Reconstruction of the Lip may include:
- Lip lesions such as benign moles or vascular lesions
- Open defects left from Moh’s surgery for skin cancer
- Lacerations from facial trauma
- Scar deformities from previous lip surgery
Lip reconstruction is a very common procedure performed in plastic surgery because of the complexity and precision needed to effectively treat this area.
The lips and peri-oral area encompass a region from below the nose to the chin and out as far as the smile lines or nasolabial folds. The upper lip’s main function is phonation, and is defined by the vermillion border, philtral column, and cupids bow. It is made up of three elevations composed of both wet and dry mucosa. The lower lip functions more as a dam for saliva, and is less defined and only has two elevations. The lower lip is 50% percent larger than the upper lip.
Upper and lower lips are composed of:
- Mucosa:the red wet and dry lining of the lips
- Mucosal glands: which relate to the volume of the lips
- Muscle (Orbicularis Oris): which contribute to the movement and tone of the lips
The goal of lip reconstruction is to preserve the form and the function of the lips. The complexity of the reconstructive procedure is related to the location and the size of the lip defect.
Dr. Trussler has significant experience in the reconstruction of the lip after Mohs surgery and after facial trauma.
What Are My Options?
The method of lip reconstruction depends on the size of the defect and the area of lip. There are multiple common methods of plastic surgery reconstruction including:
Straight line closure: brings the two edges of the open wound together creating a straight-line scar.
Rotational flap: brings tissue beside the open defect over to cover the open wound. This typically requires another incision so that the adjacent tissue can be rotated.
Pedicled flap: brings tissue from another area close to the open wound on a “leash” of blood vessels and skin so that the living flap of skin can be transferred a larger distance to cover the area.
Skin graft: a partial thickness or full thickness piece of skin is taken from another area called a “donor site” and then placed on the open area. This skin graft adheres to the open wound and survives as a skin covering to defect.
Composite graft: is similar to a full thickness skin graft but also includes a layer of fat which all adheres to the wound to cover and fill the open area.
Fat grafting: is used to fill areas that are thin and scarred. Fat is harvested from another area in the body and then injected into the lip to help to maintain shape to the lip.
Free tissue transfer: skin, muscle and/or bone are taken from a donor site on the body and then transplanted by suturing the blood vessels of the flap to blood vessels near the open wound using an operative microscope. The “free flap” is living, growing tissue used to cover large and complex areas of Moh’s surgery.
Location and size are the main issues when considering lip reconstruction. Small defects on the lip can be closed in a straight-line. In difficult areas, like the upper central lip including the vermillion border, philtral column, and cupids bow even small defects require more complex reconstructive procedures such as rotation or pedicle flaps. In laceration repair and the correction scar deformities of the lip, these borders of the lip should be precisely aligned. Larger areas on the lip may be covered with adjacent mucosa or complex rotational flaps.Free tissue transfer may be indicated in entire lip reconstruction.
Reconstruction of the lip after Mohs surgery can often be coordinated the same day or the day after the clearance procedure. Simple reconstructive procedures can performed in an office based setting under local anesthesia, but more complex procedures may need to be performed in the operating room.
The reconstructive goals for the lip is the closure of the open area, or the correction of the scar deformity with the maintenance of form and function. For the perioral area the maintenance of the mouth area for speaking and eating is very important therefore complex pedicle and rotation flaps are more commonly used to maintain the opening capacity of the mouth. In the reconstructive process there may be more incisions and/or donor sites created to harvest the tissue used for closure. These incisions will form scars which will heal and fade over time. Additional procedures may be needed such as scar revisions, flap division and inset, and scar care after the area of lip surgery is healed.
Lip Reconstruction is usually an outpatient procedure performed either under local or general anesthesia. The lip is very sensitive and in order for Dr. Trussler to perform precise and complex procedures the patient needs to be comfortable.
Mohs surgery is performed on an outpatient basis in your dermatologist’s office.After the cancerous tissue has been removed completely, the open wound is typically dressed with gauze and arrangements will be made to consult with Dr. Trussler, a reconstructive plastic surgeon, that day or the day after the procedure. Closure of the open area may take place at that time either in the office or in the operating room as an out-patient procedure. Lip reconstructive surgery after Moh’s surgery or after trauma may take one to two hours, and depending on the complexity of the procedure and the location, can usually be performed with local anesthesia with or without twilight sedation.
