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Making a small lip bigger is by far the most requested cosmetic lip change. However, there are some patients, both men and women, who feel their lips are too big and wish they were smaller. When someone’s lips are naturally excessively large, they can functionally interfere with lip competence (come together and create a lip seal) and be a source of too much attention and embarrassment.
Very large lips, also called macrocheilia, can arise for several reasons. Some people just have them naturally, and others develop them for a variety of unusual medical reasons. While big lips have an important ethnic association, I’ve also seen a number of white people of various origins have them as well. In my plastic surgery practice in Indianapolis, I have treated as many whites as other ethnic groups for lip reduction.
A lip condition that can be confused with macrocheilia is the double lip that 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 (mucous membrane) of the upper lip. This becomes apparent when one smiles, as this extra roll of mucosa is seen as a horizontal roll of tissue under the upper lip. The surgical removal is done slightly differently than a large outer upper lip.
The goal of lip reduction is to create lip sizes that are more in proportion to each other and the rest of the face. At the very least, a patient’s goal is not to have them as the most dominant feature of a person’s face that attracts attention.
Lip reduction is straightforward, but the surgical planning (marking) is key. An initial mark (line) is drawn at the wet-dry transition, 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 may be more wet vermilion and mucous membrane. Careful preoperative examination of the lip should be done to make this decision. No matter which part of the upper lip is removed, you don’t want the final closure (and subsequent scar) to be visible when the lips are in the resting or smiling position. A wedge of excess lip is marked and tapered as it goes into the corners of the mouth to prevent excess ant tissue. I like to keep the last edge of the cutout a few millimeters away from the corner of the mouth.
Lip reductions can be done under local anesthesia, although more significant anesthesia would be more comfortable. Once anesthetized, the wedge excision primarily removes the outer mucosa and underlying submucosa. (in medical macrocheila, the lip tissues removed may be deeper and more extensive) There is no need to remove muscle for cosmetic reduction and the labial artery must be preserved. I find that a pinching technique is very useful. In this method, the planned amount of mucosal excision is squeezed with a special instrument until the entire desired amount is in the squeeze. This is then cut with scissors and closed with an absorbable running suture. Only antibiotic ointment or petroleum jelly is applied to the dry vermilion to keep it hydrated as the lips swell and are prone to tearing and pain.
The lip will swell considerably, which is normal, and it may take several weeks to appreciate the amount of reduction. Usually a reduction of about 4 to 6 mm (sometimes more) of the actual horizontal lip size can be easily achieved.
Make a big lip smaller – Lip reduction by plastic surgery
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