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Restored the proportions of my face... - San Diego, CA

I've been researching lip lifts for about a year....

I've been researching lip lifts for about a year. Age and a rhinoplasty had elongated the distance between my nose and mouth, which prior to surgery measured about 17mm. I was really impressed with Dr. HIlinski's before and after photos; some of his patients had narrow noses with lips that extend a bit beyond the nasal base (like mine) and he was able to give them a natural (but noticeable) result without hiking the center part of the lips up, rendering the sides too "slopey."

Dr. Hilinski measured my face and decided to excise 5mm in the center and 6 going out toward the sides, at the longest point, leaving me with a distance of about 12mm. He only cuts skin, not muscle, and I've had no problems with movement or function of my mouth. After one day of pain I was fine. No bruising at all. My stitches were neat and tidy and my scar (after an initial bit of redness) is healing nicely. I had to fly out for the surgery, and the doctor is always quick to respond to follow-up emails and address any concerns.

I was hoping to have a bit of tooth show when all was said and done; I do have more when I smile, but not when my mouth is relaxed. That's the fault of my jaw anatomy, though, and not the doctor's--if he had removed any more I think I would have looked unnatural and "hiked up." I'm especially pleased with the increased vermillion show; he was able to "roll it out" and give me back a cupid's bow.

Here's one before and after; I'll post more later.

Two more photos...

Shortened length and improved angle from the side.

Reposting pictures...

Thanks for your support and encouragement, everyone--I'm reposting pictures. I'm about five weeks post-op now and am really pleased. The reduced distance is a HUGE improvement on my face, my upper lip is fuller from the vermillion "roll out," and my scar is fading nicely. But I am contemplating going back to have 2 more mm removed. I'm not sure this would finally result in tooth show, but I'm so close right now that it's possible. Dr. Hilinski has very kindly offered to excise more skin at no extra charge should I decide that's what I want. But he is concerned with maintaining a natural result (as I am) so I'm going to wait a few months and see how things settle. But I'd love any of your opinions...

I was also wondering if anyone out there had a strip of mucosal edge removed--one doctor on the Q&A section said that this procedure is sometimes necessary to achieve tooth show. If you don't already have an abnormally large lip, this seems a bit drastic to me, but I'd love to hear about any first-hand experiences.
San Diego Facial Plastic Surgeon

