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Bullhorn Lip Lift; detailed and ongoing review of entire experience

I had a bullhorn lip lift 4 days ago and wish more...

I had a bullhorn lip lift 4 days ago and wish more than anything I could undo it. I think that too much skin was taken in then center, not enough on the sides, leaving me with a strange triangle shaped mouth, a long and distorted columella, and no upper lip at all. I just hope that there is some way I can have this fixed. I cry every time I look in a mirror...

It's now day 8 and things are looking a bit...

It's now day 8 and things are looking a bit better. My doctor gave me steroids (Millipred DP) to help with the swelling and it is making a difference. My columella is still huge but there is now more space between my lips and nose (it was only 4 mm when the first photos were taken and now it's up to 6 mm). My doctor said that since the columella is the lowest point on the nose, it's the place where much of the fluid accumulates and also the last place for the swelling/edema to subside. I'm trying to remain hopeful (I know that its way too early to see the final result) and staying far far away from mirrors right now... they are NOT my friends! I'll post more pictures as things progress.

11 days post-op though it feels more like a month....

11 days post-op though it feels more like a month... people rarely talk about the emotional toll that the recovery process can take; up, down, hopeful, depressed, regretfull, excited, anxious, all within the space of one day; it's a roller-coaster ride and a long one at that. My face still looks far from normal, I'm still extremely swollen, my lips are a still a funky shape, and the columella is still distorted. I just keep reminding myself that it's way too early to see the final result. I've had two previous rhinoplasties as well as lower eyelid surgery and I do know that it really does take time for things to settle in and for all of the swelling to go away. I find it really misleading when you read up on procedures and they tell you you'll be back at work in one week... um, yeah if you don't mind going back to work looking terrible (and like you've obviously just had plastic surgery). That is the beauty of real reviews from real people and I hope that this one helps out! I just measured the vertical space between lips and nose and it's now up to 9 mm... YAY! I was really afraid I'd lost my upper lip altogether. I'll post more pictures next week :)

Day 17 and so far from looking or feeling normal....

Day 17 and so far from looking or feeling normal. This is NOT a quick or easy recovery so please learn from my experience and don't expect it to be no matter what you read (or are told)! As the healing process progresses my whole lower face feels tight and numb and my nose feels like it's been shrink-wrapped as thick scar tissue forms around and inside of it. This is quite uncomfortable and I feel like I'm stretching the scar tissue when making certain facial expressions; I wonder what the best thing to do is here: try to keep everything still or try to keep everything mobile? Educated opinions much appreciated! I still cannot drink through a straw and the incisions are not well healed enough yet to be unnoticeable in person even when wearing makeup. This is difficult to see in photos but it is the case (my sister agrees). Lip to nose distance is still 9mm and columella is still very swollen. I'm resolved to the fact that I've got a ways to go still before I know how this whole thing is going to turn out. Fingers crossed

To Sandra 11 It is still too raw to start...

