between the nose and the lip, rolling the vermilion out to create a more youthful and functional pout. Structural fat grafting may be used to restore lost volume and support the oral sphincter.
Actinic cheilitis is a pre-cancerous condition caused by chronic sun exposure, presenting as a scaly, rough, and ulcerated lower lip. If left untreated, it can progress to squamous cell carcinoma. The lip becomes painful, dry, and prone to splitting.
The procedure of choice is a “lip shave” or vermilionectomy. The surgeon removes the entire damaged lip surface and advances the healthy lining from inside the mouth to cover the defect. This is both a treatment for the disease and a reconstructive measure to provide a new, healthy lip surface.
Functional incompetence refers to the inability to maintain a tight oral seal, leading to leakage of saliva or other liquids. This can be caused by nerve damage, muscle weakness, or scar tissue preventing the lips from meeting.
Reconstruction focuses on tightening the oral sphincter. This may involve static slings to support the lip or dynamic muscle transfers to restore active closure. The goal is to provide enough support to prevent drooling while maintaining the ability to open the mouth for eating.
The lips are essential for forming bilabial sounds (P, B, M). Defects or weakness in the lips can result in slurred or unintelligible speech. This is common after extensive resections or nerve injuries, when muscle continuity is disrupted.
Reconstructive surgery aims to restore the continuity of the orbicularis oris muscle loop. By reconnecting the muscle fibers, the surgeon enables the patient to press the lips together firmly, a critical step for proper articulation. Speech therapy is often required postoperatively to retrain the muscles.
Facial nerve paralysis (Bell’s palsy or trauma) can cause one side of the lip to droop and become immobile. This leads to marked asymmetry and functional issues with eating and speaking. The paralyzed side acts as a dead weight, pulling the healthy side down.
Reconstruction involves static and dynamic procedures. Static procedures use slings (such as the fascia lata) to elevate the paralyzed lip to a symmetrical position. Dynamic procedures involve transferring nerves or muscles (like the temporalis) to restore active movement and smiling.
Scar contracture occurs when a healing wound shrinks and pulls the surrounding tissue. On the lip, this can cause notching, elevation of the vermilion border (sneer deformity), or distortion of the Cupid’s bow. It is a biological response to injury or surgery.
Reconstruction involves scar revision techniques such as Z-plasty or W-plasty. These geometric incisions break the straight line of the scar, releasing tension and allowing the lip tissue to relax back to its normal position.
A lip shave, or vermilionectomy, involves surgically removing the top layer of the lip skin that has been severely damaged by the sun or has pre-cancerous cells. A flap of healthy pink tissue from inside the mouth is then pulled forward to resurface the lip.
Dog bites often cause jagged tears and tissue loss. While surgery can significantly improve appearance by realigning borders and removing excess scar tissue, a faint scar will always remain. Multiple minor surgeries may be needed for the best result.
We can use a “static sling,” which involves placing a strip of tendon or graft under the skin to lift and support the drooping side physically. In some cases, we can transfer a working muscle to help the lip move again.
If a cancerous spot occupies more than half of the lip, we may need to use tissue from the other lip (Abbe flap) or rotate tissue from the cheek (Karapandzic flap) to close the hole while keeping the mouth functional.
Yes, revision of a cleft lip is typically considered reconstructive surgery, regardless of age, because it addresses a congenital deformity that affects speech and appearance. However, specific coverage depends on your individual insurance plan.
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