Aging of the upper lip, part II: Evidence Based Rejuvenation of the Upper Lip: a Review of 500 consecutive Cases

Background: Findings from photometric analysis and measurements in soft tissue on cranial magnetic resonance imaging show that the aging upper lip suffers from significant lengthening, thinning and volume loss and deepening of nasolabial folds. In this study, these findings are implemented in a review of 500 cases of upper lip rejuvenation to propose an evidence based strategy for surgical rejuvenation of the upper lip. Methods: The charts of 500 consecutive surgical perioral rejuvenation patients treated at the senior authors' (PLT, AMV) private clinic from October 2014 till January 2018 were reviewed. The methods of the surgical technique of lip lift and fat grafting were described in relation to the cases and the metric data. Results: Of the 500 patients, 51 had an isolated procedure like a lip lift (16;3%), lip augmentation (15;3%), augmentation of the nasolabial folds (8; 2 %) or skin resurfacing (12;2%). The remaining 449 patients underwent combinations of lip lift, augmentation of the lip and nasolabial fold (158;32%), lip lift with augmentation of the lip and nasolabial fold with resurfacing (151;30%), lip augmentation and resurfacing (72;14%), or lip lift and resurfacing (68;14%). Conclusions: Rejuvenating the upper lip needs to address both lengthening as the volume loss. This requires a combination of surgical shortening of the upper lip by a precisely designed lip lift and a differential filling of certain upper lip regions by microfat grafting. The combination of these two modalities works synergistically and produces a result that is more than the sum of the different components. Financial disclosure: The authors have nothing to disclose. No funding was received for the article. Presented at No where Corresponding author: Patrick L Tonnard, MD, PhD, Coupure Centrum for Plastic Surgery, Ghent, Coupure Rechts 164C-D, 9000 Gent, Belgium email patrick@coupurecentrum.be ©2019American Society of Plastic Surgeons

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