To Sandra 11

It is still too raw to start using scar creams at this point; there are places where the incisions are still pretty raw. I've been keeping it constantly covered in a thick layer of Aquafor. This is a luxury that those that have to go back to work right away cannot afford and one of the reasons that knowing how long you REALLY need to recover is so important). It's so nice to have the time to recover in an ideal way. I once had a bike injury and ended up with really bad road rash, I never ever let it dry up or scab and kept it constantly covered in Aquafor until there was new skin under the goopy salve. Now the large patches of skin on my arms and leg that were scraped down to the fat layer are barely scarred at all, no scar creams even needed. I'd been worried that I was going to have huge ugly scars so I researched the best way to prevent scarring and that is what I read. I'm a true believer after my bike accident so I wanted to pass along that little tid-bit of knowledge to you. (This is not a good idea for burns and I'm not sure as far as lasers go. I've read pro's and con's about Neosporin after a certain point in the healing process so Aquafor is like the ointment without the antibiotic. The theory is that by keeping it constantly moist you never allow it to form a scab which will make a much more noticeable scar and people who pick scabs will have even deeper and worse scars. I think Band-Aid makes scar prevention blister bubbles for that very reason but it’s almost impossible to attach a band aid to many parts of the body like creases (which is where most plastic surgeons try to strategically hide incisions) and highly mobile areas like elbows and knees) A thick ointment will mold anywhere allowing it to do what the Band-Aid can’t do here. Hydrogen Peroxide is also not a good idea after a certain point as it can cause necrosis of the tissue, as can steroid creams and injections. I did take the oral steroids so I read up on them and they can slow down wound healing and thin the tissue. They did, however drastically help with the swelling. Not sure if it's worth the trade- off. I'd like some plastic surgeons' and dermatologists' opinions if you’re out there and of course discuss the best course of healing with your plastic surgeon, that is what you are paying them for. Be annoying; ask lots and lots of questions:) I will begin using scar creams and massaging them as soon as the incisions are completely healed and everything has calmed down a bit. It's hard to show this in photos because a lot of what is going on is inside of my nose and nostrils. With this procedure they end up having to sew a piece of skin that is longer horizontally than the width of your nostrils so puckering can occur (I have a little by my left nostril but its getting better.) This can happen with face-lifts & donut breast lifts as well. Any time you're sewing a larger piece to a smaller opening this can occur. It almost always resolves itself naturally as the swelling subsides, the skin starts to relax, and the scars begin to mature but it can take time. My doctor attached some of that long ribbon of skin to the inside of the nostrils and spread out the tension inside of the nose to keep the incisions free from shouldering all of the tension. He said that I should not have distortion of the columella because of this re-distribution of tension. That being said my columella looks horrific to me close up as it’s massively engorged and does look distended. I’m only 18 days post-op and swelling in the columella can take a year and a half or more to completely resolve. Swelling in the nose will also take longer to subside if you’ve had previous rhinoplasty (ies), and longer with each one. So I guess what I'm saying is that there is a lot going on that pictures don't show and I'm still not able to see the final results. Like I said before this is not an easy two-week recovery so if you’re considering it please give yourself more time off if you can! I absolutely plan on posting photos as things progress; I feel like if we all really detailed our experiences with photos and comments through each stage of the experience then there would be a wealth of knowledge based on real experiences from the patients' standpoint and we would be able to research the procedure more effectively so that we can make truly educated decisions and go into it feeling as if we knew what to expect. There is such a wealth of dis-information out there regarding healing times and the recovery process because the only one who can really write about this is the patients! We are the ones who go through it and it’s up to us to document it for each other. I was unprepared for this because I didn't know what to expect so this is my way of doing good and helping others, pass it along! That's what this site is for, lets share!

In response to the question from Kenya123, My...

In response to the question from Kenya123,

My upper lip feels numb and my facial expressions are not back to normal at all yet. Smiling wide hurts as does opening my mouth wide, as does anything that feels like it's stretching my face. You have to remember that a scar takes a full 3 months before it's considered mature and then continues to flatten for the next year or so. If you look at the photos immediately following the surgery you can see that a large amount of skin was cut and there is a large incision (therefore there will be a large amount of scar tissue). This scar tissue forming combined with swelling is what causes those issues with facial movement, the tightness at this stage of the game. Like I mentioned before I've had two previous rhinoplasties and the recovery for this procedure if FAR longer and more intense. There's just a lot of tissue that needs to heal and flatten and a lot of swelling that needs to resolve. I'm thinking its going to be a good 8-12 weeks before that thick scar tissue starts to flatten and things start to loosen up again. How long has it been since your procedure? Did your surgeon cut the muscle? Mine did not. The muscle surrounding the mouth is circular, sort of like a doughnut with your mouth in the doughnut hole, and I have read that when they cut that muscle it can interfere with the natural movements of the mouth. If your muscle wasn't cut and it's still early in the scar formation process, try to be patient and see how the healing process progresses. If your muscle was cut I would go back to your Plastic Surgeon and discuss it with him/her AND seek a second opinion from a qualified doctor. Do know though that most Plastic Surgeons don't like to review/comment on other surgeon's work until after the healing process is complete. It's hard to accurately see what's going on with all that swelling, scar formation etc going on. This is why my review still says "undecided" it's the same boat that I'm in. It cannot be un-done, and the healing process cannot be sped up (don't we all just wish). So hang in there, stay focused on positive things, and my fingers are crossed for you!

