This surgery is an interesting surgery. During the surgery, a large portion of the upper lip and upper jaw gums is removed and the lip mucosa is stitched to the gums that are left intact. What is actually done is to fix the lip in a low position. Normally, there is a large space in the inner part of the lip through which it can move upwards. This gap is removed and destroyed by surgery. In this way, the lips can no longer slide upwards when smiling. It is no longer possible to see the gums when smiling, because the lip cannot move upwards. Therefore, the gums remain covered by the upper lip even when smiling.

You can see the plan of the surgery in the drawing below. In the picture, (A) shows the inner side of the upper lip, (C) shows the gums of the upper jaw. The part of the mucosa removed during surgery is shown with (B). The part marked (B) is removed as is, bleeding is stopped and this part is closed and stitched. Thus, upward displacement of the upper lip is made impossible. Gummy smile deformity no longer occurs.

If there is no abnormality in the bone structure in the upper jaw, the gummy smile deformity will be corrected with this surgery. If the upper jaw height is too high, the gummy smile will still not improve, because the problem is actually in the bone structure. Therefore, it would be good if patients who will undergo surgery have a cephalometric analysis. If the cephalometric analysis shows that the patient does not have long face syndrome, Rubinstein-kostianovsky surgery will most likely correct this aesthetic defect.

The surgery is performed with general anesthesia. A medication that prevents bleeding is injected into the inner part of the upper lip and the gums of the upper jaw. A large piece of the gums and inner lip mucosa is surgically removed, leaving an area of the gums that needs to be stitched. Bleeding is stopped. The mucosal edge on the inside of the lip is stitched to the remaining part of the gums. A printed patch bandage is applied to the upper lip.

The patient should be fed with liquid food for 3-4 days. Solid food should not be eaten for these first 3-4 days. Mouth disinfectant and antibiotics should be used. The bandage on the upper lip is removed within 1-2 days. It will be harmful to laugh during the recovery period (first 1 week). The patient should not laugh. The swelling on the upper lip will largely disappear within a week.

Usually there is no need to remove the stitches. All stitches are made with self-dissolving threads. Therefore, the stitches dissolve and fall off within 2-3 weeks. If the threads have not fallen out after 3 weeks, they can be removed.

The surgery is actually a technically simple surgery, but its result is very effective in terms of aesthetics. The most important point of the surgery is to adjust the size of the removed tissue well and plan the level at which the lip is sutured and fixed. At the end of the surgery, after the recovery period, the tips of the teeth in the upper jaw should be visible when the patient smiles. It is normal for even 1-2 millimeters of gums to be visible. Therefore, in my opinion, the most important point of the surgery is to correctly determine the level at which the stitching is applied while detecting the upper lip. There is no mathematical way to set this. Fixing the lip to the correct level depends entirely on the experience of the surgeon.

Oytun İdil M.D.
(Aesthetic, plastic and reconstructive surgery specialist)

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