Sternocleidomastoid Muscle, Fascia Grafts an Option for Aging Lips

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.

Lip augmentation with autologous sternocleidomastoid muscle and fascia grafts results in enhanced vermilion show and lip projection up to 2 years post procedure, according to a single-center, retrospective study.

“This is another tool in the plastic surgeon’s armamentarium to combat the aging lip, which along with every other technique has some limitations, yet is effective in our practice,” wrote Dr. Anurag Agarwal, of the Aesthetic Surgery Center, Naples, Florida, and colleagues in the March/April issue of Archives of Facial Plastic Surgery.

“Based on the present study, patients who desire subtle, yet long-term lip augmentation can be counseled to expect approximately a 20% to 25% increase in vermilion show and approximately a 1-mm increase in lip projection at 2 years and longer from baseline.”

The study compared baseline and postprocedure photographs of 25 consecutive patients who underwent sternocleidomastoid (SCM) muscle and fascia augmentation of the lips with concurrent cervicofacial rhytidectomy (Arch. Facial Plast. Surg. 2010;12:97-102).

They were compared to similar baseline and postprocedure photographs of 25 control patients who received cervicofacial rhytidectomy alone, with no lip augmentation.

The mean postoperative photograph was taken at 25 months in the SCM group and 21 months in the control group. The ages of the patients were not reported.

For each patient, frontal and right lateral photographs were analyzed. The frontal analysis included measurement of the right and left, upper and lower lip vermilion show. The right lateral analysis included measurement of the anterior-most projection of the upper and lower lips.

Exclusion criteria included a concomitant chin augmentation, as well as use of injectable and/or surgical lip fillers or perioral skin resurfacing within 6 months of the preoperative photograph.

Compared with the group that did not receive lip augmentation, the mean changes from baseline in the lip augmentation group were statistically significant, reported the authors.

Comparing baseline and postprocedure photographs among the lip augmentation patients, the mean increase in upper lip projection from baseline was 0.99 mm, and in lower lip projection it was 0.90 mm. The mean increase in upper lip vermilion show from baseline was 20% on the right side and 22% on the left. The mean increase in lower lip vermilion show from baseline was 23% on the right side and 24% on the left.

Regarding complications, “there were no contour deformities, no limitations in head movement, no increased postauricular neck pain, no spinal accessory nerve injuries, and no difference in temporary numbness around the ears between the SCM graft and control group patients,” wrote the authors.

A medical chart review revealed that a deep focal lump developed in the upper lip of one SCM patient 3 years postoperatively. The etiology of the lump was unknown but it resolved after two triamcinolone acetonide injections, they reported.

“All patients were subjectively pleased with their degree of lip augmentation,” but one patient requested additional augmentation 2 years postoperatively, which was performed successfully with injectable gel, they said.

The SCM muscle and fascia graft has been performed by the authors since 1996, most commonly in conjunction with cervicofacial rhytidectomy, but also as a stand-alone procedure.

When performed with rhytidectomy, the superficial musculoaponeurotic system incision is extended inferiorly along the anterior border of the SCM muscle. Then, a segment of the SCM muscle and fascia is harvested from the mastoid process inferiorly, along the posterior border. Hemostasis is achieved with bipolar cautery, and the donor defect is closed.

After completion of the cervicofacial rhytidectomy, single incisions are made just inside the mucosa on each corner of the mouth, through which upper and lower lip tunnels are created in the superficial orbicularis oris muscle. The graft material is then pulled through the tunnels and positioned symmetrically, and the incisions are closed. “It is imperative to contour the grafts so that they are smooth and free of any muscle bulges that may be visible postoperatively,” they wrote. The grafts are intentionally left slightly longer than the distance between the incisions. “We have found that tucking the lateral ends of the grafts slightly lateral to the corner of the mouth incisions helps counteract the natural tendency for the grafts to horizontally shorten. This allows preservation of lateral lip fullness,” they explained.

After the procedure, antibiotic ointment is applied and patients are asked to limit their mouth opening for 2 weeks postoperatively.

When performed without rhytidectomy, “the same horizontal limb of the rhytidectomy incision is performed in the hair-bearing scalp to access this portion of the SCM, but the patient must be counseled about a donor site incision that would not be required with a nonautologous implant material.”

Neither dermal cysts, or prolonged stiffness or sensory changes were encountered in the study group – problems that have been reported with other lip augmentations procedures, they wrote.

“We have seen occasional asymmetries in the lips after SCM grafting,” they wrote. “Fortunately, these findings are rare,” they continued, without specifying their frequency in the study group. “There are several possible explanations for this finding: the presence of slight contour irregularities in the grafts when they are implanted; asymmetric graft compression; differential resorption with a given graft; and/or a contribution from dynamic movement of the lips.”

They study’s main limitation was some variation in the camera’s distance from the patient, although an attempt was made to control for this with the calibration of photographs, the authors wrote. In addition, they noted, patient satisfaction was not formally measured.

The researchers reported no financial disclosures.