Update, four weeks post-op: In answer to...

Update, four weeks post-op:

In answer to Kathy’s questions, yes, you can see the scar right now, even with makeup (it’s like a newborn baby at this point, red and raised which is perfectly normal for its age, no scar will be flat and colorless in 4weeks!). I’ve added new photos without any makeup and in natural daylight to really try to give you a close up look; I picked the worst of the worst photos (no vanity) so that you can really get an idea of what my scar looks like at 4 weeks without any camouflage of any kind and in the harshest lighting. I’m not overly concerned with the scar at this point as it looks as though it will eventually resolve and become barely perceptible, hidden in the crease of the nose and further disguised by makeup (there are also scar creams, dermabrasion, and lasers if the scar doesn’t heal as well as expected). As you can see I had a scar at the base of my columella before and it really didn’t bother me. What I AM still very concerned with is the length/distortion of my columella which is still very different than it was pre-op. It’s still very stretched looking and I’m holding out hope that this will subside with the swelling. The nostrils do appear to be wider but my whole nose still feels very swollen right now and I do remember a similar look to the nostrils after my last revision rhinoplasty. In that instance I didn’t start to feel like I looked “back to normal” until my nose sort of “shrunk up” at about 3 months post-op. The volume of my upper lip has increased and more of the vermillion shows. Also notice that the overall shape of my mouth has changed. The tightness that I was feeling at week 3 has improved quite a bit and my face feels like it’s slowly becoming more mobile, though I still can’t drink out of a straw easily. I hope that I’ve answered your questions and I’ll post again and add more photos as things continue to change!

I'm adding new photos, up the nose close ups...

I'm adding new photos, up the nose close ups of the scar at 6 weeks with and without makeup (as requested by Kathy, yikes! Busy week and I'm running late so I'll respond to questions next week, Sorry! Hope you all had a happy 4th!

So sorry I've been M.I.A., I've been...

So sorry I've been M.I.A., I've been dealing with some family/personal issues... I'm now 9 weeks post-op and much of the swelling has subsided. I'm still not happy with the columella but it has improved a bit and I'm just hoping that it will continue to do so. I've read that this procedure is often overcorrected initially as the skin relaxes quite a bit in the first 6 months. I just hope that mine will relax enough to improve the stretched down appearance of my columella. The distance between my lips and nose has held steady at 10mm which is only 1 mm shy of the "ideal" although at this point I'm not even concerned with the ideal, just a normal looking columella. I'm trying my best to stay patient and hopeful but sometimes it's so hard and I'm really struggling right now. I just want to feel happy with the result after all of this! The scar has improved and I'm massaging the area with a silicone based cream twice daily. I've posted a few new pictures and will go through the posts and answer any questions that I can. :)

Dr. Scott E. Kasden in Southlake, Texas

1 out of 5 stars Overall rating
1 out of 5 stars Doctor's bedside manner
1 out of 5 stars Answered my questions
1 out of 5 stars After care follow-up
1 out of 5 stars Time spent with me
1 out of 5 stars Phone or email responsiveness
1 out of 5 stars Staff professionalism & courtesy
1 out of 5 stars Payment process
1 out of 5 stars Wait tmes
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I just had an upper lip lift 4 weeks ago and my columella is stretched down and my nose is so long looking and pulled down. When is smile my nose looks terrible and points downward. This was NOT the case before. I have great tooth show and my shape of my mouth is pretty. But my face looks so disportoned now because of my stretched downward nose. I think too much skin was cut. Do you the this will resolve over time? What is the healing time. Omg I think I made a terrible mistake. I may have to get tip Arty to reduce the Size of my nose. :((
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I'm scheduled to have a lip lift soon to correct the spreading out and lengthening of the area between nose and lip from a gortex implant I had removed thank god! The gortex implant caused damage cause I couldn't smile much and over the years, my lip (area above my lip and under nose )stretched out and lengthened from repeated smiling over the years because there was so much tension in my actual lip. My question is, will the scar from the subnasal lip lift cause tightening in the smile or nose to spread alot during smiling? After that nightmare wit h the gortex I'm hesitant to do something that will cause a problem with my smile. Also unnatural spreading of my nose and nostrils from smiling. Does this procedure cause this to happen? Thanks so much, any advice is appreciated! :)
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Becky thanks for looking this up. They were talking about taking cartliage from the ear to make the columella. They were getting skin from somewhere else on the body. Isn't this a nightmare. This doctor needs to be shot. He knows better than this. He advertises he does noses. I looked him up on real self. He said, He had satisfied customers with the lip lift. What a laugh! if this Clef lip doctor I am going to see can't do anything for me after that sort of an education, who can. Did you see any of the entrys from mrs ? She had a lift by Harry Glassman that is Victoria Principals ex-husband. She said her lip lift was the best thing she ever did. Those poor children. bye
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Who is Victoria Principal?
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More links for research for Sandy.

