Background: I have an upper lip that is not very...
10 Mar 2016
Day of treatment
Background: I have an upper lip that is not very harmonious with other features nor is it attracitvely shaped. My original upper lip length was 22mm. I had an upper lip lift with Dr Stephen Baker 6 months ago, so it is now 16mm. It was a traditional skin only lift. (For that experience, see my other review.) The corner and side areas of my lips curled under and down and I also had a corner that dipped down, all of which made my smile teepee-ish and a little grim. (For the latter, I had tried filler but it didn't work.) So I wanted to see what I could do to help the side and corners of my upper lip.
Pre Op Exerpeince with Dr Haworth's staff:
Professional, kind and accomodating. No complaints. It was a good experience. They answered quetions, had paperwork ready, helped in any way they could.
Pre Op Experience with Dr. Haworth:
Phone Consult: I first had an initial phone consult with him 8 months ago but ended up going with Dr Baker. Dr Haworth had recommended a series of procedures that were not within my budget and I was nervous about a lip lift that involved muscle hemming. On top of that, I was worried about a doctor who lived in Beverly Hills. I assumed the aesthetic I sought was not part of the Beverly Hills world.
In-person consult: He was professional. Offered his perspective on my previous lip lift with another doctor, which I requested. To wit, he said that Baker did a good job but that had I gone with him, Haworth, he would have been able to take out an additional 3-4 mm from the center and 8mm from the sides and that with his technique he would not have distorted my nostrils. Baker did not want to take out that much at once. Baker wanted to take it in stages. Baker had said he wanted to do an approach where he took off 8mm at first -- but it has since dropped 1.5mm-- and if I still wanted more taken off at one year post op, he would decide if it could be done without nostril distortion.
Dr Haworth believes that the external medialized lip lift he was suggesting I do would make a big difference in my lip's appearance. I felt good about our consult and decided to go through with the operation, which was the next day.
Day of Surgery:
People in the office were nice and processional. Dr Haworth spent an enormous amount of time marking my lips and then he put me under anesthesia for the procedure. It was twilight supposedly but I was completely and totally out. (WIth Dr Baker and the upper lip lift, I had a dental block of some kind and was awake and talking the whole time.) During the operation, Dr Haworth also, at my request, lasered my scar under my nose from previous surgery, which was raised..
I am now a few hours post op and so far so good. My lips are a little sore and achey but I am armed with pain killers so I will use them soon. I was told to expect swelling to increase over next few days. But in comparison with lip lip, this surgery should not take as long to recover.
I am returning to Dr haworth's office in 5 days to remove the stiches.
Stitches Review and Corner
It's now 12 hours post op and I've had a chance to clean off most of the caked blood and blue pen markings from my incisions and lip. I also have anti-bacterial goop on my lips.
I have to say, I am impressed. The stitches are tiny. Almost imperceptible, except where there is a knot and except at the very corner area. My camera was not able to get in close enough and stay in focus so that you could see what an amazing job he did. I am feeling quite hopeful about the outcome. It might even better than I expected.
The one area that has me puzzled and with no idea what the result is going to be is the very extreme corner. If you check my before photos from the other review, you will see that I had the beginnings of a downward drop that portends those dreaded marionette lines. Fillers hadn't worked. Facelift didn't work. Haworth said he could address them and make them not droop downward. From the looks of things right now, an observer could conclude that I now had a Joker's corner slit. But he assured me that this would not be the result. In the pre-op markings phase he draws a line where the NL fold is and never goes beyond that. When I open my mouth, the corner of my mouth is further in, not at the edge of all that lump stitchy area. I will have to ask him when I next see him to explain what he exactly he did there.
For meds, the office has given me a 5 day course of steroids, instructions to clean with hydrogen peroxide, and I have some mild pain medicine, which is all I need, along with ambien if I need it. I have chosen to do some icing of the upper lip. (Although I worry about the bacteria in the water of the ice. Let's hope the Beverly Hills govt has a govt and good EPA crew that won't let them have a Flint. Although given everyone here is rich, I imagine they won't go the Flint route. But I digress.)
Finally, Haworth fraxel lasered my raised scars from my previous upper lip lift. The incision is a deep red but when I inspect the area, it appeas that he had successfully obliterated the raised scar. But I'll have to see when it heals. I asked him what setting he used and he wrote back, "35/8/8. We can take it up from there to 40/8/8 or 45/8/8, depending on how you're healing. I would not go much higher than that." Given that I am at the 6 month mark (or 5.5 actuallly) I am hopeful that doing this won't cause the body to react by laying down more collagen to build a big scar again. But will just smooth it out.
