Lip plastic surgery - Causes, symptoms and treatment. MF.

Harmonious plastic of lips

To the cosmetician in the practice quite often it is necessary to carry out volumetric plastic of labiums both to young, and people with age changes of a skin and proportions of the face. During the consultation, the doctor needs to analyze the problem that the patient has addressed, determine the ways to solve it, taking into account all the wishes and coordinate with the patient the planned program.

When inspecting the lips pay attention to their size, shape, contours, color, relationship with each other and the dentition. Lips should be examined not only at rest, but also with the use of dynamic tests( smile, grin, conversation, tight closure).The lips are examined in full-face and profile.

At rest, the mouth width is 6 upper teeth, and the corners of the mouth are located at the outer edge of the canine teeth. The height of the red border of the upper lip is, as a rule, 2/3 of the height of the lower one. Only the edges of the upper incisors are seen in rest. The dimensions of the teeth, the width of the base of the nose and the filter are interrelated.

The width of the filter is equal to 2 central incisors: the wider the incisors, the wider the filter.

With a harmonious smile, the upper teeth are exposed to 2/3, and the edge of the upper lip repeats the occlusal surface of the teeth. Lower lip reveals lower teeth only slightly. There is a clear correspondence of the curvature of the line of the proboscis of the upper lip of the line of the four upper incisors. The edge of the lower lip with a smile also corresponds to the cutting edge of the upper teeth and repeats its bends.

The excessive shortening of the upper lip when smiling, when the gum is visible, is called a gingival smile. A deficient smile does not bare teeth enough and can be both a feature of muscle activity and a consequence of age-long lip. In addition, with a smile, the elevation of the corners of the lips should be expressed. Also pay attention to the tucking of the red border and the formation of horizontal folds on it. The width of a normal smile usually reaches the pupil line. With a smile, the filter and white roller are smoothed, which can be outlined by intradermal injection of injectable materials.

Where radial wrinkles cross a white roller, more filling is required with the injection material. Research in the profile gives a good idea of ​​the relationship between the lips and the dental arch and between themselves. Normally, the upper lip slightly protrudes forward. When the upper jaw( overgrown) is extended forward, the upper lip hangs over the lower one and covers it. Westing of the upper lip is observed during the prognosis, loss of the upper teeth or in inadequate prosthetics when the senile atrophy of the alveolar process is not replenished. The tightening of the lips and the deepening of the folds in the corners of the mouth can also speak of insufficient filling of the occlusion height during prosthetics. Such shortcomings should be eliminated first of all, otherwise when performing cosmetic correction in the lip will have to inject a very large amount of filler: without this, a satisfactory cosmetic effect will not be achieved.

In practice, patients of all age groups most often have to increase the volume and height of the upper lip. Reducing the height of the red border with age occurs both due to atrophy of its submucosal layer, and because of the turning of the red border due to lengthening of the skin of the lip or atrophy of the alveolar process of the upper jaw. It is unacceptable to use a large amount of injectable material when correcting the lower lip in elderly patients, as this can lead to its reversal, sagging due to decreased muscle tone. The introduction of the filler in the zone of the red border is desirable to be done deeply, in the submucosal layer.

Thus, the possible heterogeneity of the implant is camouflaged. It is desirable to distribute the material evenly in the submucosal layer, squeezing it out while the needle moves. Large drops of filler are easier to migrate, create unevenness, cause compaction of surrounding tissue. Injections of gels directly under the mucous membrane are fraught with uneven contours and migration of individual portions. It is inadmissible to introduce material into the circular muscle, since it is a substrate that provides movement of the lips. For contouring the white roller and filterum, on the contrary, it requires an intradermal, sufficiently superficial introduction of the filler, which is conveniently controlled by clamping the roller in the pinch between the thumb and forefinger. Injection of materials into the submucosal layer along the line of closure of the lips leads to a greater increase in the height of the lip, the introduction under the mucous membrane adjacent to the teeth, moves the lip away from the teeth, slightly turning it out. Too deep penetration of the needle from the inside is dangerous due to injury of the circular artery passing here.