http://www.ncbi.nlm.nih.gov/pubmed/20679836
Plast Reconstr Surg. 2010 Aug;126(2):543-53.
Long-term evaluation of elongating columella using conchal composite graft in bilateral secondary cleft lip and nose deformity.

http://www.ncbi.nlm.nih.gov/pubmed/20574219
Ann Plast Surg. 2010 Jul;65(1):56-9.
Anatomic study of the nostril sill: classification and histologic findings.
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Oh, that article also said some of them got necrosis(skin rott) isn't this scary. i saw on haworths site that they don't like to cut down at the base of the columella as they are afraid of necrosis. i guess may and i are lucky we didn't end with some kind of bad infection, or worse.
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Michael Jackson's nose is a typical example of necrosis.
It takes up to 12 months before you can see the final result of this kind of operations. So try and be (a) patient and don't blame your surgeon the day after the operation.
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Becky this is all excellent stuff. Thanks for posting.

If anyone is interested, there is a surgeon in Tucson - Dr Menick - who does outstanding reconstructions and is used to working around scar. His revisions look excellent.
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Qnoq, this is Sandy. I looked up this Dr. Fredrick Menick. I have seen more web sites than I care to count. This is the most amazing site I have ever seen. I was just sitting with my jaw dropped , as I know you were. God, the Universal force, something directed to this website. I bet getting getting an appointment with him would be something else, but I am certainly going to give it a go monday morning. I didn't know a doctor could do what this man can do. Magic, is the only word that comes to mind. I feel so thankful I read your entry. We absoubtly have got to get this great news spread around. I'm almost high I'm so thankful. Our girls on Real Self are complaining about nothing compared to those people on his web site. Can you even imagine the mental torture they have been through and how thankful they are to him. Where in the world is he getting the tissue. Their nones look like noses taken out of a magazine. He dosen't give them a ugly, or pig nose either. Those are nice nose he is creating. I would not thought it possible had I not seen it with my own two eyes. Bye for now
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I am just not sure that I will go ahead with this surgery now, it seems that too much can go wrong that far outweigh the look of having a long upper lip.

So sorry for all who have had a bad result from this surgery, it is just too bad.

All your info has been incredibly helpful.
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Hi everyone, I haven't been on this site in a while. But I had a lip lift 8 months ago right around the time May had hers. It has been a roller coaster experience. My scars have definitely improved, but the jury is still out on how I feel about the lip lift. One positive aspect is that I feel it improved my marionette lines (laugh lines) and it did slightly improve the shape of my upper lip.

