Cheiloplasty is the technical term for any surgical procedure performed on the lip. This procedure is carried out by plastic surgeons or oral and maxillofacial surgeons with the goal of improving the lip’s overall appearance, function, or both. Whether addressing a birth defect, repairing damage from an injury, or altering shape and volume, cheiloplasty involves the manipulation and reshaping of lip tissue to achieve a more balanced or functional outcome.
Defining Cheiloplasty and Indications
Cheiloplasty is a versatile surgical technique that addresses a wide range of concerns, broadly categorized into reconstructive and aesthetic goals. Reconstructive cheiloplasty is frequently performed to correct congenital anomalies, such as a cleft lip. This type of surgery involves bringing the separated portions of the lip together and reconstructing the surrounding muscles, like the orbicularis oris, to form a continuous, functional lip structure. Repairing this defect is often timed in early infancy, typically around three months of age, to improve feeding ability and support normal speech development later on.
The reconstructive application also extends to repairing damage caused by trauma, such as accidents that result in significant lacerations or tissue loss on the lip. In these cases, the surgery focuses on restoring the lip’s anatomical continuity, symmetry, and muscle function to minimize scarring. Aesthetic cheiloplasty, conversely, is sought by individuals looking to alter the size or shape of their lips for cosmetic reasons. This can involve lip augmentation, which increases volume, or lip reduction, which decreases the size of the lips.
The Surgical Process
The surgical journey begins with a pre-operative consultation where the surgeon details the steps and assesses the patient’s medical history. For complex procedures, like cleft lip repair, general anesthesia is administered to ensure the patient’s comfort and safety. Less extensive cosmetic procedures, such as minor augmentations or reductions, may sometimes be performed using local anesthesia combined with intravenous sedation.
Once the anesthesia has taken effect, the surgeon makes precise incisions, the location of which varies based on the specific goal of the cheiloplasty. For cleft lip repair, the surgeon may employ specialized techniques involving creating tissue flaps that are rotated and moved into position to close the gap and reshape the lip. This process requires manipulation of the underlying muscle layer, the orbicularis oris, to ensure proper function for speaking and eating.
For cosmetic alterations, the incision is often placed in less visible areas, such as inside the mouth or along the vermilion border, to minimize the appearance of a scar. In augmentation procedures, the surgeon may insert an implant or inject tissue grafts, while reduction involves excising a precisely measured strip of tissue from the inner lip. The surgeon uses fine sutures to close the incisions, aligning the skin, muscle, and mucosal tissues to achieve the desired contour and minimize tension along the wound line. Before final closure, local anesthetic with a vasoconstrictor is often injected directly into the lip tissue to reduce pain and control bleeding.
Post-Operative Expectations and Recovery
Following the cheiloplasty, patients will experience swelling and bruising around the lip and sometimes the surrounding facial area. Pain is managed through prescription medication, with the pain level typically remaining low after the initial recovery period. Immediate post-operative care involves close monitoring, especially in cases where general anesthesia was used, to ensure airway patency, which can be affected by the edema of the surgical site.
Wound care involves gently cleaning the incision site to prevent the buildup of crusting. Caregivers are instructed to clean the lip with a wet cotton-tipped applicator, followed by the application of an antibiotic ointment. The stitches, which may be dissolvable or require removal, are often trimmed or taken out around the sixth or seventh post-operative day, a period sometimes requiring mild sedation for infants.
To protect the newly repaired site, specific restrictions must be followed for several weeks after the procedure. Patients must adhere to a modified diet, typically consisting of liquids and very soft, non-chewable foods, and are prohibited from using straws or pacifiers due to the suction that can strain the sutures. Vigorous activity and any potential trauma to the face must be avoided, and infants may be placed in arm restraints to prevent them from inadvertently touching or rubbing the surgical area. While minor blood-tinged discharge is expected in the first 48 hours, any sign of excessive bleeding, pus, or a persistent fever should prompt immediate medical attention as these can be indicators of a developing infection.