LAM FACIAL PLASTICS

Hi dr lam,
Some 15 years ago I approached a surgeon since my upper lip did not raise when smiling and my appearance was edentulous. The surgeon performed and operation designed to raise my lip but rather than the bulls horn type procedure, he took a full thickness crescent of skin from the floor of the nasal vestibule in each nostril as well as segment of the nasal spine lifting the nasal base and sill into the deficit on closure. The depth of the crescent of skin also removed most of the soft tissue from the premaxilla. This left me with an unattractive “flat lip” which gives the impression of being overly long as well as a raised nasal sill and acute N.L angle.. Much more importantly, it left me with difficulties in balancing the most central elevator muscles which seem unrestrained possibly due to the missing bulk of the premaxilla. I think I originally had an unusual configuration of the proximal facial muscles which exacerbated these issues. I had restylane injected into the premaxillary area some time ago which very temporarily helped but I believe that the original incision needs releasing to allow the nasal labial angle to fall back into place for the best function and cosmetically. It is a complex problem but doable I believe and frankly I am unsure how to proceed or better describe the subjective problems I have. Any advice or help would be welcome.

this sounds very complex and perhaps outside of my terrain in terms of experience. obviously, the only real way i could even take a stab at this is to see you, put on gloves and look around. but i am not confident that i have a good solution even then. sorry about that.

s.