Sandy, in one of your comments you mention that you think a cleft lip surgeon from a med school would be a good idea. I thought I should mention that my lip lift doctor specializes in cleft lip surgery and is a director at UCSF, one of the top med schools in California, and he cut into my nasal sills. Like everyone else, his cutting into my nasal sills was very upsetting. Unlike Paris, Sandy, and May, my nasal sills were flat to begin with so my issue is not that the nasal sills need to be built up but that the scar has definitely warped the shape of my nostrils. I've come to the conclusion that plastic surgery is not a perfect art. I have yet to have a surgery that I'm completely satisfied with and I have had quite a few procedures done. Each time I've done my research, thought I picked the right doctor and yet ended up with issues. I honestly feel like I've spent the last couple of years fixing problems. If I had the opportunity to go back in time I would have never started!!! For those contemplating surgery, really weigh out the potential consequences b/c I get the feeling that the outcomes tend to be more negative then positive. I miss my old face!!! :(
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Kenya, Good to hear from you. I feel exactly as you do. I haven't had anything done that was good. It goes to show you most men can't do delicate work anyway. The only exception would be an artist. When you get into a fix that has to be corrected you are really in trouble. This correction stuff is really something these doctors have not been trained as each boo boo is different. What doctor did you go to. We really shouldn't go to anyone that is in practice by themselves. If they had other in practice with them, there is a chance they would be more caucious, also afraid the office girls would spread the gossip on them. Good doctors don't like to office with unskilled doctors. At least they would have another doctor to converse with if they did have a question. When these doctors are alone they can do anything they want to you. If they were with other doctors, and they put out junkie work they would be giving the Practices of other doctors a bad name too. Maybe they would turn you down if they aren't sure they are going to put out good work. Bye for now Sandy
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Sandy,
Do you have photos you can post on here? You could do your own review and post them there if you cannot insert in this thread.
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Hi, this is Sandy from. My first input is to stay from Dr. Scott Kasden and possibly Dr. Haworth. What Dr. Kasen did to me and May is something unheard of, this is not even how a lip lift is done. You don't go ripping the nose backwards cutting off the nasil sills and shortening the columella and moving it forward onto the top lip. Let me know what doctor you are going to, and let;s make sure you don't get off in a ditch like we did. May, asked this doctor that we went to if this would effect the nose, as she had just gotten her nose where she wanted it. He told her it would not effect her nose, then he cut her nasil sills completely off, worse than mine actually and pulled her columella down on her top lip. So you tell me! Yes you need to discuss with them about the surgery, but who knows if this is what you get. These are the facts. Lip should be 1/2 inch(1) centimeter or 12 millemeters. All the same from columella to top of lip. I would discuss if he believed in shortening or hemming the muscle as Haworth calls it(look up his web site) he talks a good game. Now! do you have a small nasil base? I do I should have been approaches in two ways . Bullhorn with a gullwing onthe sides of the lip. Look up Dr Steven Svehlak for sure I like him. I think Go to Youtube and type in lip lift and watch one preformed. I like phillip young in washington. Tell me where you live and we will go from there. bye for now Sandy

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I am having a liplift very soon for long upper lip, although reading your experiences has made me much more aware of the risks. Thanks for the sharing of info as I now feel I can ask the right questions of the surgeon before any work is done. I am kind of rethinking this whole procedure now after reading of your experiences, although a few posters on here have been happy with their results and that gives some hope that it can work out great.
I was going to be getting a corner lift too, but I understand that scarring can be quite a risk here?
Am I right in understanding for bullhorn lift it is better to:

*Just cut the skin, rather than muscle.
*The incision is best under the nose, the surgeon shouldn't put the scar inside the nostrils. This can lead to distortion of the nostrils otherwise.
*The surgeon should leave the columella alone!

Would you add anything else to this checklist, from all your experiences?

Thanks so much for your input
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I only know that he had a series of operations on the cleft when he was young at our Children's hospital here in San Deigo. That was about 20 years ago, though. His scars don't look that good however. The main point I was hoping to make was that if anyone knows how the lips and nose should be done right, it would be those people and hopefully, they have come a long way. I will see if I can find some articles.

Sandy, I think it is a very positive move that you will be seeing that expert in Texas. Sometimes I think about the stuff the true reconstruction surgeons do and what they figure out and I wonder how well it translates to the elective cosmetic surgeons. However, even the spa docs should have had intense residencies fixing deformities and tumor wounds.