Straight line closure: can usually be performed in the office under local anesthesia and the wound edges may be removed and then elevated so that they can be brought together with limited tension and closed accurately with stitches under the lip and in the skin or mucosa of the lip. The majority of traumatic lacerations of the lip can be closed in this fashion.
Rotational flap: the design of the flap takes into account the size of the open area and the amount of locally available skin. The flap is incised, elevated and then rotated into place with the donor area closed in a straight line and the flap secured with stitches in the skin. Scar deformities of the lip are typically incised with the scar tissue released, and then the lip is closed with local flaps referred to as Z-plasties which can help align the important borders of the lip without tension.
Pedicled flap:the design of the flap takes into account the size of the open area, the location of the pedicle which includes the blood vessels, and the location of the donor site for the flap. The flap is incised, elevated and then rotated into place with the donor area closed in a straight line and the flap secured with stitches in the skin. Pedicle flaps in the lip may rotate tissue from the upper lip to fill the lower lip and vice versa. These are left in place for 10 days to 3 weeks until they are divided. Pedicle flaps may need a secondary procedure which divides the skin bridges and blood vessels after a couple of weeks of healing. This technique can bring a significant amount of skin from a distant area which will cover the open area with living tissue and restore form and function to the area of Moh’s surgery.
Skin graft: a partial thickness or full thickness piece of skin is taken from another area called a “donor site” and then placed on the open area of Moh’s surgery. This skin graft adheres to the open wound and survives as a living skin covering to defect. Split thickness donor sites will heal on their own and are covered with an occlusive dressing, where as a full thickness graft donor site is closed with stitches. Skin grafts are rarely used in lip reconstruction.
Composite graft: is similar to a full thickness skin graft but also includes a layer of fat which all adheres to the wound to cover and fill the open area. The graft donor site is closed with stitches.
Fat grafting: Fat is harvested from another area in the body called a donor site. Hand held liposuction is typically used for fat harvest and then the fat is re-injected into the lip to help to fill out areas of scar and to maintain shape.
Free tissue transfer: skin, muscle and/or bone are taken from a donor site on the body and then transplanted by suturing the blood vessels of the flap to blood vessels near the open wound using an operative microscope. The “free flap” is living, growing tissue used to cover large and complex areas of Moh’s surgery. This is a complex total lip reconstructive technique which Dr. Trussler has significant experience. The procedure can take over 6 hours and requires a short hospitalization after for free flap care.
The incisions for most reconstructive procedures are closed with deeper absorbable sutures and a combination of dissolvable and permanent sutures in the skin. In pedicle flaps there may be open areas which area dressed with non-adherent gauze and anti-bacterial ointment.
After Care & Recovery
Recovery from lip reconstruction depends on the type of treatment performed.
For a short time after surgery, patients may experience some swelling and bruising. This is typically reduced with the use of ice packs on the lips. Most patients feel like themselves within two days and return to work in about a week. All stitches are removed in one week. Normal activity can be resumed in 3 weeks.
The results of lip reconstruction become gradually apparent as the days pass after surgery and swelling recedes. Swelling may reappear from time to time in the first year after the procedure. It is typically more noticeable in the morning and fades during the day.
Scar care will be started at the three week point after surgery to help fade scars. Dermabrasion and laser resurfacing may be needed to help flatten the areas of reconstruction. Revision procedures and flap divisions may usually be considered at the three week to three month point after surgery, however scars will typically take about one year to fully mature and fade. Lip volume can be increased in areas of thinness with the addition of fat grafting or collagen grafts.
Patients with realistic goals for lip reconstruction are generally very happy with the new shape of the lips and this can be appreciated almost immediately. The exact results depend on the patient’s lip volume and scar healing.
Dr. Trussler will provide patients with specific after care instructions in order to facilitate proper healing and successful results.
- Trussler AP, Kawamoto HK, Wasson KL, Dickinson BP, Jackson E, Keagle JN, Jarrahy R, Bradley JP. Upper Lip Augmentation: Palmaris Longus Tendon as an Autologous. Plast Reconstr Surg 2008 Mar; 121(3): 1024-1032.
Whether you have a question or would like to setup a Lip Reconstruction consultation, Dr. Trussler and his staff are here to help. Please fill out our contact form, or call our office at 512-450-1077 to schedule an appointment. Start your journey to not only looking, but feeling better today!