Autologous Lip Augmentation: a Comparative Analysis

Andrew P. Trussler M.D., Brian P. Dickinson M.D., Jennifer J. Keagle M.D., James P. Bradley M.D., Henry K. Kawamoto D.D.S., M.D.

INTRODUCTION: Lip deficiencies may arise from facial aging, previous ablative procedures or congenital absence of lip volume. The goals of lip augmentation are to increase deficient vermillion volume and elevate the ptotic vermillion border.[1,2] Currently, results form office-based fillers, such as hyaluronic acid and collagen, are short-lived. Variable outcomes have been documented with operative procedures, such as fat grafting by injection, dermal fat grafting or V-Y advancement.[3-6] The palmaris longus tendon, commonly used in tendon transfers for upper extremity reconstruction, has also been used for lip augmentation. This study compares the efficacy of these three autologous modalities of upper lip augmentation: 1) palmaris longus tendon, 2) fat injection and 3) dermal fat.

METHODS: A retrospective review of pre and post-operative photos evaluated for aesthetic results and scored (1 poor to 5 excellent) was assigned to the comparative individual appearance. Patient satisfaction, complications and revisions were recorded. Three different methods of lip augmentation were performed. (1) Dermal fat grafts were harvested from a deepithelialized donor site. The grafts were proportioned and contoured to the lip. The dermal fat grafts were inset through small incisions at the commisure or through V-Y mucosal incisions after a submucosal bed was developed. (2) Fat for injection was harvested according to the Coleman technique and injected into the desired area of the lip. (3) Palmaris longus harvest was accomplished with a tendon stripper via a small incision in the volar wrist crease. The tendon was stacked, with an average of 3 layers used for lip augmentation. Bilateral commisure stab incisions were made and tendon passer was used to pass the layered graft through the submucosal tunnel (Figure 1).

RESULTS: A total of 38 patients (18 palmaris/11 fat injection/9 dermal fat) with an average age of 35.1 (range 15-70) underwent autologous lip augmentation between 1998-2005. Indications for operation included cosmetic (15), and reconstruction (23). The average length of follow-up was 19.5 months (range 1-64). There was improvement of the overall appearance based on evaluation of pre and post-operative photos (Average score 3.7/ palmaris 4.2> dermal fat 3.6>fat 3.5) with a significant improvement of the palmaris graft as compared to the fat injection (p<0.05). Eighty four percent of patients were subjectively satisfied with their appearance, with palmaris satisfaction (94%) greater than fat injection (82%) and dermal fat (78%). Fat injection had a lower rate of complication (9%) compared to palmaris (39%) and dermal fat (33%). Complications included graft exposure (6), asymmetry (2), lip stiffness (2) and infection (1). The rate of graft exposure was highest in the palmaris group (28%). Lip stiffness was seen only in the dermal fat group. The fat injection group had a 36% need for re-injection where as the palmaris and dermal fat groups had a 6 and 11% re-grafting rate, respectively. There were no donor site complications in any group.

CONCLUSION: All three autologous modalities were effectively applied to augment the lip. Palmaris longus tendon provided the most reliable soft tissue implant. Fat injection required multiple revisions and dermal fat grafting negatively affected lip mobility with stiffness.

Figure 1. a) Palmaris longus harvest was accomplished with a tendon stripper via a small incision in the volar wrist crease. b) Tendon passer was used to pass the layered graft through the submucosal tunnel.

REFERENCES

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