5 out of 5 stars Overall rating
5 out of 5 stars Doctor's bedside manner
5 out of 5 stars Answered my questions
5 out of 5 stars After care follow-up
5 out of 5 stars Time spent with me
5 out of 5 stars Phone or email responsiveness
5 out of 5 stars Staff professionalism & courtesy
5 out of 5 stars Payment process
4 out of 5 stars Wait times
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Hi there, any chance you can post some updated photos? I'm considering your doctor and your result is one of my favourite! Thanks :)
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Yes I agree, beautiful lip lift.
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Love your results! I am starting to look for a wonderful doctor to do a lip lift on me and came across you! I did go on your dr's website, but he did not have many pictures, just a few. Although, the ones he did have are natural a I do like them. Could you tell me if he also does corner lifts as well, OR rhinoplasty's with lip lift? Thank you for your help! I love your results:)
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I was researching your doctor online since your lip lift has always been one of my favorites and I saw a great article that your doctor wrote, one that I recommend to everyone, and I was especially intrigued by this excerpt; "One of the few controversial topics in the world of upper lip lift surgery is whether or not this muscle should be cut at the time of the operation. In my humble opinion, I do not recommend cutting or hemming this muscle. I realize there are other plastic surgeons out there who do perform muscle tailoring (hemming) with lip lift surgery and achieve very nice surgical results. But I prefer not to cut or hem the muscle because of my concern with creating an abnormal smile after surgery. I have seen this type of outcome on occasion (from other plastic surgeons’ work) and would like to avoid it if possible. Since it is possible to attain very nice results without cutting the orbicularis oris muscle, I choose to avoid this maneuver. Instead, I lift the lip by placing several strategic sutures deep underneath the skin but above the muscle layer. [http://www.drhilinski.com/procedures/upper-lip-lift-lip-shortening-san-diego-ca/upper-lip-lift-case-example-2/] I have seen this type of outcome on occasion (from other plastic surgeons’ work) and would like to avoid it if possible."
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Thanks for posting, Sarah! I am still debating going back to remove another mm or two, but I would never have the muscle cut (and Dr. Hilinski's non-hemming technique is one of the reasons I chose him).
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Amen to that.
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I meant Amen to Sarah's post about Hilinski's article on his website about lip lifts.
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Looks beautiful ;} How long did it take for the scar to look good enough to be concealed under foundation?
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Thanks, Pixie! The scar could be concealed fairly easily with foundation at around two weeks, although there was still some redness. Two months later and it's not noticeable at all.
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Excellent results! Did he do the surgery in his office or a surgi-center? And $2,500 was the total fee?
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Thanks so much! Dr. Hilinski's office is in this adorable Craftsman in downtown San Diego, and he has a fully equipped surgery center in there. I rented a little studio within walking distance, so it was really convenient. I had to stay there for five days so he could remove the stitches. I'm glad I regular stitches and not dissolvable, which I think leave a greater risk for scarring.
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Neely brings up an important point well worth consideration - stitch technique. Many of the lip lift specialists use dissolvable stitches because their patients fly in from other parts of the country (or world) and then go home immediately post-op. Neely was wise to remain longer in order to have her doctor remove her stitches. I say this not because of the scar (mine is barely visible) but because of pimple-like cysts along the incision line. I wish I had not had dissolvable because I am seven weeks post-op and I still have one cyst remaining, under my right nostril. For me, this was the worst part of the healing process. I don't know if I had an allergic reaction to the underlying sutures or why I was so plagued by this...other RealSelfers who have had LL's have told me they experienced the same thing. One of the gals who works for Dr. P. had a lip lift years ago (very natural, nice result - her pics are on his website). Right before I had my LL, I asked her what did she remember as being the worst part of recovery and she said, "Well it's gross because as the stitches make their way out. You get these little lumps that look like pimples." So that tells me this must be common with the dissolvable stitch technique. Normally my skin is flawless and to go two months with these little bumps that look like pimples is ridiculous! Especially if it can be avoided. So amen, Neely. You are on the money - don't go the dissolvable stitch route if you can opt for regular stitches that the doctor has to remove five days later. It is worth staying in town rather than deal with weeks (in my case months) of gross bumps. My doc put me on two different courses of antibiotics to help eradicate the mess dissolvable stitches made. I will be so glad when this last one I have is finally gone.
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Thanks for elaborating on that, MM! If it's out of the question to stay away from home for five days, I suppose you could always ask your doctor of choice to use regular stitches, and then have them removed by your local doctor at home...
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I have to mention what my own surgeon said about dissolvable sutures. He said the dissolvable suture material is considerable more expensive to purchase, so some doctors don't spend the extra money. He prefers dissolvable sutures and uses them, regardless of cost, regardless of whether or not the patient is able to return, for all his patients. The sutures don't actually dissolve over many months in contact with the skin but rather soften in areas just enough to come clear of the incision site in a matter of a week or so, aiding by gentle rubbing. Further, he says removal of the cheaper, non-dissolving sutures can be uncomfortable for patients as it requires some tugging on delicate, traumatized tissue. As important as any other consideration, he finds the results flawless. No downside. Whatever bumps that occur are not the result of residual dissolvable suture material, because none exists. They are the result of pore material caught in the incision which used to go directly to the surface of the skin. There is no correlation between that issue and the use of dissolvable sutures. With the greatest respect, I just had to weigh in with some facts.
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Thanks, Catherine. I was just going by what my doctor said with regard to dissolvable... for the record, the removable of regular sutures wasn't uncomfortable for me at all (others may have a difference experience, of course).
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Thank you Catherine - wow, so the bumps I've had are not residual stitch material, but essentially pores that clogged? But if you have regular stitches, wouldn't there be no reason for the pores to clog? Neely never experienced a single cyst...
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There is a lot of controversy regarding dissolvable sutures. Some people are allergic to the cat gut protein in dissolvable sutures. That is why some dissolvable sutures have been developed that are made out of synthetic material, however most doctors still use the cat gut sutures. Anyway all doctors have their own opinions, I guess!!
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Omigosh, I am a huge animal lover and involved in animal rescue and I had no idea cat gut protein is used in dissolvable sutures. Well, I am convinced I was allergic because my skin erupted along the incision line. I will post a no-makeup pic of the remaining nodule...stay tuned...
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Um. "Cat gut" isn't actually the guts from cats. Just thought I'd clear that up. Dissolvable sutures or "cat gut" is now, essentially exclusively, a synthetic, hypoallergenic polymer. Hope that helps. ;-)
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Hi Catherine, I certainly don't want to fight over this but cat gut sutures are derived from sheep or cow intestines and that is why some people have an inflammatory reaction to the sutures.
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Certainly, we're all just trying to clarify. My point is that polymers have replaced gut as dissolvable suture material, despite the continuation of the term. It's an important distinction to note.
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I think it bears mentioning that the sophisticated hypoallergenic dissolvable polymer suture material is decidedly expensive relative to both of the others and that is why doctors may elect not to use it. My doctor uses it exclusively, as many surgeons do here in Canada.
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OK I understand where you are coming from now. Maybe in Canada they are using the synthetic dissolvable sutures exclusively, but here in the US they (most surgeons, at least the ones that I have had this discussion with) are still using the cat gut derived from the intestines of sheep or cow, unless a patient informs the doctor that they reacted negatively to the cat gut in the past. Then the surgeon offers the synthetic dissolvable or permanent sutures like Neely got which can later be removed.
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Oh and I wanted to say that the fact that your doctor is using the hypoallergenic dissolvable suture is a very good thing, BTY.
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That is probably why most of the doctors here in the US are not using it! That is pretty sad especially when the surgical costs can certainly cover the extra cost of the best suture material!
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