Procedure "Paris lips"

This procedure is offered by American plastic surgeons. You can give the person an additional charm by emphasizing the rollers of the filter and more clearly indicating the white roller. White roller( white lip roll) is a thin strip of light skin surrounding the red border of the lips. With age or with some congenital pathologies( FAS - fetal alcohol syndrome developing in the case of active drinking of a pregnant woman), these areas become flattened and the lips lose some of their expressiveness.

When carrying out the procedure, imantates are introduced into problem areas: either filaments based on polytetrafluoroethylene( about 1 mm in diameter), or injecting materials( more often, dinitelnoe, such as Artekoll).During the development of the method, it is more expedient to refer to biodegrading materials based on hyacuronic acid or collagen.

When using injection materials, the required volume should be calculated in advance. Introduction of threads is considered as a surgical technique that requires appropriate conditions for carrying out. It is important to remember that in case of unsatisfactory result the thread can be extracted, but provided that after the operation, not too much time has passed. Otherwise, it is very difficult.

As a result of the procedure, the mouth becomes more expressive, sensual. When using threads or synthetic injection materials, the effect persists for a very long time.

On consultation it is convenient to use a cosmetic stick, which can be flattened or turned out a red border, creating the illusion of increasing the lip. Before the mirror, together with the patient, it is detailed what parts of the lip should be changed and whether it is necessary to increase the volume of the proboscis, the lateral sections of the upper lip, the filterrum, the cupid arch( white roller), or the increase in the volume of the lower lip, the correction of the corners of the mouth?

However, the lowering of the corners can also be a visual illusion created by changing the slope of the lip closure line and deepening the folds in the corners of the mouth. Increasing the volume of the outermost part of the upper lip and removing the folds in the corners of the mouth visually raises the corners of the lips.

The examination should reveal an asymmetry of the lips at rest and with a smile. It is desirable for the patient to point out it and explain that asymmetry is poorly amenable to full correction and is often a consequence of the bite pathology or functional asymmetry of the cerebral hemispheres. A clear control over the amount of material introduced and preliminary marking of the lip make it possible to avoid asymmetry as a consequence of the cosmetic procedure performed. Careful massage of the lips after the introduction of the filler also nicely eliminates small errors. In this case, it is desirable to massage the lips, pressing them to the dentition and stretching in a smile.

Lip Plasty

There are several ways to change the shape of your lips. Most often increase the volume of the upper lip. To increase the volume of this or that part of the lips, injectable fillers are most often used. There are many natural and synthetic fillers on the market. The most popular derivatives of hyaluronic acid( Resteline, Restylane, Surgiderm, etc.) that dissolve after a certain time. With their help, you can increase the central or lateral parts of the lip, emphasize the white roller, the edges of the filter( see Harmonious plastic lips).The lips are enlarged with the help of their own tissues. When performing liposuction or other plastic surgery, lipids can be transferred to the lips( lipofilling, lipotransfer, and fettigraphy) or strips of own tissues( autografting).The results are more stable in terms of resorption, however, the technique of increasing is more difficult. A stable increase provides VY plastic lip. The method is based on the surgical extension of the red lip rim, while the seams are hidden on the inside of the lip.

Shortening of the upper lip is necessary in the event that the edges of the upper incisors are barely exposed, even with a smile. This operation is also called a bull horn( plastic) for the shape of a seam in the form of a buffalo horn, which is hidden beneath the base of the nose.

Bull horn of plastic shortens the skin of the lip. At the same time, the red rim turns out and the lip is enlarged.

Stretching with age of the skin of the upper lip, on the contrary leads to a tightening of the red border and a visual diminution of the lip.

In addition to enlarging the lips, sometimes it is necessary to reduce them with the congenital or acquired increase. Lip augmentation can cause not only an excess of introduced filler, but also a pathological proliferation of lip tissue in response to the introduction of even a minimum amount of filler( for example: Biopolymer gel).Excess filler can be removed through punctures. The expanded tissues either are removed, retaining the shape of the lip, or conservative treatment is performed.