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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 143-145

Lip repositioning: Surgical method of beautifying the smile


Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India

Date of Submission19-Apr-2020
Date of Acceptance29-Apr-2020
Date of Web Publication26-Mar-2021

Correspondence Address:
Dr. Archana Chaurasia
Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjps.tjps_11_20

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  Abstract 


In today's era, it is said that an oral and maxillofacial surgeon with knowledge of aesthetic surgery is like two eyes on the face. Smile is recognized as a killer app for young adults, mainly in young females and people with less beautiful smile face embarrassment. Due to less harmonic smile, people suffer from mental trauma and depression. So many treatment options are advocated to overcome this problem, which included several surgical and nonsurgical methods. Here, we present a case report of a 15-year-old young girl who reported to us with a chief complaint of gummy smile. We advocated surgical lip repositioning procedure, and on 6-month follow-up, no relapse was observed.

Keywords: Excessive gingival display, gummy smile, killer app


How to cite this article:
Chaurasia A, Dandriyal R, Lal V, Gupta S, Sharma H. Lip repositioning: Surgical method of beautifying the smile. Turk J Plast Surg 2021;29:143-5

How to cite this URL:
Chaurasia A, Dandriyal R, Lal V, Gupta S, Sharma H. Lip repositioning: Surgical method of beautifying the smile. Turk J Plast Surg [serial online] 2021 [cited 2021 Apr 23];29:143-5. Available from: http://www.turkjplastsurg.org/text.asp?2021/29/2/143/312174




  Introduction Top


In this era, the smile and aesthetics is the main concern all over the world. The smile is the first thing which is noticed on an individual's face while talking or smiling. In another word, it can be explained that smile is a “killer app” in young adults.[1] Excessive gingival display destroys harmony of aesthetic smile. Gummy smile or excessive gingival display while smiling can be due to vertical growth of the maxilla, incompetent lip, and delayed eruption.[2],[3] Treatment option is always based on the harmony of lips, gingival display, and tooth.[1] Gummy smile due to excess vertical growth of the maxilla can be treated by orthognathic surgery. Here, we present a case of gummy smile which was treated with lip repositioning surgery.


  Case Report Top


A 15-year-old young girl was reported to the outpatient department of oral and maxillofacial surgery with a complaint of excessive gingival display while smiling even after orthodontic treatment. On local examination, excessive gingival display was noticed while talking and smiling. The upper lip length was 20 mm [Figure 1], and excessive gingival display of 5 mm was recorded from the marginal gingiva to the inferior border of the upper lip while smiling [Figure 2]. The patient was planned to be operated under local anesthesia for relieving the hyperactivity of elevation group of muscles of the upper lip, i.e., zygomaticus major, orbicularis oris, and levator labii superioris to provide harmonic smile.
Figure 1: Lip length measuring from the subnasale to the inferior portion of the upper lip, which is about 20 mm in length

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Figure 2: The total excessive gingival display was approximately 5 mm

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The procedure was advocated under all aseptic conditions. All the surgical markings were made using a surgical marker on the gingiva from first molar to another first molar. The first marking was made at 5 mm height from marginal gingiva and another marking was made at 5 mm above the first one [Figure 3]. Using number 15 BP blade, the partial-thickness flap was elevated, and this tissue was excised [Figure 4]. The first incision at origin of the zygomaticus major muscle was done in front of the anterior surface of the zygoma and the second incision at origin of the levator labii superioris from the zygomatic process of the maxilla near to the infraorbital foramen. The abovementioned elevator muscle was released to relieve the contraction of the upper lip to protect the relapse of gummy smile [Figure 5]. The closure was done using 3-0 vicryl suture. The first suture was placed at the midline to stabilize and maintain the integrity of the labial frenum of the upper lip, followed by rest closure. The patient was prescribed capsule amoxicillin 500 mg thrice a day and tablet ibuprofen 600 mg twice a day for 5 days. The patient was recalled after 7 days to remove alternate sutures, and the remaining sutures were removed on the 15th day of follow-up. The patient was taken up on regular follow-up for 12 months, and no relapse was noted on 6 months [Figure 6] and 12 months [Figure 7].
Figure 3: Marking on the attached gingival margin and mucogingival junction, lower marking was 5 mm above the marginal gingival and another at 5 mm above the first marking

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Figure 4: Partial-thickness incision was given, and partial-thickness tissue was resected

