Lower lip ptosis refers to having a drooping lower lip. Most people develop some loss of facial structure integrity during the natural aging process, but ptosis is diagnosed when the tissue sagging is more severe than average.
Ptosis is a word that was derived from the Greek word for “dropped”, “a fall”, or “falling”. Today, it is used as a medical term to describe drooping in the body. Generally, it refers to dropping in the eyelids (lower or upper lid ptosis) or sagging breasts (breast ptosis).
However, it can also refer to brow ptosis, ptosis of the chin, kidney ptosis (nephroptosis), stomach ptosis (gastroptosis), abdominal viscera ptosis (visceroptosis), and lower lip ptosis.
Causes of Lip Ptosis
According to a case report in the Journal of Oral and Maxillofacial Surgery(JOMS), “Ptosis of the lower lip is a distressing, unaesthetic facial deformity that commonly follows contraction of burn scars or skin loss in the area below the lip or mentolabial fold.”
JOMS states that lower lip drooping can also follow contraction of tissues and wound healing in the chin and lower lip areas. Further, it can result from maxillofacial surgical procedures involving extensive soft tissue reflection, degloving, and/or improper wound closure.
)ther possible causes of lower lip ptosis are:
- Damage to sympathetic nerves in the head or neck
- A bacterial infection spread by ticks called Lyme disease
- Side effects from neurotoxin injections (such as Botox® or Dysport®)
- Abnormal immune system responses that weaken facial muscles
- Bell's palsy that weakens or paralyzes some of the facial muscles, typically on one side of the face
Anatomy of the Lip
The lips are composed of the orbicularis oris muscle, which surrounds the mouth and is covered externally by the skin and internally by mucous membrane.
With typical anatomy and physiology of the muscles in the mandibular symphyseal region, levator muscles support the chin and lower lip to keep them from sagging. Some of these include the orbicularis oculi muscle, superior tarsal muscle, and the mentalis muscle.
However, most people tend to lose muscle mass and strength as they age, and this includes the muscles in the face. So, aging is also a cause of lower lip ptosis, although many people might be able to avoid this type with proper nutrition, regular exercise, adequate hydration, and other positive lifestyle choices.
Surgical Correction of Lip Ptosis
Plastic surgery is often required to correct lower lip ptosis. Various procedures may be suitable depending on the cause and severity of the lip drooping. It is best to ask a plastic surgeon who specializes in oral and maxillofacial surgery about the best approach for you.
Don’t confuse lower lip ptosis with the natural facial asymmetry that all people have. Not all lip drooping cases require ptosis surgery. For instance, lip drooping caused by aging can often be corrected with a midface lift or placement of dermal fillers in the nasolabial folds.
Some other types of drooping in the lips and facial region can be effectively, yet only temporarily, corrected by injecting dermal fillers like Juvederm®.
All patients are unique, each requiring a customized sequence of surgical planning. However, some common surgical procedures used for correcting ptosis in the lower lip are:
- Lip Reduction
- Corner Lip Lift
VY Mucosal Advancement of the Lip
Lip Reduction The medical term for a lip reduction surgery is cheiloplasty. It is commonly recommended for correcting macrocheilia (big lips) due to ethnicity or dentofacial deformity. It is also helpful for correcting some cases of lower lip ptosis, especially in cases caused by dysfunction of the orbicularis oris muscle.
Cheiloplasty often involves the manipulation of soft tissues, muscles, and nerves. In some cases, bone grafts are also necessary. This procedure produces safe, effective, and permanent results for correcting lip ptosis. However, it is important to remain realistic about the possibility of poor results or the need for additional surgeries.
Corner Lip Lift Many people experience some degree of lip ptosis as they age. It is especially common for the corners of the mouth to develop wrinkles and begin to droop, producing the appearance of dissatisfaction, anger, or other displeasing emotions.
A corner lip lift surgery can reverse the down-turned appearance of the mouth and yield a more youthful, contented appearance. This can be very meaningful to those who have been dealing with lower lip ptosis chronically. Successful surgery can lead to increased self-image and improved life quality.
VY Mucosal Advancement of the Lip This surgical procedure is useful for correcting lower lip ptosis and various other lip and facial challenges as determined on a case-by-case basis. It involves making a V-shaped incision on the interior of the lip, revising some of the soft tissue found there, and then, suturing the V together appropriately to form the shape of a Y.
This surgical technique can also be used to create the appearance of fuller lips in those with thin lips, without needing to use synthetic dermal filler injections.
According to Pubmed research from the Hirosaki University Graduate School of Medicine, “A V-Y advancement flap from the submandibular region is one of the useful techniques to reconstruct the lower lip, and it is suitable for a wide horizontal defect.”
The VY lip advancement technique is popularly recommended for people with either this or drooping lips. Ask a skilled plastic surgeon who specializes in facial and lip reconstruction about the best treatment option for you.
Lower lip ptosis occurs due to aging, trauma, genetics, wound healing, nerve damage, bacterial infection, and other causes. It presents different severity levels in different patients and no two cases are the same.
A customized care plan is needed for each lip ptosis patient. Simple and quick filler injections might be very helpful in some cases while surgery involving bone grafting may be needed in others. It is necessary to ask a skilled plastic surgeon all the questions you have. The doctor will be able to give you the answers you need to understand the next steps to take.