Before Corner/External Medialized Lift (and 6 months post 1st lip lift)
Just as a refresher, this is a photo of my lips the day before I had the external medialized corner lip lift so you can see the 6mm of inverted upper lip on either side plus the downward groove at the end corner of the lips. You can also see that the first upper lip lift I still there. It is a modest change and I am still considering a second one later. My vermillion show is small and makes me look like I have a small mouth with two slits on either side, which I did not like. Hopefully, this surgery with Haworth will correct that.
Ideal Upper Lip Horizontal Corner Vermillion Show Vs Mine
So you can understand why I decided to get the corners addressed, I have taken a "before" shot of my upper lip and compared it to two ideal pairs of lips. Notice that if you draw a straight line down from the outside of the nostril to the lips on the ideal photos, there will still be vermillion exposure to the outside of that line. But on me, it basically disappears. I hoped this operation would bring mine a tiny bit closer to ideal. We shall see.
3 Days Post Op
I've had considerable swelling in the upper lip post surgery, which I expected. Pain has been completely manageable with just 2 pills, one on each day. (FYI, the office gives you meds for pain, anxiety, antibiotics and also a dose of steroids for swelling.) I decided to stay in the area rather than fly back home right away. I thought it best to get the stitches removed by Dr Haworth's office and also to get a fraxel laser on my scars, since that is included in the price.
If you review my "before" photos, you will see I had nascent marionette lines on both corners of my mouth. Filler, ultherapy and facelift did nothing for it. Dr. Haworth did a type of stiching that reminds me of what you see on the side of a sofa cushion. It looks a little frightening, frankly. Joker-like slits extending horizontally out from the sides. When I asked about this, I was told the bunching will stay that way until he takes the stitches out and then the skin will smooth out over time. On me, he said, he had to extend the line a little longer than usual. Fingers crossed this doesn't mean I will have a long scar that extends outward just like the Joker. Stay tuned. I'm a tad nervous about this. But again, I signed up for this procedure knowing the risks and knowing surgery means scars.
Dr Haworth also did an agressive form of laser on the raised scar from my upper lip lift, which included dermabrasion. He said, "I was actually scraping away at the scar tissue." Now I know what it is so red and so flat.
Dr. Haworth called tonight to check up on me, which I appreciated.
I should note that I have not been in hiding. I donned a surgical mask and have been walking around Rodeo Drive, West Hollywood, and Beverly Hills. Today, I took an 8 mile hike to one of the parks in a canyon. I get strange looks because of the mask but mostly people look away. I hope the mask provided enough protection from the sun, which I am supposed to avoid while I am healing. I suspect I might have pushed things too far today so will try not to be out and about as much tomorrow.
Day 4 Corner Lip Lift
Still swollen, but not as much as days 2 and 3. Tomorrow, I get the stitches out. My upper lip here is bigger than my bottom lip. Prior to the surgery, it was the same size so I am sure it will go back down to thatl . The surgery did not touch my cupid's bow, only my sides.
Seeing if this photo comes out more clearly.
I had the stitches taken out yesterday. Holy moly was that painful. Afterwards, when I held up the mirror, I was in shock. The incision looked really good, although a tiny bit of scabbling was forming from where the stitches had been pulled.
Removing the stiches from the Joker line areas helped to bring down the bulging ridge, they are still definitely there and there is scabbing from the blood drawn when removing the stitches in that spot.
Dr Haworth came in to do a Fraxel on the area where he did surgery. He assured me that the Joker lines would eventually smooth out and leave me without any discernible scar. I left his office elated, feeling the worst of the recovery was over.
I was premature.
Today, I woke up and was more swollen today than yesterday, which I am assuming was because of the laser. The incision area now has a slightly raised ridge. Again, I assume a reaction to the Fraxel. I got a little bummed out but told myself to get a grip and approach this as a long term recovery. Haworth's staff said it would take about 3-4 weeks for things to calm down.
Right now, my appearance is such that I look like I have cold sores at the corners of my mouth and that I am about to get a cold sore any minute on both sides of my lip. I have smeared antibacterial goo on everything. In other words, not a good look. The area under my nose that he lasered is also still red but getting a little better.
By evening, the swelling calmed down a little but I am still swollen. Curious to see if I am embarking on a several week cycle of being more swollen in the AM but a bit better in the evening. I assume (hope) the ridge on my lip will go away. I know that RealSelf member Anon101010 had this same procedure and she said it took a number of fraxels and a good 4 or so months for the incision site for the corner lip lift to disappear. So I am using her time frame as my time frame.