Glad you have put such a positive spin on your confinement. What a healthy and wise approach that it. Let us know how the new doc at the hospital goes.
Becky
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Becky, look up this Dr. Joshua Demke and look at the babies he fixed and the nose job's of a couple of girls. I just don't know if he can lift the lip. Bye Sandy

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http://www.ttuhsc.edu/som/surgery/faculty/jdemke.aspx
Sandy,
Dr. Joshua Demke seems impressive. He does a wide variety of surgeries. If doing the cleft palates of babies doesn't teach you about nasal sill cartilage, then I don't know what it would take. He must certainly have some good experience.
I want to know why a lift lip would need so much structural anchoring that you would mess with the columna as opposed to just pulling up the skin. Pulling up the skin rolls out the lip and seems to make it fuller..maybe. There must be a book somewhere that that diagrams this for docs. But maybe not.
Anyway, Sandy, the university library should have those medical articles and the librarian there should be able to help you. The more you refine research, the more you can dialogue with your doc. And he doesn't have time to research everything. You do. I think patients who do the research and talk to their doc, have an opportunity to make their docs better, to help them grow as docs. Not always, but docs do not know everything.
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he wasn't suppusto touch the columella. He told me while he was taking my stitches out he literally ripped my face off. Those are his exact world. He knew I came to hime for a traditional bullhorn lift. He broke the cartilage above me left nostril. All this crap took him about four hours. No one has ever heard of what he did. May and I are like you why! I don't know what I think about the muscle being shortened, but in my case my whole lip has dropped since surgery and covers all of my teeth. This low columella business is real uncomfortable, now I can't tell if my lip feels heavy or its my columella. Again what was the point when a small amount of skin could have excised from under the nose and left the nose alone. We have wondered if he hates women, it this drug related, what what what! We can't figure it out, it is nutty. Between May and I we have been trying to figure this out for 14 months, night and day. Her 8 months and my 6 months. He knows we are livid with him. We both got him off of the web sit Make Me Heal. He did a girl names Carla in 2008 she loved him and he gave her a traditional lip lift. She has real good on going pictures. He didn't do this to her. So we both thought we were getting a traditional lip lift.This doctor advertises he does rhinoplasty, so he knows better than to tear the bottom out of a persons nose. May said her new Doctor told her Nasil sills can't be remade. I told her that Haworth advertises a non surgical nose lift. I've seen him on Youtube. They squirt some kind of a permant filler out of a needle. The right doctor could squirt a small strip when the original sill was, like decorating a cake. What if the doctor wasn't a artist. All of this is nonsense. Believe me I am still researching. The idea about the clef lip doc. is an idea for sure
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Is that Randall Haworth in Beverly Hills?
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You got the wrong person, I didn't make an entry about Haworth. I made an entry about fat transfer and didn't name my doctor.
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(sorry my comment above was in response to Sandy's comment). Sandy says that May went to Haworth to get her lips corrected and is waiting on the result.
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Hi Unoq, Sorry about that I will be more careful. Sandy
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Hi Becky. I think you might be so right. We have a clef lip man right here in my home town fo Lubbock, Texas. He is at Texas tech University. His name is Doctor Joshua Demke. I happen to have an appointment with him on the seventeenth. This is the first encouraging thing I have heard in a long while. He does beautiful work. It would be worth it for all the girls to check out his site and his work. Just unreal Becky you thought of this. Even though I have an appointment on the 17 of January my hopes were low. Because of where this guy is at a University, I am sure he dosen't want to do to bad of a job on anyone as people at the University Medical Center would be down on him. Thanks again.. I kind of feel like when the student is ready the teacher will arrive. I have done alot of soul searching while I have been so called house bound. Maybe I wouldn't have stopped long enough to think pray and get spitual had this crappy lip lift not happened to me. WOW.Tell me who neighbor boy went to also. Bye for now Sandy from Texas
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Sandy, this will get you started on some scholarly research.
http://www.ncbi.nlm.nih.gov/pubmed/12016489

Columellar lengthening using the interdigitation of triangular flaps

I went to pub med and searched "nasil sills". You can look at the linked articles and build from there.

Various applications of chondrocutaneous composite grafts in secondary cleft lip nose patients
http://www.ncbi.nlm.nih.gov/pubmed/17119406
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