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Authors of section


Damir Matic, John Yoo

General Editors

Daniel Buchbinder

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Horizontal shortening

1. Introduction

With prolonged facial paralysis, the orbicularis oris muscle atrophies. This results in lower lip thinning and elongation.

Options for corrections include:

  • Wedge resection of the lower lip
  • Lower lip plication
horizontal shortening

2. Planning and surgical preparation

The amount of resection is determined by pinching the lower lip of the patient until the lip tubercle is centered at rest. Generally, this amounts to 10-20 mm of resection.

horizontal shortening

3. Technique

Wedge resection of the lower lip

This procedure allows full thickness removal of the paralyzed side of the lower lip, resulting in centralization of the lip tubercle and symmetry at rest.

It can be performed under local anesthesia.

A triangular wedge is drawn out in a vertical fashion starting 5 mm from the oral commissure.

horizontal shortening

A full thickness incision is performed, and the defect is closed in 3 layers (mucosa, muscle, and skin).

horizontal shortening

Alternative: lower lip plication

Alternatively, only the skin and red lip mucosa can be removed. The underlying orbicularis oris muscle is plicated enhancing the lip volume.

horizontal shortening


The skin and mucosa are closed as separate layers.

irreversible paralysis mouth lower lip

4. Case example: longstanding facial paralysis

a) Patient with longstanding facial paralysis causing elongation of the lower lip.

b) Postoperative wedge excision improves lower lip symmetry at rest and with smile.

horizontal shortening

5. Aftercare

Routine wound care is all that is necessary for the majority of the procedures.