Making a little 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 big and wish they were smaller. When one’s lips are excessively large by nature, they can functionally interfere with lip competition (joining together and create a lip seal), as well as being a source of too much attention and embarrassment.
Very large lips, also known as macrocheilia, can develop for multiple reasons. Some people have them naturally, and others develop them for many rare medical reasons. While big lips do have a significant ethnic association, I have also seen a number of Caucasians of various origins have them as well. At 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 in proportion 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, the dried vermilion is the dominant part to remove. For others, it may be more of the wet vermilion and mucosa. A careful preoperative examination of the lip must be performed to make this determination. No matter how much of the upper lip is removed, you don’t want the final closure (and subsequent scar) to be apparent when the lips are in a resting or smiling position. A wedge of excess lip is scored and tapered as it is drawn into 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 anesthetic would be more pleasant. Once anesthetized, the wedge excision primarily removes the external mucosa and the lower submucosa. (in medical macrocheila the excised lip tissues can be deeper and more extensive) It is not necessary to remove muscle for cosmetic reduction and the labial artery must be preserved. I find a pinch technique to be very helpful. Using this method, the planned amount of mucosal excision is pinched off with a special instrument until the full desired 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 dried vermillion afterwards to keep it hydrated as the lips swell and are prone to cracking and pain.
The lip will swell considerably, which is normal, and it may take several weeks to appreciate the amount of reduction that has been made. Typically, a reduction of approximately 4-6mm (sometimes more) from the actual size of the horizontal lip can be easily achieved.
