Dear Dr. Yang,
I recently read about this problem in the Rhino and liplift forum. I will quote it below.
Anterior spinae removal and upper lip muscles released
“had rhinoplasty 4 years ago and have been living a nightmare ever since that day. All I asked for was a hump removal and the Dr. tried to deproject my nose without discussing it with me first. He removed nasal spine and released the connection the obicularis muscle had with the nasal base (this is all the information he gives me). It is not written in the post op report that he did this ‘extra work” and is very vague when I asked him exactly what was done and if ay other muscles were touched. As a result I now have an awful smile and a very long upper lip. The lip moves differently than before and I have ALOT of extra skin between my upper lip and nose. In addition my facial skin in this area only is not tight and I look 10 years older than I did before the surgery. I went to see other doctors for a correction and they seem to not want to touch me because they do not know exactly what was done. I was wondering if anyone else had a similiar experience and if so what they are doing to correct it. PLEASE any advice would really help. Thanks”
I am very scared. I ended up with the same outcome after my liplift. During the liplift my physician operated on the muscle and the skin of the upper lip. It’s been over a year and the situation is getting worse. If this is what happened to me, (the doctor released the connection the obicularis muscle had with the nasal base) do you think the muscle can be reattached. Thank you, I kindly wait for your reply.
I’ve been doing some research on the board and maybe the muscle that was damaged or cut by accident during the liplift was the depressor septi muscle. Can this muscle be reattached? I did not have a rhinoplasty, just a liplift.
I offer injectable lip augmentation; however, Lip lifts are not a procedure that I offer. I have consulted with patients who have already had lip lifts by other surgeons for a face and necklift consultation, and they were not happy with the results of their lip lift. One patient had a bullhorn upper lip lift with the incision under her nose to shorten the distance of her long upper lip. Her complaint was, that although it did shorten her upper lip length, she could not move her upper lip the same way as she did prior to surgery. She could not smile and retract her upper lip to show her upper teeth anymore. It felt like a “dead” upper lip. It sounds like the same thing happened to you, too.
Another person contacted me through Makemeheal, and complained that after her upper lip lift, her upper lip was retracted and it showed her upper teeth all of the time, and she had trouble covering her upper teeth after the lip lift. These are the two extremes, one showing too much teeth, while the other can’t show the upper teeth at all. We didn’t even discuss the length of the upper lip, since the lack of normal movement seemed to trump any improvement that they may have had in the overall length of their upper lip. Both wished that they could have their “pre-liplift” lips back with the longer upper lip. This kind of negative feedback before I even attempted an upper lip lift on one of my own patients is the reason why I don’t offer it. If the best way to not create a problem is not to perform the procedure, but at the same time, I do not have the benefit of seeing these patients early after the lip lift and follow them post-operatively to know what kind of normal and abnormal issues that they are having.
Since I have this question and answer forum, many people contact me with the problems that they have had after different procedures. I have decided that there are certain procedures which I don’t want to do and will refer them out if the patient really wants to have them performed. An upper lip lifts seems to be one of those procedure, although it does not seem to be a difficult procedure.
The muscle attachments of the lips are difficult to identify. It is easy for a surgeon to separate a muscle attachments to bone, but to then take a muscle and then intentionally attach it to a bone is actually difficult. The suture has no place on the bone to be anchored. Sewing soft tissue to soft tissue is easy, but muscle or soft tissue to a bone surface is hard. I don’t know if the surgeon can drill bone bridges on the bone of the upper maxilla and place sutures from the bone to the muscle or not. It is not a procedure that I have seen in any articles or papers. Whether sewing the muscle to the bone will then create another problem is also a possibility. A surgeon who performs a lot of lip lifts will be the best resource on what bad things can happen and why, and possibly also the best surgeon to repair them since they have likely fixed their own lip lift problems.
I’m sorry I don’t have more experience with this problem. I have seen an a web article describing botox to the upper lip to reduce a gummy smile and it created an unusual upper lip configuration in their before and after photos. That combined with the two people who had poor results has made me think the upper lip is a difficult area to treat, since the orbicularis muscle a floating muscle is not actually attached to bone, but to other muscles. Most other muscle have a single linear movement with bony attachments at least on one side. This creates a level of complexity which I think may be difficult to fully control and increases the possibility of having bad results.