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Lip lift surgery using bullhorn technique without any visible scar

29/6/2016

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A 24 year old girl from Dubai, a known case of unilateral cleft lip and palate reported to our hospital seeking for lip correction. Primary cleft lip repair was done elsewhere resulting in thinning of upper lip. Maxillofacial Surgeon Dr. S. M. Balaji successfully corrected this defect using bullhorn lip lift technique.

There are different types of lip lift surgery. The most commonly used lip lifting technique is known as the ‘bullhorn lip lift’. Pre-operative markings on the skin ensure the lip lift is approximately symmetric. Advancement of the inferior edge of skin directly beneath the nasal base lifts the lip, producing more visible vermilion and about 3 mm of teeth show at rest. The position of the final incision is such that it is located within the shadow of the nose. Meticulous technique produces an almost invisible scar. The amount and width of skin excised is individualized depending on the desired aesthetic goals. Lip lifts using this technique provide an immediate, dramatic, and permanent result.
Thin upper lip due to secondary cleft lip defect
Using Bullhorn technique the skin along with subcutaneous tissue excised to raise the lip
Immediately after suturing by raising the inferior border of the incision to the base of the ala raising the vermillion
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Cleft rhinoplasty with secondary lip correction without scars

21/5/2016

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​A 16 -year-old girl reported to our hospital seeking specialized treatment to correct her cleft nose defect. She was previously operated for cleft lip and palate elsewhere. Due to the cleft defect her nose was collapsed on the left side and it affected her facial appearance.
Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the Corrective rhinoplasty or nose correction. A costochondral graft (rib graft) was harvested and used to reconstruct the collapsed nasal framework. The surgery was approached from inside the nose so there was no scar. Secondary lip repair was also done to correct the vermillion defect. Immediately after surgery, the nose appeared sharp and definite giving a more pleasing appearance. The patient was very happy to have her nose defect corrected without any visible surgical marks on the face. 
Defective nose due to cleft and short upper lip due to incorrect lip repair done elsewhere
Depressed columella of nose and left alar shape was defective due to incorrect primary lip repair
Costochondral rib graft obtained from right side to reconstruct the ala of the nose
Immediate postoperative view showing corrected shape of the nose giving enhanced appearance
Raised columella of nose intranasally also shape of the left ala was also corrected giving symmetrical appearance
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Successful cleft nose and lip correction with Abbe flap

9/5/2015

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A 22 year old boy born with bilateral cleft lip and palate came to our hospital for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip and broad flattened nose for which he sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose was reshaped to make them more proportionate and balanced. Following surgery, the nose appeared sharp & defined with more proportionate profile.
Preoperative view showing broad flat nose with defective upper lip
Profile view showing ill defined columella of nose with depressed nasal tip and defective upper lip
Intraoperative view showing raised columella of nose and correction of upper cleft lip defect
Immediately after suturing showing corrected nose and lip defect using Abbe flap technique
Postoperative profile view showing raised dorsum of nose with nasal tip giving pristine appearance
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Combined jaw correction & lip and nose defect correction with Abbe flap technique & rehabilitation with implants for bilateral cleft lip & palate

10/11/2014

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A 19-year-old boy reported to our hospital seeking to correct his nose, lip and jaw defect and to replace his missing upper front teeth. He was previously operated for bilateral cleft lip and palate elsewhere where his entire premaxilla was removed. His upper lip was very thin in the middle, his lower jaw was severely protruding and his nose defect affected his facial profile giving an unpleasant appearance. Also because of his missing upper front teeth he was unable to bite and eat properly. 

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed a combined jaw, lip and nose correction. An Obwegeser’s bilateral sagittal split osteotomy was done reshaping the lower jaw bone and bringing it into proper alignment with the upper jaw. Dental implants were placed in the upper jaw to replace the missing teeth. In the Abbe flap technique, a flap of tissue was taken from the lower lip, rotated across the mouth and sutured together with the thin upper lip with the base of the flap still attached to the lower lip to maintain blood supply. The flap was taken with hair follicles to ensure proper moustache growth. After 3 weeks the flap was divided giving the upper lip a normal form and function. Ceramic crowns were fixed to the implants. Following complete rehabilitation, his appearance and self-confidence improved greatly and he is very happy with the results.

Preoperative facial view showing defective cleft lip and nose due to bilateral cleft defect
Preoperative intraoral view showing incorrect bite due to removal of premaxilla leading to missing teeth in upper front region of jaw
Reconstructed columella and shape of the ala of the nose by Abbe flap technique
Immediate postoperative view showing corrected bite by following Obwegeser's bilateral sagittal split osteotomy in mandible and lip revision by Abbe flap
Postoperative image showing corrected bite and missing teeth replacement with dental implant prosthesis
Postoperative facial view showing corrected lips, nose and missing teeth replacement giving enhanced appearance
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Simultaneous nose & jaw correction and lip correction with Abbe flap in cleft child from Seychelles

23/9/2014

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A 13-year-old boy from Seychelles, born with bilateral cleft lip and palate was brought to our hospital by his parents for expert cleft treatment. He was operated elsewhere for primary cleft lip and palate. He had a thin upper lip, broad flattened nose and protruding lower jaw for which he sought treatment.

Maxillofacial Surgeon Dr. S.M. Balaji performed the specialized Abbe flap technique to correct the upper lip. A flap of tissue was taken from the lower lip and used to reconstruct the upper lip with the base of the flap still attached to the lower lip. Once blood supply is established, the flap will be divided giving the upper lip a more natural, improved form.

Simultaneously, the broad nose and protruding lower jaw was reshaped to make them more proportionate and balanced. Protruding lower jaw was corrected by following bilateral sagittal split osteotomy (Obwegeser’s osteotomy) and excess bone obtained was used to augment the dorsum of the nose. Following surgery, the nose appeared sharp & defined with more proportionate jaw profile. 

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Residual lip defect corrected following failed treatment done elsewhere

21/3/2014

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A 10-year-old boy was brought to our hospital seeking specialized correction for his lip defect. They gave a history of the boy having undergone treatment elsewhere for hemangioma of both upper & lower lip. The lesion had been removed but the lip was not reconstructed properly. The thin & disproportionate upper lip caused difficulty in pronouncing certain words and also his appearance was affected.

Maxillofacial Surgeon Dr. S.M. Balaji performed the lip reconstruction surgery. The bulky lower lip was skillfully reduced and thin upper lip was corrected by increasing the fullness from the adjacent region without any graft. Thus the newly reconstructed lip was blended naturally with very minimal scars. This surgery improved his appearance and his pronunciation better. This made his parents feel very happy. 

Pre op view showing lip defect due to improper hemangioma treatment done elsewhere
During surgery - upper lip defect was corrected and approximated and lower lip swelling was removed and adjusted to normal size
On the next day of surgery - improved appearance with very minimal scar
Post op view showing enhanced appearance with scarless lip
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