|Year : 2021 | Volume
| Issue : 2 | Page : 143-145
Lip repositioning: Surgical method of beautifying the smile
Archana Chaurasia, Ramakant Dandriyal, Vishakha Lal, Sakshi Gupta, Himanshu Sharma
Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh, India
|Date of Submission||19-Apr-2020|
|Date of Acceptance||29-Apr-2020|
|Date of Web Publication||26-Mar-2021|
Dr. Archana Chaurasia
Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Bareilly, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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. 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., Treatment option is always based on the harmony of lips, gingival display, and tooth. 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|| |
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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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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| Discussion|| |
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. According to the literature, the results with Botox are transitory lasting from 3 to 6 months, and it requires repeated therapies.
The surgical procedure for gummy smile was first advocated by Rubinstein and Kostianovsky in 1973. 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. Litton and Fournier in 1979 described that detachment of elevator muscles is must for the correction of gummy smile. 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. 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. 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. 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|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]