AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Early Surgical Management of Lip Hemangiomas: Fifteen Year Experience With 214 cases
Wai-Yee Li, MD1, Sheryl Lewin, MD2, John F. Reinisch, MD2.
1Childrens Hospital Los Angeles, Los Angeles, CA, USA, 2Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PURPOSE: The lips are important functional and aesthetic landmarks of the face. While hemangiomas can cause noticeable distortion of these structures, early surgical treatment is rarely considered. The concept that hemangiomas involute completely over time, as well as the fear of causing an iatrogenic deformity, may account for this reluctance. From a review of our large series of early surgically managed lip hemangiomas, we formulated surgical guidelines for obtaining optimal aesthetic outcomes of these visually apparent and often distressing lesions.
METHODS: We performed a retrospective chart review of pediatric patients with vascular birthmarks of the lip, at a large children’s hospital between 1992-2006. We excluded all vascular malformations, as well as non-surgically treated hemangiomas. Pre and post-operative digital images from our hospital database were subjectively reviewed for aesthetic outcomes by the authors. Charts were reviewed for location, previous therapy, age of treatment, surgical technique and complications.
RESULTS: We identified 249 patients with surgically managed vascular birthmarks of the upper and lower lips. Of these, 214 were found to be lip hemangiomas, with the remainder being arterial and venous malformations (n=29), capillary malformations (n=2) and lymphangioma (n=4). The age of patients at the time of surgery ranged from 2 months to 12 years, with an average age of 23.6 months. No transfusions were required. All but two patients (lip switch flaps for major tissue loss) were managed on an outpatient basis.
CONCLUSIONS: We present data from the largest series of lip hemangiomas in a pediatric population and conclude the following: 1) Although hemangiomas involute, they can leave significant residual stigmata (figures A and B). 2) Laser therapy during the hemangioma’s proliferative phase, can cause ulceration with subsequent scarring (figure C) or permanent bleaching of the vermilion (figure E). 3) Lip hemangiomas cause displacement of adjacent normal tissue, allowing a more aggressive resection, with less distortion than traditionally expected (figure G and H). 4) Even with resection of the Cupid’s bow, an aesthetically acceptable lip can be achieved if lip symmetry is maintained. (figures I and J)
Our experience justifies early outpatient surgical treatment of deforming lip hemangiomas, with the expectation of minimal complications, excellent aesthetic outcomes and a high degree of parent satisfaction.





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