Correction of a Long Face: Simultaneous Reduction of the Upper Lip Using a Modified Endonasal Technique and Le Fort I Osteotomy Superior Impaction.

Abstract

Although Le Fort I osteotomy superior impaction during bimaxillary surgery is beneficial for patients with a long face, achieving satisfactory results can be challenging due to the redundant upper lip. However, upper-lip reduction has rarely been performed during or following bimaxillary surgery because of the difficulty in estimating the required amount of cutaneous resection needed and the apparent horizontal scars left behind. Therefore, no simultaneous cutaneous upper-lip reduction with orthognathic surgery has been reported. The authors present successful clinical outcomes using a modified endonasal upper-lip reduction technique performed with orthognathic surgery. A total of 33 patients underwent simultaneous cutaneous upper-lip reduction with orthognathic surgery. Of those, 15 patients were statistically analyzed. The amount of skin excised was individualized depending on the amount of Le Fort I osteotomy superior impaction and the aesthetic goal. Postoperative changes in upper-lip length were assessed with lateral cephalography. Most patients had satisfactory results without serious complications. Overall lip contours, especially lip height, were greatly improved. The scar was hidden intranasally, aside from inconspicuous scarring in the subalar area. Regarding Le Fort I osteotomy, the amount of superior impaction averaged 3.26 mm (range, 0-6.0). The amount of upper-lip reduction averaged 3.42 mm (range, 3.0-6.0). Upper-lip length decreased from 25.27 ± 0.94 mm preoperatively to 21.22 ± 0.94 mm postoperatively (P < 0.05). Upper-lip reduction is essential for achieving desired results during orthognathic surgery for patients with a long face. Our method enables simultaneous maxillary height and cutaneous upper-lip reduction without a continual, visible cicatrix.