title: Comparison of lip enhancement using autologous superficial musculoaponeurotic system tissue and postauricular fascia in conjunction with lip advancement.
abstract: OBJECTIVE
  To evaluate and compare the short- and long-term aesthetic results of surgical lip enhancement using the superficial musculoaponeurotic system (SMAS) and postauricular fascia graft implantation with and without vermilion border advancement.
  
  
  METHODS
  A single-blinded cohort study was performed using 39 patients who underwent surgical lip enhancement at a private facial plastic surgery practice between 2005 and 2007. The cohort was grouped as follows: 14 patients underwent lip augmentation using SMAS grafting; 10 patients underwent lip augmentation using postauricular fascia grafting; and 15 patients underwent combined lip augmentation and lip advancement (SMAS grafting was used in 8 of the procedures, and postauricular fascial tissue was used in 7). All procedures were performed in a controlled setting by a single surgeon (E.G.M.). Patients who had undergone previous lip augmentation of any kind were excluded from the study. Preoperative and postoperative photographs were analyzed by 3 blinded physician observers using the Lip Fullness Grading Scale. Postoperative photographs were evaluated at approximately 6 months and 1 year after the procedure.
  
  
  RESULTS
  Reviewers noted a significant improvement in aesthetic scoring for each of the methods of lip augmentation examined at 6 months after surgery. This result was sustained at 12 months after surgery. Postauricular fascia graft lip augmentation and combined lip advancement and postauricular fascia augmentation recorded the highest scores after surgery. The largest mean scoring increases of 1.459 (t = -9.5049; P < .001) at 6 months and 1.584 (t = -9.0308; P < .001) at 1 year were found in the lip advancement and SMAS lip augmentation study group.
  
  
  CONCLUSIONS
  Youthful, natural-appearing lips tend to enhance an individual's appearance. Surgical lip augmentation using SMAS or postauricular fascia, with or without vermilion border advancement, is a straightforward, safe, potentially long-lasting treatment for hypoplastic lips, with little to no morbidity.
authors.affiliation: Section of Facial Plastic and Reconstructive Surgery, North Shore University Hospital,Manhasset, New York, USA. william.recupero@amedd.army.mil
authors.forename: William D
authors.initials: WD
authors.lastname: Recupero
authors.forename: E Gaylon
authors.initials: EG
authors.lastname: McCollough
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008046:Lip / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016037:Single-Blind Method; D013524:Surgical Flaps; D013536:Suture Techniques; D020858:Tissue and Organ Harvesting / Q000379:methods; D055815:Young Adult