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Figure 5: Releasing of elevator muscles of the upper lip

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Figure 6: Postoperative 6-month follow-up

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Figure 7: Postoperative 12-month follow-up

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  Discussion Top


There are so many nonsurgical techniques available, but they have their own disadvantages. Nowadays, botulinum toxin Type A (Botox®) has been widely used in the aesthetic correction. Botulinum toxin inhibits the transmission of alpha-neurons at neuromuscular junction which causes weakness of striated muscles.[4] According to the literature, the results with Botox are transitory lasting from 3 to 6 months, and it requires repeated therapies.[5]

The surgical procedure for gummy smile was first advocated by Rubinstein and Kostianovsky in 1973.[6] After that, so many modifications had undergone lip repositioning surgery. The indications for surgical lip repositioning for gummy smile are vertical maxillary excess, altered passive eruption, hypermobile upper lip, short upper lip, and gingival hyperplasia.[7] Litton and Fournier in 1979 described that detachment of elevator muscles is must for the correction of gummy smile.[8] In 1983, Miskinyar observed no relapse found in 27 patients who were treated with lip repositioning with myomectomy and partial resectioning of one or both levator labii superioris muscle bilaterally.[9] Ishida et al. observe a significant reduction in gummy smile in 14 patients who were treated for the same with release of the levator labii superioris, subperiosteal dissection, and frenectomy.[10] Modified lip repositioning, however, does not include the maxillary labial frenum. The main objective for preserving the maxillary labial frenum is that it prevents the midline being shifted, thus guiding for an aesthetically pleasing smile, and also avoids the morbidity associated with the removal of the maxillary labial frenum. Muthukumar et al. in 2015 observed that surgical lip repositioning is less traumatic and has fewer complications and faster recovery as compared to orthognathic surgery.[11] In this case, we preferred surgical procedure for lip repositioning over so many other nonsurgical procedure, and on 6-month follow-up, no relapse was observed.


  Conclusion Top


Here, we conclude that surgical lip repositioning is better over other surgical and nonsurgical procedures such as orthognathic surgery or Botox injections. On 12-month follow-up, we recorded that the harmony of aesthetic smile was remained the same as postoperatively with no complication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Izraelewicz-Djebali E, Chabre C. Gummy smile: Orthodontic or surgical treatment? J Dentofacial Anom Orthod 2015;18:102.  Back to cited text no. 1
    
2.
Garber DA, Salama MA. The aesthetic smile: Diagnosis and treatment. Periodontol 2000 1996;11:18-28.  Back to cited text no. 2
    
3.
Wennström JL, Zucchelli G, Pini Prato GP. Mucogingival Therapy – Periodontal Plastic Surgery. Clinical Periodontology and Implant Dentistry. 5th ed. Oxford: Blackwell Munksgaard; 2008. p. 955-1028.  Back to cited text no. 3
    
4.
NIH. Toxin botulinum. Consens Statement 1990;8:1-20.  Back to cited text no. 4
    
5.
Mann DH. Lip repositioning to eliminate the gummy smile. Inside Dent 2017;13:3.  Back to cited text no. 5
    
6.
Rubinstein A, Kostianovsky A. A Cosmetic surgery for the malformation of the laugh: Original technique. Prensa Med Argent 1973;60:952.  Back to cited text no. 6
    
7.
Billichodmath S, Geeta K, Sameera U. Lip repositioning with myotomy – A surgical approach to treat gummy smile. J Evol Med Dent Sci 2019;8:2526-9.  Back to cited text no. 7
    
8.
Litton C, Fournier P. Simple surgical correction of the gummy smile. Plast Reconstr Surg 1979;63:372-3.  Back to cited text no. 8
    
9.
Miskinyar SA. A new method for correcting a gummy smile. Plast Reconstr Surg 1983;72:397-400.  Back to cited text no. 9
    
10.
Ishida LH, Ishida LC, Ishida J, Grynglas J, Alonso N, Ferreira MC. Myotomy of the levator labii superioris muscle and lip repositioning: A combined approach for the correction of gummy smile. Plast Reconstr Surg 2010;126:1014-9.  Back to cited text no. 10
    
11.
Muthukumar S, Natarajan S, Madhankumar S, Sampathkumar J. Lip repositioning surgery for correction of excessive gingival display. J Pharm Bioallied Sci 2015;7:S794-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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