LIP AND PERI ORAL SCARRING

[drmithila]

Dentists routinely see patients who are suffering from trauma to the lips. If we do not personally treat and suture these patients’ lips ourselves, we are at least witness to a significant amount of lip and perioral scarring which formed subsequent to previous trauma. Most injuries to the facial structures seen in the emergency room are related to the soft-tissue of the lip and perioral area (62.8%).^1,2A majority of these traumas are suffered by children.^3,4 In most instances, patients who have suffered lip and perioral soft tissue trauma are treated without regard for potential unaesthetic scarring.⁵ Postsuturing revisionary surgery can be complicated and may involve more scar tissue. With the advent of newer aesthetic materials, and minimally invasive cosmetic procedure (MICP), lip and perioral scar revision can be treated in the dental office with local anesthetic in a short sequence of treatments. 

 

Many methods have been used to relieve lip and perioral scarring including chemotherapy, and surgical/nonsurgical procedures. Since the advent of modern day MICP procedures, a significant number of scars around the lip and perioral may be treated in the office with little or no down time.⁶ Techniques such as subcision, dermal fillers, and ablative laser therapy have been successfully used. The combination of subcision and immediate dermal filler placement can present advantages to treatment. In addition, laser ablative treatment for a final cosmetic treatment results in a marked reduction in scar appearance.
This article will demonstrate the use of a combination method of needle subcision and filler placement to reduce mild to moderate lip and perioral traumatic scarring. In addition, fractional laser ablative treatment on upper lip (Zone A) to enhance scar cosmesis will be demonstrated. The Gordon lip and perioral classification for the treatment template will be used.

GORDON CLASSIFICATION (CLASSIFICATION SYSTEM DESCRIPTION) 

Maxillary Labial

Zone A (ZA) extends from, and includes, the superior aspect of the vermilion border to the lower border of the columella nasi of the nose. This zone is wider due to the philtrum that is, at times, augmented in this zone. Zone B (ZB) is the area midpoint between the inferior border of the vermilion border (ZA) and the superior border of Zone C (ZC). ZC is the area from the inferior border of ZB to the lower transitional zone (wet/dry line) lip (Figures 1 and 2).

Mandibular Labial
ZC extends from the transitional zone (wet/dry line) to the border of ZB. ZB extends from the middle of the lip (border of ZB) to the vermilion border of the lower lip. ZA extends from, and includes, the vermillion border and the cleft, superior to the metal protuberance of the chin. Classification I, which applies to the lip and perioral area, is a template (or a border) that defines an area of treatment with MICPs. The Gordon Classification maps the lip and perioral area in order to facilitate communication, teaching, and recording of treatment.

        

[drmithila]

 

Figure 1. Illustrated here are the zones and segments of the lip and perioral area. In addition, the planes make up the lips as a template for treatment procedures.	Figure 2. This is an illustration of the zones associated with the lip and perioral area.
Figure 3. The patient at the initial visit: full face.	Figure 4. Notice the indurations of scar tissue in Zone A (ZA), segment (seg) 2 to 3. In addition, there is a slight asymmetry between the volume and lip architecture in ZA, seg 1 to 3.

        

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