Extreme Close-Up Photos
I had a friend take extreme close up photos using a Laika camera of my lips to show you the incision. I hope these photos come out on this website. The actual incision is impressive. The redness is from the fraxel that was done above the lip line and under my nose.
On the Road to Flawless
The redness I experienced was most likely an allergic reaction to my prolonged use of an antibacterial ointment. That was my mistake. As soon as I stopped putting anything on the treatment areas, the redness started to calm down and now the tiny pimples have all but disappeared. The corner lift incision that Dr. Haworth created is flawless. Absolutely flawless. Bordering on wizardry. The area on the sides which I refered to as Joker lines is also calming down. There is ZERO scar there. Within 2 weeks, I am pretty sure all the redness and raised areas will be gone and when that happens, I will post a photo with the final result and will then render a final verdict. (If I had to post one now, I'd say, "Worth It" but I don't think RealSelf reviewers should render a final verdict until everything is completely healed.)
Frankly, I never expected this good of an outcome; I didn't think it was actually physically possible.
Comparison Photos Day 13 Post
Using MacBook Air photo book here are two comparison photos of before and after corner lip. When all the healing is complete, I will update using Laika camera. The vermillion can be seen all the way to the corners now, and the droopyness of the corners is not as pronounded. Redness is now faded to pink. Scar under nose from previous lip lift is diminished, but not yet gone. I may need to do another fraxel in about 3 months.)
I saw the doctor for a post op review last week. He tackled the two areas on the side of my mouth where he had performed surgery on my nascant marionette lines. As you recall, he had originally used a long mattress stich. For the post op appt, he used a laser and an injection to help start to smooth it out. Right now, a few days after he did this, these areas are red (but that will fade) and a bit smoother. I am guessing I may need to do this a couple more times.
The incisions on the vermillion edge of my upper lip continue to be flawless. I can still feel the stiches inside, which are supposed to take another 4 months to dissolve.
One concern I have (which has nothing to do with the corner or upper lip lift surgery I had) is that my upper lip lift area (the distance from vermillion to nose) is not natural looking. It is too poofy and like a teepee, perhaps the result of what I tried to do years ago when I wanted to address the fact that I did not have philtrum and asked a surgeon to try to make one using fat grafting. Or maybe it is poofy because of another reason. I am not sure if I should do anything more to this area. I realize that my current 16mm upper lip is still too long and ideally I should have it be 3-4mm shorter. But at the moment, the idea of more surgery and the very long recovery time associated with it is overwhelming.
I will post again when there is any progress or change.
PS Sorry about my whiskers. I haven't dared wax for fear of more irritation.
Side by Side Before/After
7.5 months post upper lip lift and 2 months post corner lip lift
Profile pics Before/After
17 May 2016
2 months post
The before photo is before I had any kid of lip surgery. The after photo is 8 months post upper lip lift and 2 months post corner lip lift.
22 May 2016
2 months post
The far corner areas are improving. They are not as red nor as raised.
One of my corners had been more droopy than the other so Haworth had a challenge. He did say that because of the droopiness of my corners, he went out further than he normally does with the mattress stitch. I had been a little skeptical that a mattress stitch solution could actually work, but he assured me it would eventually smooth out. Time is proving him right.
As I said in earlier posts, healing takes time and also may need help either from a laser, needling, or injection. So to anyone who does a lip procedure, just remember not to freak out. Take the long view. Plan for the final results to take a year and be pleased if it happens earlier.
As for the vermillion area, I still feel a little ridge. I am assuming that is from the internal stitches that will take another 2-3 months to dissolve.
Overall, I am very happy with Haworth's work. It has exceeded my expectations. If I do a second lip lift, I may go to him, if I can find a way to finance it and can gird myself for the recovery. If I could do it all again, I would have gone to him the first time for both procedures, which would have allowed me to have 11 or 9mm taken off all at once, rather than have 2 lip lifts to take off that total distance.
Virtually No Scar
23 Nov 2016
8 months post
Here is the latest. Basically, I have a very minor scar easily covered by makeup. I am happy with the conservative result. The difference this minor procedure has made in my appearance has been huge. I look 15 years younger and it has moved the needle a little toward the Pretty side of the scale.
One Marionette Line Returns
19 Feb 2017
11 months post
I think it is important that people continue to update for a year post op. Things can change. In my case, one of my marionette lines has returned to it previous appearance, but the other side has so far managed to stay marionette line free.