We thank Dr. Malaviya for sharing his opinion and commentary on autologous lip augmentation. Palmaris longus tendon is a soft, thin, autologous implant that does restore volume in a hypoplastic or scarred lip. It is a valuable and versatile soft-tissue filler that has taken the place, in certain circumstances, of other autologous options, such as microfat grafting and dermal fat grafts. The donor-site incision is small, inconspicuous, and well tolerated. We doubt the options presented by Dr. Malaviya, including the fascia lata and gracilis, could have the same small donor site and longevity objectively demonstrated in our article. We agree that lip augmentation has no one answer, as Dr. Malaviya has commented. In the reconstructive lip, the palmaris longus tendon is readily available and form-stable, with the ability to contour with stacking to fill the specific void after a stable soft-tissue envelope has been created. A multimodal approach should be applied to the lip and should include volume augmentation, combined with skin resurfacing or scar revision, and alteration of the orbicularis oris, either surgically or through chemodenervation. These principles hold true for both the cosmetic and the reconstructive patient. We believe that the palmaris longus tendon does play a role in this multimodal approach. It is presented as a viable, safe addition to the lip algorithm and not as a single solution, as Dr. Malaviya suggested. Plastic surgery has been plagued by subjective opinions and dogma; this article offers objective data that support our technique. The author has obviously missed the point of the article and, ironically, fallen into the trap of subjective opinion in his letter.
Andrew P. Trussler, M.D.
University of Texas Southwestern Medical Center
James P. Bradley, M.D.
UCLA Division of Plastic and Reconstructive Surgery
Los Angeles, Calif.
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