title: Upper lip augmentation: palmaris longus tendon as an autologous filler.
abstract: BACKGROUND
  Lip augmentation is used to enhance a thin upper lip or correct lip deficiencies. The palmaris longus tendon, an accessory tendon of the wrist, has been used successfully for upper extremity reconstruction and was used in this case series for upper lip augmentation.
  
  
  METHODS
  Patients underwent upper lip augmentation using palmaris longus tendon grafts at the University of California, Los Angeles from 1998 to 2005 (n = 38). Vertical lip height, lateral lip projection, and dynamic smile length were measured preoperatively, at 6 weeks, and at 1-year follow-up, and complications, lip mobility, and physician/patient outcome surveys were recorded.
  
  
  RESULTS
  Palmaris graft lip augmentation was performed for cosmetic (n = 21) and reconstructive (n = 17) indications. There were two infections and two graft exposures, with no long-term sequelae. The vertical height of the upper lip had a mean increase of 204 percent and a mean relapse of 9 percent (change from postoperative period to follow-up). Lateral projection of the upper lip showed a mean increase of 180 percent and a relapse rate of 7 percent. Dynamic lip mobility had a mean grade of 4.7 of 5 at 1 year, and the postoperative smile length was close to the preoperative length (mean postoperative length was 96 percent of preoperative length). One patient developed a stiff upper lip and required reoperation and therapy for a good final outcome.
  
  
  CONCLUSIONS
  The authors' case series shows that the palmaris longus tendon provides a reliable option for soft-tissue upper lip augmentation, with improved vertical height and lateral projection and maintenance of lip mobility.
authors.affiliation: Los Angeles, Calif. From the Division of Plastic and Reconstructive Surgery, David Geffen School of Medicine at the University of Los California, Los Angeles.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Trussler
authors.forename: Henry K
authors.initials: HK
authors.lastname: Kawamoto
authors.forename: Kristy L
authors.initials: KL
authors.lastname: Wasson
authors.forename: Brian P
authors.initials: BP
authors.lastname: Dickinson
authors.forename: Eric
authors.initials: E
authors.lastname: Jackson
authors.forename: Jennifer N
authors.initials: JN
authors.lastname: Keagle
authors.forename: Reza
authors.initials: R
authors.lastname: Jarrahy
authors.forename: James P
authors.initials: JP
authors.lastname: Bradley
mesh_terms: D000293:Adolescent; D000328:Adult; D003357:Cosmetic Techniques; D005260:Female; D005542:Forearm; D006801:Humans; D008046:Lip / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures; D013710:Tendons / Q000637:transplantation*