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BULLHORN SUB-NASAL LIPLIFT REVISITED

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I receive e-mails from dissatisfied plastic surgery patients on a monthly basis looking for help. Over the last few years, one of the highest rates of dissatisfaction has come from patients who have had an upper lip lift. I have been sent e-mails from desperate patients looking for help. One of the common themes among most, not all, but most of these e-mails are that these patients did not have a simple skin only lip lift, they had the type of liplift that also involved surgery on the orbicularis oris muscle. 

The most common lip-lift procedure today is called a bullhorn liplift. This procedure consists of an excision of the white part of the upper lip directly beneath the nose in the shape of a 'bull's-horn', with advancement of the inferior border of the incision to the area directly beneath the nose. The incisions are hidden along the base of the nose. This procedure shortens the distance between the top lip and the tip of the nose allowing for more upper tooth show when the lips are slightly parted. It also everts more of the upper lip vermilion, therefore creating more "poof" in the upper lip. Some plastic surgeons are also operating on the orbicularis oris muscle besides the skin while doing the upper lip lift, sometimes known as a muscle liplift. Then they are suturing the orbicularis oris muscle to the periosteum or other tissues underneath the nose. Many, many more complications have been seen using this technique so it is not widely accepted or recommended. Severe stiffness and numbness can be experienced lasting for many months and in some cases can be permanent. By suturing the muscle to the periosteum or any other tissue, you are interfering with the natural sphincter movement of the upper lip which can lead to abnormal movements of the lip and nose. A sequelae of this can be bizarre looking movements of the upper lip during animation and possible speech disturbance. Also, the natural pretty flow of the philtrum columns can be changed when the position of the muscle has been altered, creating a "chopped off" look. It has been reported that muscle and nerve damage can occur from this suturing technique. Most plastic surgeons will only do a skin only liplift whose effectiveness has been well documented in peer-reviewed journals.

Bullhorn lip-lifts can change the shape of your nose so this risk needs to be discussed with your surgeon. Also, some surgeons are now hiding their incisions within the nostril opening. While this technique may camouflage the scar, it can lead to negative cosmetic consequences with patients who have prominent nasal sills. The removal of the sills at the base of the nose can lead to enlarged nostril openings and a distorted nasal base. With the bullhorn lip-lift you also have a risk of scarring under the nose. With most people this scar fades but if you do not scar well or have a history of developing keloids then any of the lip-lift procedures are not for you.

Corner liplifts can be another area of possible dissatisfaction.  I've had individuals write to me and inform me that after their corner liplift they have to constantly stretch their mouth. They describe a mouth that constantly feels tight and this is two years post surgery. This is probably secondary to scar tissue formation with subsequent contracture. Unacceptable external scarring can occur too.

When patients are considering undergoing a procedure that involves a "new" technique or type of technology, they should further inquire if results supporting the safety and effectiveness of the procedure have been documented in a peer-reviewed journal or other reputable publication. If the surgeon just came out with a new procedure, give it at least two years before you submit. You do not want to be a guinea pig! It takes years to know what the final outcome will be from a new procedure or what complications may come up. If the plastic surgeon doing the procedure is the only one doing it, then there must be a reason for that. OR IF THEY CLAIM THEY INVENTED IT AND NO ONE ELSE DOES IT BUT THEM,  BE VERY WARY. Talk to other well respected doctors about the procedure and see what they think of it. These are your lips; you speak, eat, drink kiss and do many other things with them on a daily basis. The last thing you want is a complication that can never be reversed or revised if needed. Even the slightest bit of numbness to your lips can be devastating for the rest of your life. Imagine not being able to sense a runny nose or sense if any food is stuck to your lip. There's no "alittle bit of numbness" when it comes to your lips.  Demand to see past surgical patients in person. Watch them when they animate. Do not just go by before and after still pictures. They will never tell the whole story!

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