:?: Post Op - Short Upper Lip Mystery
Posted: Sun Dec 20, 2009 8:09 am
Hey, this is my first post here having spent the best part of my day on Google trying to search for answers. So hopefully someone here will have the answer!
In May of this year I had Mandibular Sagittal Split Osteotomy to move my lower forward so that I would have a perfect bite and a more pronounced jaw and chin. My bite is now where it is and there were no complications.
Two weeks before the operation I met with the surgeon to discuss exactly what it was that I expected from the operation and I explained a more pronounced jaw line and chin as well as a good bite. At the time he asked me if I felt I showed too much teeth (some gum) when I smile to, which I said no to but delve further to see the meaning of the question. Essentially it was possible to move my upper jaw upwards to reduce the amount of gum on show when smiling. However after some reconsidering he decided it was actually a case of my upper lip being too short and the additional surgery was not appropriate. A Bimaxillary Osteotomy I believe. I did and do show too much teeth (some gum) when smiling according to the relevant measures but it is not an issue for me.
Soon after the operation I realised that my chin was not as pronounced as I would have liked it to be, it did not lay on the Frankfort Horizontal Line. However I was very happy with the overall improvement and continue to be.
Towards the end of May I met with the surgeon for a post operative review and raised the question of my chin. It was my theory that by pushing my jaw out the soft tissue of the chin had been stretched leading my chin not to be as pronounced as it could be despite having a perfect bite (presumably as indicator of a perfect alignment of my lower jaw/chin too). He agreed and assured me that a chin implant could be performed quite easily to rectify this once my braces had been removed.
On November the 2nd I met with the surgeon for another review and again everything looked very positive. It was a far more rushed affair this time with another person taking the measurements and the surgeon visiting at the end to confirm the positive measurements. Afterwards he said his final farewell at which point I asked about the chin implant. His reply was that my problem lay with having a too small an upper lip and that a chin implant would not help. It was added that the original additional surgery on my upper jaw would not have helped and lengthening my upper lip was not really viable.
This set me back a bit as I had a solid expectation that my chin would finally lay on the Frankfort Horizontal Line, my original criteria for success along with a perfect bite.
On November the 3rd I saw the orthodontist who was satisfied with my bite and removed my braces. In discussion I shared my reservations about the surgeon having told me one thing only to say another subsequently. The orthodontist was very helpful and examined my profile closely. He highlighted that my lips did not meet when relaxed (a large inter-labial gap) something I had never knew to be out of the ordinary previously. The significance being that when my mouth is close my lower lip stretches upwards to meet my upper lip and thus the soft tissue on my chin is stretched. When my lips are relaxed my chin lies nearer to the Frankfort Horizontal Line but still falls short.
At this point it was my belief that my upper lip needed somehow to be lengthened to reduce my inter-labial gap to normal at which point a chin implant could be an option.
In my research I discovered the article “Effect of lip training in children with short upper lip” by Bengt Ingervall and Gun-Britt Eliasson (1982) a “one-year study of the effects of a simple lip exercise on incompetent lips.” It concludes “Upper and lower lip length were increased, and the inter-labial gap reduced.” On my return to the orthodontist on the 10th of November I asked him about such exercises and he said he would email a response having researched them first.
In the meantime I have measured my upper lip, ‘lower lip and chin’ and inter-labial gap. They are as follows:
• Upper lip: 23 mm
• Lower lip and chin: 50 mm
• Inter-labial Gap: 7 mm
Researching how normal these measurements are I have found the following:
Upper lip length is measured from the base of the nose (subnasale) to the inferior part of the upper lip (upper lip stomion). The normal length of an adult male lip is 22 ± 2mm. For a female, it is 20 ± 2mm. Upper lip length is the basis for establishing vertical face dimensions in the lower third of the face since the upper lip length usually is not easily altered. This measurement is the basis for establishing the vertical length of the lower two thirds of the lower third of the face.
‘Oral and Maxillofacial Surgery’ by Raymond J. Fonseca 2002
The length of the lower lip should be about twice the length of the upper lip.
‘Facial plastic and reconstructive surgery’ by Ira D. Papel, John Frodel – 2002
It seems as if my upper lip is perfectly within the norm. My measurements were taken with the guidance of the following diagram.
I am no expert and I have explored whether I have made an error in measurement but I really struggle to find a length below 20 mm (the limit of the normal range). Only if I measure my lip as being from the subnasale to the labrale superius, am I able to find an upper lip length that is shorter than the 20 mm.
With all this in mind I am left with a number of questions.
Firstly does the short upper lip theory have much creditability? It was only put forward when I pressed him further on the “do you think you show too much teeth/gum when smiling?” question. It seems increasingly like it was a white lie.
