Reducing a Large Lip – Lip Reduction Plastic Surgery

Making a small lip bigger is by far the most requested cosmetic lip makeover. However, there are some patients, both men and women, who feel that their lips are too large and wish they were smaller. When one’s lips are excessively large by nature, they can functionally interfere with lip competition (joining and creating a lip seal), as well as being a source of too much attention and embarrassment.

Very large labia, also known as macrocheilia, can develop for multiple reasons. Some people have them naturally, and others develop them for a variety of rare medical reasons. While large lips have a significant ethnic association, I have also seen several Caucasians of various origins who have them as well. In my plastic surgery practice in Indianapolis, I have treated both Caucasians and other ethnic groups for lip reduction surgery.

One lip condition that can be confused with macrocheilia is double lip which occurs only on the upper lip. This is because the upper lip is too large (too much outer vermilion), it is because there is an extra roll of tissue on the underside (mucosa) of the upper lip. This becomes apparent when one smiles, as this extra roll of mucosa looks like a horizontal roll of tissue under the upper lip. Therefore, its surgical removal is slightly different than a large outer upper lip.

The goal of lip reduction surgery is to create lip sizes that are more proportionate to each other and to the rest of the face. At the very least, a patient’s goal is not to have them as the most dominant feature of the face that draws attention to them.

Lip reduction surgery is not complicated, but surgical planning (marking) is the key. An initial mark (line) is drawn at the wet-dry junction, but may change depending on which part of the lip is more prominent, the dry vermilion, or the moist mucosa. For some large lips, dry vermilion is the dominant part to remove. For others, it may be more of the moist vermilion and mucosa. A careful preoperative examination of the lip should be performed to make this determination. No matter what part of the upper lip is removed, you don’t want the final closure (and subsequent scar) to be evident when the lips are in a resting or smiling position. A wedge of excess lip is marked and tapers as it enters the corners of the mouth to avoid excess ant tissue. I like to keep the final edge of the cut a few millimeters away from the corner of the mouth.

Lip reductions can be performed under local anesthesia, although a more intense anesthesia would be more pleasant. Once anesthetized, the wedge excision primarily removes the external mucosa and inferior submucosa. (in medical macrocheilia the lip tissues removed may be deeper and more extensive) It is not necessary to remove muscle for cosmetic reduction and the labial artery should be preserved. I find a pinch technique to be very helpful. Using this method, the planned amount of mucosal excision is pinched with a special instrument until the desired total amount is in the pinch. It is then cut with scissors and closed with a continuous absorbable suture. Only antibiotic ointment or Vaseline is applied to the dry vermilion afterward to keep it hydrated as the lips swell and are prone to chapping and soreness.

The lip will swell considerably, which is normal, and it may take several weeks to see the amount of reduction that has been made. Usually a reduction of about 4 to 6 mm (sometimes more) of the actual size of the horizontal lip can be easily achieved.

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