What is Lip
Lip reconstruction in NYC & NJ tends to pose a particular challenge for some plastic surgeons as the lips are the dynamic center of the lower third of the face.
A person's lips play a huge role in aesthetic balance, facial expression, speech, and deglutination. This is not replicated by any other tissue substitute. The goals of lip reconstruction are traditionally both functional and aesthetic. The specialized surgical methods employed are oftentimes overlapping. There are many potential defects to focus on where there is significant loss of tissue which may require flap reconstruction. Dr. Monica Tadros specializes in reconstructive facial surgery for her patients in NYC & NJ.
The etiologies of lip defects are quite diverse including:
- Oncologic Resection
- Traumatic Avulsion
- Congenital Deformities
Defects of the lower lips are more often encountered due to the higher incidence of lower lip cancers.
Various types of flaps described may include Abbe cross-lip flaps, Karapandzic rotation advancement flaps, and single and dual free-flap lip reconstructions. The principles and techniques described are broadly applicable to other flap designs that are expected to meet both the aesthetic and functional results of a lip reconstruction procedure.
Lip Reconstruction In Depth
Lip reconstruction in NYC & NJ plastic surgery clinic requires familiarity with the surface anatomy, underlying muscular anatomy, and neurovascular anatomy of the lower face.
From an aesthetic perspective, lip reconstruction is meant to provide adequate replacement of external skin while maintaining the physical balance of the vermiliocutaneous junction and lip aesthetic units. The functional aspect of lip reconstruction is to protect intraoral mucosal lining and to preserve the surface area of the oral aperture. The competence of the orbicularis muscle sphincter must also be controlled, as this is critical to achieving an operative recovery. Ideally, cutaneous sensation is retained or reestablished to provide proprioceptive feedback for speech, animation, and management of secretions.
Breaking Down Defects
Due to the fact that no surgical defect is exactly the same, an very customized approach must be anticipated. General guidelines exist to help in the classification of defects according to the targeted depth and location. Such simplified categorization has its limitations but is quite instrumental in providing an organized strategy to this highly variable problem.
Superficial Defects of the Upper Lip
Most upper lip reconstructions involve the perioral skin rather than the vermilion or red lip because basal cell carcinoma is overwhelmingly the predominant pathology. Since there is a lack of excess skin in the areas between the lip and nose, traditionally reconstructions for this area use medial cheek advancement.
- Superficial defects of the lateral upper lip may be closed primarily in harmony with the relaxed skin tension lines.
- Defects closer to the nasolabial sulcus may be closed primarily within this fold. Small defects in those lateral sub-units may also be amenable to an A-T closure using incisions at the vermilion border or medial cheek advancement.
- Larger superficial defects of the lateral upper lip may require excision of the entire sub-unit.
Superficial Defects of the Lower Lip
A variety of techniques are used to correct management of lower lip defects.
- Very common problems encountered in the lower lip are leukoplakia and actinic cheilitis. These conditions are often observed in association with squamous cell carcinomas. For this reason, lip shave or superficial excision, including vermilionectomy, of such damaged mucosa is commonly employed.
- Buccal mucosa can be undermined sharply and bluntly to allow advancement to the previous red-white junction. Occasionally, such defects are too large to allow undermining alone, and a pedicled flap must be used. The ventral surface of the anterior tongue is a dependable location. Flap division requires a separate procedure and can be performed 2 weeks after the initial procedure.
- Smaller partial-thickness defects can often be allowed to heal secondarily, or buccal surface grafts can be harvested from a separate site and used for a full-thickness graft.
- Similar to the upper lip, common adjuncts include A-T flaps with relaxing incisions either at the vermilion border or at the labiomental crease.
How Lip Reconstruction Works?
Another important area of facial reconstruction is that of lip surgery. Lip Deformity can adversely affect one's overall facial appearance and can be a great source of concern to the affected person. Like with most reconstructive surgery, the goal of lip reconstruction is to reestablish the lip's appearance as well as its function, which includes facial expression, eating, speaking, kissing, and feeling.
When large sections of lip are removed, simply sewing the edges together to close the wound will not work: the result would either be a wound that fell apart from too much tension, a mouth that was too small to open, or a dramatic size mismatch between the upper and lower lips.
Instead, best plastic surgeon Dr. Tadros uses techniques that transfer adjacent tissue on its nerve and blood supply, sometimes even borrowing from the other lip (e.g.,Abbé, Estlander, and Karapandzic flaps). This careful rearrangement of tissue, which sometimes requires two separate stages, can help restore the patient's appearance and function.
You may be a candidate for lip reconstruction in NYC & NJ if you are concerned about the appearance of your lip(s), which may be related to trauma, skin cancer, scar formation, aging or other factors.
Lip reconstruction is performed either in the office or an operating suite on an outpatient basis. Reconstruction is performed under local anesthesia alone or in combination with sedation based on your preferences. Patients are able to return home shortly after the procedure.
Following lip reconstruction, you can expect a few days of swelling and soreness which is well controlled with oral pain medications. Dressings are typically removed on the day after surgery. Sutures are removed between 5-7 days after the procedure. Makeup can be used at this point to camouflage any bruising or maturing scars. Swelling and bruising generally subside by 7-10 days. You can resume most normal activities after a couple of days, except for intense exercise, which may be resumed at about 3 weeks. Return to work is usually permissible within a few days, although most patients return to work within 1-2 weeks.