Making a small lip bigger is, far and away, the most common cosmetic lip change requested. However, there are some patients, both men and women, that feel their lips are too big and desire that they be smaller. When one’s lips are naturally excessively large, they may functionally interfere with lip competence (coming together and creating a lip seal) as well as being a source of too much attention and embarrassment.
Very large lips, also known as macrocheilia, can develop for multiple reasons. Some people just have them naturally and others develop them from multiple uncommon medical reasons. While large lips have a significant ethnic association, I have also seen a number of Caucasians from various descents who have them as well. In my Indianapolis plastic surgery practice, I have treated as many Caucasians as other ethnic groups for lip reduction surgery.
One lip condition that can be confused with macrocheilia is the double lip which occurs only in the upper lip. This is because the upper lip is too large (too much outer vermilion), it is because there is an extra roll of tissue on the underside (mucosa) of the upper lip. This becomes apparent when one smiles, as this extra roll of mucosa is seen as a horizontal roll of tissue beneath the upper lip. It surgical removal is done slightly different than a large outer upper lip.
The objective of lip reduction surgery is to create lip sizes that are more proportionate to each other as well as the rest of the face. At the least, a patient’s goal is to not have them as the most dominant feature of one’s face that draws the eye right to them.
Lip reduction surgery is uncomplicated to do but the surgical planning (marking) is the key. An initial mark (line) is drawn at the wet-dry junction but may change based on which part of the lip is more prominent, the dry vermilion or the wet mucosa. For some large lips, the dry vermilion is the dominant part to remove. For others, it can be more of the wet vermilion and mucosa. Careful preoperative examination of the lip must be done to make this determination. No matter which part of the upper lip is removed, you do not want the final closure (and subsequent scar) to be evident when the lips are either in rest or smiling positions. A wedge of excess lip is marked out and tapered as it goes into the corners of the mouth to prevent ant tissue excesses. I like to keep the final edge of the cut out away a few millimeters from the corner of the mouth.
Lip reductions can be done under local anesthesia, although more significant anesthesia would be more pleasant. Once anesthetized, the wedge excision removes primarily outer mucosa and the underneath submucosa. (in medical macrocheila the lip tissues removed may be deeper and more extensive) It is not necessary to remove muscle for cosmetic reduction and the labial artery should be preserved. I find that a pinch technique is very useful. By this method, the planned amount of mucosal excision is pinched up with a special instrument until the entire desired amount is in the pinch. This is then cut off with scissors and closed with a resorbable running suture. Only antibiotic ointment or vaseline is applied to the dry vermilion after to keep it moisturized as the lips swells and is prone to cracking and soreness.
The lip will swell considerably, which is normal, and it may take several weeks to appreciate the amount of reduction that has been done. Usually, about 4 to 6mm reduction sometimes more) of actual horizontal lip size can be easily achieved.
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