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3. How do you minimize the risk of nerve injury during facial implant surgery?
To minimize nerve injury, identify and preserve facial nerves during dissec-
tion, use blunt dissection techniques, and ensure that the implant does not apply
excessive pressure on the nerves.
4. How do you decide between general anaesthesia and local anaesthesia with
sedation for facial implant surgery?
Factors to consider include the patient’s preference, medical history, extent of
the surgery, and the surgeon’s experience and preference. Local anaesthesia with
sedation may offer quicker recovery and fewer side effects, while general anaesthesia may be more appropriate for patients with anxiety or more extensive
procedures.
7.9 Lip Augmentation/Reduction
Indications for Surgery
• Thin or underdeveloped lips
• Overly large or protruding lips
• Asymmetrical lips
• Aesthetic concerns related to the size, shape, or position of the lips
Specific Risks Involved with the Surgery
• Bleeding
• Infection
• Scarring
• Nerve injury (e.g. labial nerves)
• Asymmetry or unsatisfactory cosmetic result
• Anaesthesia complications
Steps of the Surgery
1. Preoperative planning: Assess the patient’s anatomy, goals, and expectations.
Mark the incision site and desired lip contour.
2. Anaesthesia: Administer local anaesthesia with or without sedation, depending
on patient preference and medical factors.
3. Incision: Make incisions along the vermilion border or inside the lip, depending
on the specic technique being used.
4. Tissue manipulation: For augmentation, inject dermal llers and autologous fat
or place lip implants. For reduction, excise excess tissue and reshape the lip as
needed. See Fig.7.9.
5. Closure: Close the incision with sutures, ensuring good apposition of the wound
edges. Apply a light dressing.
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Fig. 7.9 Lip anatomy and zones. Illustrated by Vikum Liyanaarachchi
S. AlHassan et al.
Important Points to Note for Surgery
• Lip augmentation and reduction techniques are varied to suit patient needs and
include the use of autologous materials like fat and SMAS; llers such as HA;
implants like Alloderm and silicone; and surgical methods including V-Y
advancement, double Y-V mucosal plasty, and vermillion advancement excision.
Reduction techniques include vermillion reduction and bikini lip reduction.
Questions a Consultant Might Ask a Trainee About the Operation
1. What are the key principles for achieving natural-looking results with lip
llers?
Aim for natural-looking lip enhancements by following the golden ratio, aim-
ing for a 1:1.6 proportion between the upper and lower lip for balance. Key
guidelines include ensuring symmetry, enhancing the vermilion border and
Cupid’s bow for denition, maintaining natural texture and movement, and considering age-related changes. Overlling can lead to stiffness and an unnatural
appearance.
2. What factors should be considered when deciding between autologous fat
grafting, dermal llers, or lip implants for lip augmentation?
Factors to consider include the patient’s preference, medical history, desired
lip size and shape, and the surgeon’s experience and preference. Autologous fat
grafting is biocompatible and may provide a more natural appearance but can
have unpredictable results. Dermal llers offer a minimally invasive option with
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immediate results but may require regular maintenance. Lip implants provide a
more permanent solution but carry a risk of infection, extrusion, or malposition.
3. When should a patient consider lip reduction surgery?
A patient may consider lip reduction surgery if they have overly large or pro-
truding lips that cause functional issues (e.g. difculty eating or speaking) or
aesthetic concerns. The decision to undergo lip reduction surgery should be
based on the patient’s goals, expectations, and a thorough discussion with the
surgeon about the potential risks and benets.
References
1. Naumann A.Otoplasty–techniques, characteristics and risks. GMS Curr Top Otorhinolaryngol
Head Neck Surg. 2007;6:Doc04.
2. Bailey JS, Goldwasser MS.Surgical management of facial skin cancer. Oral Maxillofac Surg
Clin North Am. 2005;17(2):205–33.
3. Naik MN, Honavar SG, Das S, Desai S, Dhepe N. Blepharoplasty: an overview. J Cutan
Aesthet Surg. 2009;2(1):6–11.
4. Barrett DM, Casanueva FJ, Wang TD.Evolution of the rhytidectomy. World J Otorhinolaryngol
Head Neck Surg. 2016;2(1):38–44.