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Lip Rejuvenation Using Perioral Myotomies and Orbicularis Oculi Muscle as Autologous Filler

Citarella, Enzo Rivera, M.D.; Sterodimas, Aris, M.D., M.Sc.; Condé-Green, Alexandra, M.D.

Plastic and Reconstructive Surgery: December 2009 - Volume 124 - Issue 6 - p 446e-448e
doi: 10.1097/PRS.0b013e3181bcf55e
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Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute, Rio de Janeiro, Brazil

Correspondence to Dr. Sterodimas, Department of Plastic Surgery, Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute, Av. Beira Mar 406, Rio de Janeiro, Brazil

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Sir:

Rejuvenation of the lips plays a key role in restoring a more youthful appearance. With aging, changes occur in the lips, such as vertical wrinkles, reduction in height of the vermilion border along with lengthening of the skin area of the lip, and “disappearance” of the Cupid's bow.1 Injectable fillers, botulinum toxin, autologous tissue grafts and fat grafting, lip lifts, lip advancements, and resurfacing procedures have been described in the literature. Temporary nonsurgical treatments and minimally invasive procedures are now the cutting edge lip rejuvenation treatments that attract the majority of the patients. However, with the increasing demand from patients comes an increasing challenge to surgeons to develop techniques that are suited to the particular concerns, desires, and anatomy of each patient.2 We report a new surgical method of lip rejuvenation.

After infiltration of both upper and lower lips with anesthetic solution consisting of lidocaine 0.5% and epinephrine 1:240,000, 2-mm horizontal incisions are made in the premarked areas at the level of the circumferential vermilion-skin border. Four incisions are made on each upper hemilip, the most medial one starting approximately 3 mm lateral to the Cupid's bow and the most lateral one ending approximately 3 mm from the angle of the mouth. On the inferior lip, the incisions are marked according to the presence of the perioral wrinkles. Small undermining is made through these incisions with tenotomy scissors to cut the orbicularis oris muscle a few millimeters above the vermilion line, taking care not to damage the superior and inferior labial arteries passing just beneath the muscle (Fig. 1). Then, an intramuscular tunnel is created using a 1.8-mm cannula, making blunt dissection across each side of the superior lip, preserving the Cupid's bow. An 18 × 1.8-mm strip of orbicularis oculi muscle is excised on each side during the superior blepharoplasty procedure. It is then pulled through the tunnel with a tendon forceps in each hemilip (Fig. 2). Finally, suture of the skin incisions at the level of the vermilion is performed with interrupted MN 6-0. Orbicularis oculi grafts used for lip augmentation produced a youthful appearance by adding natural, soft roundness and fullness to the lips (Fig. 3).

Fig. 1.

Fig. 1.

Fig. 2.

Fig. 2.

Fig. 3.

Fig. 3.

The definitive approach to lip augmentation has yet to be determined.3 Many patients suitable for a lip augmentation and rejuvenation are of face-lift and blepharoplasty age and could benefit from a simultaneous lip enhancement during those procedures. Lip augmentation with superficial musculoaponeurotic system grafts and palmaris longus tendon has been described.4,5 The perioral orbicularis oris myotomies treat the perioral rhytides without the need for repeated injections and skin resurfacing procedures that in the long run are expensive. Although there is an ever-expanding list of products for lip augmentation, the artificial appearance and feel of synthetic material injected in the lips remains a problem.4 The length of the strip of orbicularis oculi muscle corresponds to the length of a superior hemilip, which makes any tailoring of the graft unnecessary. No postoperative complications were noted apart from swelling, which lasts 5 to 7 days. This combination of perioral myotomies and orbicularis oculi muscle strip has not been described previously and provides another option that can be used for lip rejuvenation. Further cases need to be performed to better define long-term results.

Enzo Rivera Citarella, M.D.

Aris Sterodimas, M.D., M.Sc.

Alexandra Condé-Green, M.D.

Department of Plastic Surgery

Pontifical Catholic University of Rio de Janeiro and the Carlos Chagas Post-Graduate Medical Institute

Rio de Janeiro, Brazil

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REFERENCES

1. Guerrissi JO. Surgical treatment of the senile upper lip. Plast Reconstr Surg. 2000;106:938–940.
2. Clymer MA. Evolution in techniques: Lip augmentation. Facial Plast Surg. 2007;23:21–26.
3. Rohrich RJ, Reagan BJ, Adams WP Jr, Kenkel JM, Beran SJ. Early results of vermilion lip augmentation using acellular allogeneic dermis: An adjunct in facial rejuvenation. Plast Reconstr Surg. 2000;105:409–416; discussion 417–418.
4. Leaf N, Firouz JS. Lip augmentation with superficial musculoaponeurotic system grafts: Report of 103 cases. Plast Reconstr Surg. 2002;109:319–326; discussion 327–328.
5. Trussler AP, Kawamoto HK, Wasson KL, et al. Upper lip augmentation: Palmaris longus tendon as an autologous filler. Plast Reconstr Surg. 2008;121:1024–1032.

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