Lip augmentation procedures can restore volume and shape to the aging, thin upper lip, but some patients may develop problematic lip tightness. This stiff upper lip is manifested by a restricted smile and an adynamic central upper lip. We have had success in treating postreconstruction and postaugmentation stiff upper lip with a therapeutic device and treatment regimen. This therapy alleviated tightness and inability to smile. Also, the change in lip commissure-to-commissure distance in repose and when smiling improved after treatment.
The multitude of lip augmentation procedures testifies to the lack of a surefire, no-nonsense method. The volume and shape of the thin upper lip have been enhanced with addition of material (synthetic and autogenous) and by recruitment of local tissue, but this improvement does not come without a price. The cost in some patients is lip tightness, resulting in a restricted smile and an adynamic central upper lip.
The following techniques have been proposed for augmentation cheiloplasty: (1) local tissue rearrangements, such as lip border advancement (Gillies and Millard) and double V-Y plasty (Lassus, horizontal; Aiache, vertical); (2) autogenous fillers, such as temporalis fascia, dermal grafts, or fat; (3) heterologous material, such as silicone, collagen, polytetrafluoroethylene (Gore-Tex), and AlloDerm; or (4) a combination of techniques. 1-9 Local tissue flaps may have problematic cicatricial sequelae. Follow-up studies of patients with galeal graft augmentation suggest that up to 52 percent of patients report less elasticity and tightness when smiling after this procedure. 5 Permanent implants (e.g., Gore-Tex) are subject to the same contracture problems as breast implants from fibroblastic ingrowth and collagen maturation. 10
Results of fuller, more appealing lips are clouded by the loss of function (soft, supple, and sensate lips). Critical analysis of reports that present techniques for lip augmentation is difficult because subjects are shown in follow-up photographs only in repose, and the sequelae of a stiff upper lip may be missed. This is an important point because smiling often unmasks the stiff upper lip. The normal upper lip commissure-to-commissure distance at rest is approximately 6 cm. The upper lip commissure-to-commissure distance when smiling approaches 9 cm. A firm graft (fascia or galea) or implant of this size cannot accommodate the upper lip length increase when smiling.
Similar to the potential sequelae of aesthetic lip augmentation, lip reconstruction for large defects can also lead to tight lips from postoperative scarring, or microstomia may result. We have recently had some success in treating postreconstruction lip problems using a therapeutic device and treatment regimen. On the basis of this success, we decided to address the postaugmentation tight upper lip (or give lip service to the stiff upper lip) using the same therapeutic device and a similar treatment regimen.