Here is a picture of my lips/interlabial gap.
Thank you for your help! And reading this far.
In May of this year I had Mandibular Sagittal Split Osteotomy to move my lower forward so that I would have a perfect bite and a more pronounced jaw and chin. My bite is now where it is and there were no complications.
Two weeks before the operation I met with the surgeon to discuss exactly what it was that I expected from the operation and I explained a more pronounced jaw line and chin as well as a good bite. At the time he asked me if I felt I showed too much teeth (some gum) when I smile to, which I said no to but delve further to see the meaning of the question. Essentially it was possible to move my upper jaw upwards to reduce the amount of gum on show when smiling. However after some reconsidering he decided it was actually a case of my upper lip being too short and the additional surgery was not appropriate. A Bimaxillary Osteotomy I believe. I did and do show too much teeth (some gum) when smiling according to the relevant measures but it is not an issue for me.
Soon after the operation I realised that my chin was not as pronounced as I would have liked it to be, it did not lay on the Frankfort Horizontal Line. However I was very happy with the overall improvement and continue to be.
Towards the end of May I met with the surgeon for a post operative review and raised the question of my chin. It was my theory that by pushing my jaw out the soft tissue of the chin had been stretched leading my chin not to be as pronounced as it could be despite having a perfect bite (presumably as indicator of a perfect alignment of my lower jaw/chin too). He agreed and assured me that a chin implant could be performed quite easily to rectify this once my braces had been removed.
On November the 2nd I met with the surgeon for another review and again everything looked very positive. It was a far more rushed affair this time with another person taking the measurements and the surgeon visiting at the end to confirm the positive measurements. Afterwards he said his final farewell at which point I asked about the chin implant. His reply was that my problem lay with having a too small an upper lip and that a chin implant would not help. It was added that the original additional surgery on my upper jaw would not have helped and lengthening my upper lip was not really viable.
This set me back a bit as I had a solid expectation that my chin would finally lay on the Frankfort Horizontal Line, my original criteria for success along with a perfect bite.
On November the 3rd I saw the orthodontist who was satisfied with my bite and removed my braces. In discussion I shared my reservations about the surgeon having told me one thing only to say another subsequently. The orthodontist was very helpful and examined my profile closely. He highlighted that my lips did not meet when relaxed (a large inter-labial gap) something I had never knew to be out of the ordinary previously. The significance being that when my mouth is close my lower lip stretches upwards to meet my upper lip and thus the soft tissue on my chin is stretched. When my lips are relaxed my chin lies nearer to the Frankfort Horizontal Line but still falls short.
At this point it was my belief that my upper lip needed somehow to be lengthened to reduce my inter-labial gap to normal at which point a chin implant could be an option.
In my research I discovered the article “Effect of lip training in children with short upper lip” by Bengt Ingervall and Gun-Britt Eliasson (1982) a “one-year study of the effects of a simple lip exercise on incompetent lips.” It concludes “Upper and lower lip length were increased, and the inter-labial gap reduced.” On my return to the orthodontist on the 10th of November I asked him about such exercises and he said he would email a response having researched them first.
In the meantime I have measured my upper lip, ‘lower lip and chin’ and inter-labial gap. They are as follows:
• Upper lip: 23 mm
• Lower lip and chin: 50 mm
• Inter-labial Gap: 7 mm
Researching how normal these measurements are I have found the following:
Upper lip length is measured from the base of the nose (subnasale) to the inferior part of the upper lip (upper lip stomion). The normal length of an adult male lip is 22 ± 2mm. For a female, it is 20 ± 2mm. Upper lip length is the basis for establishing vertical face dimensions in the lower third of the face since the upper lip length usually is not easily altered. This measurement is the basis for establishing the vertical length of the lower two thirds of the lower third of the face.
‘Oral and Maxillofacial Surgery’ by Raymond J. Fonseca 2002
The length of the lower lip should be about twice the length of the upper lip.
‘Facial plastic and reconstructive surgery’ by Ira D. Papel, John Frodel – 2002
It seems as if my upper lip is perfectly within the norm. My measurements were taken with the guidance of the following diagram.
I am no expert and I have explored whether I have made an error in measurement but I really struggle to find a length below 20 mm (the limit of the normal range). Only if I measure my lip as being from the subnasale to the labrale superius, am I able to find an upper lip length that is shorter than the 20 mm.
With all this in mind I am left with a number of questions.
Firstly does the short upper lip theory have much creditability? It was only put forward when I pressed him further on the “do you think you show too much teeth/gum when smiling?” question. It seems increasingly like it was a white lie.
Here is a picture of my lips/interlabial gap.
Thank you for your help! And reading this far.
to this