What is the difference between lip revision and cheiloplasty?

Lip Revision vs Cheiloplasty: Understanding the Differences

Lip revision and cheiloplasty are distinct surgical procedures with different purposes, though they both involve surgical modification of the lips to improve function and aesthetics.

Key Differences

• Cheiloplasty is a primary surgical procedure for congenital lip defects (particularly cleft lip) that involves the initial reconstruction of the lip to establish normal anatomy and function 1, 2
• Lip revision is a secondary procedure performed after primary cheiloplasty to correct residual or secondary deformities that persist after initial repair 3, 4

Cheiloplasty (Primary Lip Repair)

• Primarily performed for congenital defects like cleft lip, creating a functional and aesthetic lip from abnormal anatomy 2
• Typically performed in early childhood, with some centers performing the procedure in neonates as young as 1-8 days old 5
• Focuses on establishing normal lip anatomy including:
  • Reconstruction of the orbicularis oris muscle 3
  • Creation of normal lip contour 2
  • Establishment of proper vermilion border 1
• May involve techniques such as:
  • Skin grafting for philtrum reconstruction in cases of tissue deficiency 2
  • Modified Tennison technique for cleft lip repair 5
  • Primary rhinoplasty may be performed simultaneously 6

Lip Revision (Secondary Lip Surgery)

• Performed to correct residual deformities after primary cheiloplasty 3, 4
• Addresses specific issues such as:
  • Vermilion notching deformity 4
  • Whistle deformity (vertical tissue deficiency in the medial portion of the upper lip) 3
  • Scar revision 7
  • Correction of lip length and volume 3
• May involve techniques such as:
  • Inferiorly based submucosal flaps to increase volume in deficient areas 3
  • Lengthening of oral lining 4
  • Repositioning of Cupid's bow 4
  • Complete revision of the labial anatomy 3

Timing Considerations

• Cheiloplasty is typically performed in early childhood, with some centers advocating for neonatal repair 5
• Lip revision is usually performed after growth of the lip has definitively ceased 1
• For patients with cleft lip and alveolus, revision lip/nose surgery may be performed in 21.8-27.3% during growing age, and in 51.7-72.7% after skeletal maturity 6

Aesthetic and Functional Considerations

• Both procedures aim to:
  • Restore normal lip contour 7
  • Improve function of the orbicularis oris muscle 3
  • Place scars along natural boundaries when possible 7
• Lip revision specifically focuses on correcting errors from primary repair, such as:
  • Insufficient lengthening of oral lining 4
  • Improper marking of Cupid's bow height 4
  • Addressing tissue deficiencies in specific areas 3

Common Pitfalls and Caveats

• Debulking lip lesions while preserving vermilion can be exceedingly difficult due to the challenge of separating tissue from the orbicularis oris muscle 7
• Setting the "white roll" (ridge at the vermilion-cutaneous border) and restoring normal sublabial concavity can be particularly challenging 7
• Careful postoperative management is necessary even if the columella is not reconstructed, as airway stenosis can occur 2
• Reconstruction of a lip that is scarred and disfigured is best performed only after growth of the lip has definitively ceased 1

Alternative Non-Surgical Options

• For minor lip enhancement without surgery, options include:
  • Hyaluronic acid (HA) fillers for volumizing effects lasting 6-18 months 8
  • Autologous Platelet Concentrates (APCs) for rejuvenation effects rather than significant volumizing 8
  • Platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) for improving lip color, moisture, and texture 1