Concerns After Lip Reduction: Revisited

Since I perform a very large number of lip reductions, I have worked hard to discuss with individuals all of the risks, complications, and recovery issues that I can imagine and that I have experienced over the years.  This blog article will discuss what I have encountered so that hopefully as many of your answers to your questions can be found before having a procedure done with me.

First we will address recovery issues that I think are helpful for a prospective patient to be aware of.  The number one concern that individuals have is how long will they be swollen.  This is a hard one for me to answer because swelling is variable.  I have seen as little as a few days and as great as a few months.  However, in general it is about 1 to 2 weeks of unfavorable swelling with the worst being the first several days.  In fact, the lips can swell after the first few days to be much larger than they were even before the surgery, a fact that can be alarming.  This is normal.  I repeat this is normal.  Most people take only a week off from work for practical reasons but must understand that there can be ongoing swelling into the second week.  For ethnic lip reductions, the worst that I have seen for duration of swelling was 5 weeks but this was in a woman who had a very very large lip reduced and I have yet to encounter that long a time for swelling in another ethnic individual.  For correction of previous bad silicone I have see up to 5 months of mild fluctuating swelling but that one woman had swelling that was already present before I performed her lip reductions so I believe this is an atypical case.

Corrective Lip Reduction for Aquamid

Another concern is how long will the lips have visible sutures.  Typically again this is for 1 to 2 weeks.  It is imperative that the sutures not be trimmed during the first week and only sutures that are hanging loose be trimmed after the first week.  Allowing sutures to dissolve by themselves is the key.  Also the incision for the first several weeks can be hanging outward more until the swelling starts to dissipate.  This is normal.   If the lip has some bleeding in the first week or two, that is normal.  All you have to do is hold pressure.  It will stop.  If a suture becomes unraveled early and even if the wound slightly opens, it should still heal fine.  This happens in a few cases.  The lips can also feel very numb afterward and even stay relatively numb for a few weeks to months, which should not raise alarm.  The lips can also feel tight, especially when opening one’s mouth or smiling and this can last for several weeks and at times even somewhat for several months.

Risks of a lip reduction include but are not limited to over or under reduction, scarring, and asymmetry.  I always tell my patients that it is very important for them to trust me on how much lip I can reduce because any more or any less may be a problem for them.  Too much lip reduced and the person could have a gummy smile, lip incompetence, a tight feeling or look unnatural.  Too little lip reduced and no result could be visible.  Given these limitations I always suggest that if one would need a further lip reduction that he or she wait for at least 6 months before contemplating any further reduction (for which I would not charge for the added procedure) because healing may be delayed with too quick another reduction and the risk of overreduction is then possible with all of the attendant problems enumerated above.  I only need to perform a further reduction in less than 5% of those who undergo lip reduction with me.  However, it is fully in my discretion to decline an individual in whom I think the risk is too great to undergo another reduction.

I have had two patients with scarring, and they were both African-Americans.  The scarring was only about 1 mm of thickness at the incision line and was easily handled with 1 to 2 rounds of 5-flourouracil injections.  Unfortunately, I am one of the few people who know how to do this procedure so you may have to fly back for me to do this, which you would be responsible for any incidental and travel expenses but I would not charge you for my services.  Fortunately, I have only had 2 cases of this out of several hundred so the odds are favorable that there will be no scarring.  As a reminder, an actual keloid is near impossible on the face even if you have a history of them on your ears, neck, scalp, or body so I am not concerned about that.  Asymmetry is very unlikely, and I do not remember having a case of this occur but obviously it is always a risk.  More often than not if you see asymmetry it is either something you had before (so please look at your lips carefully before having a procedure with me) or is very slight and should not be noticeable on normal social or professional distances.  I hope this extensive catalog of the risks. limitations, and recovery issues following a lip reduction procedure with me was helpful for you.

Samuel M. Lam, MD, FACS is a board certified plastic surgeon, specializing in lip reduction and lip enhancement procedures . For more info, or to schedule a consultation please call 972.312.8188. If you would like to ask Dr Lam a question please visit our lip surgery forum.