Lip thinning & this result

[april]

I was just looking at Movehed's site and came across this result. I've often heard people complain about lips becoming thinner after surgery, but this is extreme. Was this a result of surgery, or do you think she just had fillers in the before pic?


"Patient has history of asymmetry and condylar hypoplasia, planned for bilateral total joint replacement and Lefort 1 osteotomy"

https://movahedoms.com/services/tmd/combined-total-joint-replacement-with-orthognathic-surgery/case-study-5/

[Lazlo]

I've never seen a result like that. my lips got bigger and nice but I told the surgeon to do a vy plasty on my upper lip. it was great. this woman looks older in the after, like as if the after pic was taken 20 years later.

[GJ]

this woman looks older in the after

That's common, especially in women. Bigger jaw = older look because we associate a small jaw with femininity/youth.

I've seen this thinning. It's unfortunate and common. I doubt she had fillers before (wouldn't she just get fillers after if that were true? And she doesn't look like the type).

[april]

Yeah my first thought was she aged 20 years.
Results like this worry me. She had nice lips before.

She doesn't look old in the 3/4 shot, but the lip thining is majorly apparent and it's a case of "looking different, not better". Although her asymmetry was corrected, it's a really strange result.

Should most good surgeons do a vy plasty?

[ditterbo]

Her eyes are more menacing/glaring in the after 3/4, not sure why, but its messing with my objectivity a little. I think it's her make up in the after. Anyway I'm almost certain an overwhelming majority of the aging affect we're seeing is in her lips. They look substantially worse - like taken from a women twice her age or more, worse.

[PloskoPlus]

Pretty disappointing.

[kavan]

I was just looking at Movehed's site and came across this result. I've often heard people complain about lips becoming thinner after surgery, but this is extreme. Was this a result of surgery, or do you think she just had fillers in the before pic?

"Patient has history of asymmetry and condylar hypoplasia, planned for bilateral total joint replacement and Lefort 1 osteotomy"

https://movahedoms.com/services/tmd/combined-total-joint-replacement-with-orthognathic-surgery/case-study-5/

Intriquing case. Let me see if I can crack it.

Her lips LOOK smaller (but didn't shrink) because the L1 must have been a SET BACK and the double joint replacement set back the mandible and/or the chin was brought forward. All together would have made the lips look RELATIVELY smaller because they are MORE in the BACKground than prior when they were more in the FOREground.

He notes she got a Lefort 1. But it's looking like the L1 could have been in the BACKWARDS direction. I looked for that on the PROFILE view and found what I was looking for as to the most likely explanation why her lips looked smaller. For example, the nose to lip curve is MORE open in the before. So, less open in after could indicate set L1 set back where nasal spine goes backwards. LI set back puts the upper lip area more in the background which would make the lip look RELATIVELY smaller even though same size as before.

The double side joint replacement also could have given somewhat of set back to the mandible which would further explain why he had to do a L1 set back to match it. Chin also looks like it could have been brought forward.

Basically, the conVEXity of her face looks to be SET BACK so it's not as conVEX anymore. So, 'dished in' where it was conVEX. But just enough to make it straight profile and NOT conCAVE.

Trade off was the lips going BACKWARDS as in more in the BACKground where as prior they were more in the FOREground which is why they look relatively smaller.

His photos are lined up correctly (horizont can be drawn through same place on nose). Then a vertical dropped from there where you can see a set back relative to the vertical.

[apollo]

because the L1 must have been a SET BACK and the double joint replacement set back the mandible and/or the chin was brought forward

She definitely didn't have an L1 set-back. Modern surgeons pretty much have abandoned maxillary setbacks, and there's no way any half-competent surgeon (modern or not) would do one in her case.

Increased lip curl and decreased nasolabial angle are expected outcomes of CCW advancement.

The photos you linked aren't lined up correctly. https://imgur.com/NA0GU0N is a superimposition of the before and after (faded in background) without any angular adjustment. The sizes are the same, and they are lined up by soft tissue nasion. See how the forehead is more vertical in the after? This would imply a more CW rotated head posture in the after, which would result in relatively "set back" jaws relative to the true vertical through nasion.

[kavan]

She definitely didn't have an L1 set-back. Modern surgeons pretty much have abandoned maxillary setbacks, and there's no way any half-competent surgeon (modern or not) would do one in her case.

Increased lip curl and decreased nasolabial angle are expected outcomes of CCW advancement.

The photos you linked aren't lined up correctly. https://imgur.com/NA0GU0N is a superimposition of the before and after (faded in background) without any angular adjustment. The sizes are the same, and they are lined up by soft tissue nasion. See how the forehead is more vertical in the after? This would imply a more CW rotated head posture in the after, which would result in relatively "set back" jaws relative to the true vertical through nasion.

Your photo cuts off the part of her face where I demo-ed a possible set back.

You're patently claiming setbacks have been abandoned. Her case very much looks like one where excess convexity was there to the L1 area.

CCW with advancement (altough less of it than would be done with linear) is usually done in process of also doing a BSSO. Doc does not mention any BSSO and that was unlikely to do with the joint replacement.

Her nose to lip curve in before is the type where the anterior nasal spine is prominent. Hence my positing she had a set back for the reduction of it.

[PloskoPlus]

overzealous ans reduction is another possibility. Anyway tjr can alter the occlusal plane, which may necessitate posterior downgrafting of the maxilla, which would tip up the upper lip.

[ben from UK]

Why would she want to do this. She had asymmetric upper lip, her upper lip volume was great. Stupid procedure thad made her look older.

[ben from UK]

She looks older cause when we age the lips retract inwards. This is what it looks like after the procedure with her unfortunately. This is an example of how only a couple of millimeters can change the face.

She also looks more threatening in the after, partially due to bigger jaw + chin. I don't know what kind of procedures she had besides lip thinning, but i'm guessing something like jaw + chin implant.

It's rarely a good Idea to give a woman jaw + chin implants. Going to look more masculine. Small chin implants okay, but combined with jaw implant it usually looks good masculine.

[PloskoPlus]

Read the case description. It was a medical necessity.

[april]

Why would she want to do this. She had asymmetric upper lip, her upper lip volume was great. Stupid procedure thad made her look older.

I think she would have only gone into this expecting a more symmetric face, better function and less retruded chin. Nothing more, nothing less. She wouldn't have expected her lips to look way thinner.

Her braces were probably pushing out her lips a bit in the before photo, but it can't be attributed to just that. It must be a combination of the optical illusion Kavan mentions (now that the chin/lower jaw are taking up more foreground space) and some sort of negative surgical effect on her lips causing them to pull inwards. (maybe a VY was not done?) None of his other patients have had such a major change in their lips, so it's a bit strange.

If she had bigger lips (I ps'd her original shape on) no doubt she'd look better.

[ben from UK]

I think she would have only gone into this expecting a more symmetric face, better function and less retruded chin. Nothing more, nothing less. She wouldn't have expected her lips to look way thinner.

Her braces were probably pushing out her lips a bit in the before photo, but it can't be attributed to just that. It must be a combination of the optical illusion Kavan mentions (now that the chin/lower jaw are taking up more foreground space) and some sort of negative surgical effect on her lips causing them to pull inwards. (maybe a VY was not done?) None of his other patients have had such a major change in their lips, so it's a bit strange.

If she had bigger lips (I ps'd her original shape on) no doubt she'd look better.

Not bad but too masculine. Should be more v-form shaped/heartshaped. I personally don't like too much masculinity on a woman. Shaving procedures aren't done quite often like in Asian countries though. She could have been almost perfect with more v-shape.