- Double lip deformity occurs because of the persistence of the transverse sulcus between the inner lip (pars villosa) and the outer lip (pars glabra), resulting in glandular hypertrophy along with redundant labial mucosa. The excess tissue forms an accessory lip, which is apparent during smiling. The underlying orbicularis oris muscle is not involved.
- Labial "pits" -- usually described as blind epidermal invaginations of lip mucosa with occasional drainage of minor salivary gland secretions
- Ethnic variations demonstrate diffuse thickening of all lip structures and may require resection of muscle.
Acquired causes include
- Trauma -- result in an inflammatory infiltration leading to fibrosis and subsequent lip enlargement
- Melkersson-Rosenthal Syndome -- Miescher granulomatous macrocheilitis is a mono-symptomatic presentation of Melkersson-Rosenthal syndrome that is characterized by granulomatous swelling of the lips. The full syndrome is a condition characterized by the triad of facial paralysis, facial edema, and lingua plicata (furrowed tongue), similarly results in an infiltrative process of the lips.
- Ascher syndrome is identical to double lip deformity with associated blepharochalasis and endocrine disorders.
- Port-wine (capillary) vascular malformations that enlarge the lips (port-wine macrocheilia) are a different category of lesions that have a different pathophysiology and may require complex reconstruction.
CLINICAL PRESENTATION/ EXAM
- Correct underlying dento-osseous (teeth/bone)deformities.
- Establish a balance between upper and lower lips with the individual patient in mind
- Do not reduce lips if excessive interlabial distance exists.
- Optimal frontal aesthetics is more important than profile aesthetics
- When designing the incision it is imperative to place the anterior aspect of the incision posterior to the lip seal and wet line (transition from inner mouth mucosa and vermillion).
- Avoid the area of Cupid's bow as well. Cupid's bow should always be preserved during correction of a prominent upper lip since it is an important landmark of the lip.
- The marking should be made prior to the use of local anesthetics, which tend to distort the lip architecture.
- The goal should be removal of hypertrophied labial glands, fibrosis from an infiltrative process, or generalized thickened redundant tissue.
- In the upper lip, macrocheilia usually affect the lip in the vertical dimension. If the dry vermilion is not excessively large, the reduction surgery is designed as a transverse ellipse behind the wet line. However, if the entire vermilion is enlarged, then design of the excision may include the dry vermilion.
Unfortunately, all surgery has risks and complications.
Chance of asymmetry
Numbness -- usually subsides within the first few weeks, but may be permanent
Lip Reduction by Vipul R Dev MD and Peter Wang MD--eMedicine Article, June 14, 2006
Surgical Treatment of Persistent Macrocheilia in Patients With Melkersson-Rosenthal Syndrome and Cheilitis Granulomatosa; Arch Dermatol. 2005;141:1085-1091; Birgit Kruse-Lösler, MD, DMD; Dagmar Presser, MD; Dieter Metze, MD; Ulrich Joos, MD, DMD
Macrocheilia due to hyperplasia of the labial salivary glands: operative correction. Surg Gynecol Obstet. 1938;66:1024-1031; Conway H
Correction of hypertrophy of the upper lip; Plast Reconstr Surg. 1970;46:262-264; Mouly R