Reply: Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians.

Abstract

Sir: I thank Dr. Huan Wang for his interest in the article “Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip-Plasty in Asians.”1 The main focus of this technique is to make natural lip lifting with minimal scars. Therefore, we discussed specifically key suture methods under Surgical Technique in our article. First, too much excision without careful flap dissection may cause sill problems, as you mentioned. Therefore, less lip skin excision and more underdissection toward the Cupid’s bow help to reduce the skin tension. In addition, the balance between these is the main key to the result. As we mentioned in the article, the suture between the superior edge of the orbicular muscle and the base of the nose with interrupted absorbable 5-0 polydioxanone stitches (Ethicon, Inc., Somerville, N.J.) is the most important. Security of this suture helps to control the skin tension. Also, in some conditions, a strut graft also helps to make the nasal base stable. Second, it is crucial to pay utmost attention to the suture because the labial flap is longer than the nasal flap. Stitches taking the nasal flap perpendicular to the skin and the labial flap in parallel have to be placed. In this way, the length of the labial flap shortens and becomes as long as the nasal flap while the columellar skin can be redistributed without cutting this area. This technique is the most critical for minimizing sill deformity. Third, not all cases were successful with regard to scars, and we mentioned this in the Discussion section. In two of the 30 patients (6.7 percent), incisional scarring was noticeable from a conversational distance at the time of long-term follow-up. These patients underwent scar revision surgery and received comprehensive postoperative treatment to prevent additional scarring. Therefore, the surgeon must pay utmost attention to avoid scars with the exact procedure and even tension distribution. Fourth, our incision begins at the alar fold of the nose, enters the nostril, and rises medially on the lower margin of the medial crura of the alar cartilage. A separate incision begins at the other alar fold, enters the nostril, and rises medially, similar to the first incision. A vertical skin bridge is left intact between the left and right incisions. At first, this incision technique was planned because spare skin from lip lifting can be recruited to augment the nasal tip to solve the tip underprojection problem in an aging Asian nose. Therefore, our technique is not suitable for patients who need septorhinoplasty mainly. In conclusion, the objective of this study was to introduce a subnasal short scar upper lip-lifting technique that could be performed with nasal tip augmentation without additional nasal incision. There is a dramatic improvement in the patient’s facial aesthetic appearance by increasing tip projection and nasolabial angle because of skin redraping. However, as in other previous useful techniques, this is not the only method for aging patients. Careful patient selection in the preoperative planning step is most important to a successful outcome. DISCLOSURE None of the authors has a financial interest to declare in relation to the content of this communication. Jae-A Jung, M.D., Ph.D.Department of Plastic SurgeryKorea University College of Medicine Hyun Park, M.D.Park-Hyun Plastic Surgery Clinic Eun-Sang Dhong, M.D., Ph.D.Department of Plastic SurgeryKorea University College of MedicineSeoul, Republic of Korea