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 vermilion 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 Lip Reconstruction Options?
The method of lip reconstruction depends on the size of the defect and the area of the 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 of 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 vermilion 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 be 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 are 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 durable sutures in the skin. In pedicle flaps, there may be open areas which area dressed in 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 recede. 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 weeks to the 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 aftercare instructions in order to facilitate proper healing and successful results.
When Can I Go Back to Work After Lip Reconstruction?
Like most facial plastic surgeries, lip reconstruction will involve sutures, dressings, and post-surgical side effects. Your dressing may be removed as soon as the day following your reconstruction. Your sutures, however, may be present for up to seven days. Once your sutures have been removed, you might be able to apply makeup to help camouflage scarring as the tissue heals. While you may feel well enough to return to work after three to four days, you may want to schedule one to two weeks off work to allow time for optimal cosmetic recovery.
Can I Just Get Dermal Fillers for a Lip Scar?
Studies have shown that hyaluronic acid dermal fillers are effective at treating certain scars. This approach works by securing water molecules in the upper layers of the skin for a prolonged period of time. While dermal fillers are sometimes used for scar treatment, and these same products are often used to enhance the shape, volume, and definition of the lips, they may not be an alternative to lip reconstruction. There are many factors to consider when planning treatment for lip scars or deformities, including the thickness of the original wound and the nature of scar tissue itself. This tissue doesn't behave exactly like healthy tissue. It may be denser and less flexible. To achieve the most satisfying, natural-looking results, it's best to consult a board-certified plastic surgeon with specific experience performing lip reconstruction.
Does Mohs Surgery on the Lip Always Require Reconstruction?
Mohs surgery is the most effective procedure for the removal of skin cancer. It is especially beneficial for facial skin cancers due to its micrographic technique. That said, studies have shown that most patients underestimate how substantial their Mohs scar will be. It is important to engage in clear dialogue with your Mohs surgeon ahead of your scheduled surgery and to ask questions about the potential for scarring and what to do about it. Dr. Trussler supports Mohs surgeons in our local area by providing consultation and reconstructive services to patients whose procedures may leave them with a deformity. When we can prepare ahead of time, we can plan the ideal timing for reconstruction, which is sometimes the same day as the Mohs procedure.
Which Lip Reconstruction Procedure is Best for Me?
There is no perfect type of lip reconstruction that can work for every person. This is why it is important to consult with a board-certified plastic surgeon who is trained in multiple techniques. Dr. Trussler performs a thorough examination of the lip defect, scar, or deformity and considers all relevant factors that can contribute to your cosmetic outcome. The goal of lip reconstruction is not to merely close a wound or revise a scar, it is to do so in the best possible way to restore or preserve the most natural movement and appearance of the lip.
*Disclaimer: Results and individual patient experience may vary.
- 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.