Enlarging a small lip is by far the most common cosmetic lip change requested. 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 naturally excessively large, they can functionally interfere with lip competition (coming together and creating 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 just have them naturally, and others develop them for multiple rare medical reasons. While large lips have a significant ethnic association, I have also seen several Caucasians of various descendants who have them as well. In my plastic surgery practice in Indianapolis, I have treated as many Caucasians as other ethnic groups for lip reduction surgery.
A lip condition that can be confused with macrocheilia is double lip that 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 lower part (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. Surgical removal is done slightly differently 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 it may change depending on the most prominent part of the lip, 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 moist vermilion and mucosa. A careful preoperative examination of the lip should be performed to make this determination. No matter which part 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. An excess lip wedge is scored and tapers as it goes towards 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 my mouth.
Lip reductions can be performed under local anesthesia, although a more significant anesthesia would be more pleasant. Once anesthetized, the wedge excision primarily removes the outer mucosa and the lower submucosa. (In medical macrocheila, the excised lip tissues may be deeper and more extensive) It is not necessary to excise muscle for cosmetic reduction and the labial artery must be preserved. I find a pinching technique very helpful. With this method, the planned amount of mucosal excision is pinched with a special instrument until the entire desired amount is squeezed. It is then cut with scissors and closed with a running absorbable suture. Just apply an antibiotic ointment or petroleum jelly to the dried 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 appreciate the amount of reduction that has been made. In general, a reduction of approximately 4 to 6 mm (sometimes more) from the actual size of the horizontal lip can easily be achieved.
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