Pedicled buccal fat pad flap for upper lip augmentation in orthognathic surgery patients

In this article, a new method of upper lip augmentation using a bilateral buccal fat pad flap is reported. This prospective study evaluated the changes in the upper lip that occur after maxillary surgery with concomitant mobilization of the bilateral buccal fat to improve upper lip projection.

A bilateral pedicled buccal fat pad flap to fill the premaxilla, paranasal, and upper lip areas, in association with a Le Fort I osteotomy for maxillary advancement, was performed in 11 orthognathic surgical patients with a thin upper lip. Minimum follow-up was 12 months. Cone-beam computed tomograms from an i-CAT device (Imaging Sciences International, Hatfield, PA) were taken pre- and postoperatively and loaded into Dolphin software (Dolphin Imaging and Management Solutions, Chatsworth, CA) for analysis. Changes at the right upper incisor tip, upper lip anterior, upper inside, stomion superior, and subnasale were measured in each patient immediately before and 6 months after surgery. Dimensional changes of the upper lip were measured using lip length (from the subnasale to the stomion superior) and lip thickness (from the upper inside to the upper lip anterior).

The average maxillary advancement was 4.81 ± 2.47 mm, and the average vertical movement was 1.00 ± 1.75 mm; both were measured at the upper incisor tip. Upper lip movement, measured at the upper lip anterior, was 5.98 ± 2.46 mm (124.32% of maxillary advancement, mean data). Lip thickness increased 0.9 ± 0.19 mm, and lip length increased 0.77 ± 0.32 mm. The new upper lip contour was considered good to excellent in all cases.

The technique described was useful to increase the projection, volume, and contour of the premaxilla, paranasal, and upper lip areas in orthognathic surgical patients. Moreover, it appeared to be useful to control the length shortening of the upper lip in all cases.