Background The sub-nasal lip lift is a surgical technique that elevates the “lip line” (interface between vertical maxillary incisor height and upper lip) to achieve a more youthful aesthetic. Objectives This study offers the first ever definition of 3D changes to the upper lip due to sub-nasal lip lift. Methods A lip lift procedure was performed (on cadaveric samples) in a sequential manner from 2.5mm to 5.0mm intervals (n=13). 3D photographs were taken using the VECTRA H1 system (Canfield Scientific, Fairfield, NJ), and 3D analysis was performed including vermillion height and width, philtral height, sagittal lip projection, vermillion surface area, and incisor show. A subset of samples (n=9) underwent a modification of the technique by undermining of the upper lip subcutaneous tissue off of the underlying muscular fascia. Results Vermillion surface area (baseline ranged from 1.45 - 5.52 cm 2) increased by an average of 20.5% and 43.1% with 2.5 mm and 5.0 mm lip lift, respectively. Anterior projection of the vermillion increased in all cases by an average of 2.13mm and 4.07 mm at 2.5 and 5.0 mm respectively. Philtral height decreased in all cases by an average of 3.37 and 7.23 mm at 2.5 and 5.0 mm, whereas incisal show increased on average of 1.9 and 4.09 mm, respectively. Conclusions This study is the first to define the 3D morphometric changes to the upper lip following sub-nasal lip lift. Quantifying these changes aids the surgeon in both preoperative planning and guiding patient expectations.

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The published (albeit limited) experience with breast implant capsule-associated squamous cell carcinoma suggests that this is a much more aggressive pathology than BIA-ALCL, with more aggressive surgical management, as well as adjuvant therapy, necessary for disease management. 3,4,6 Our patient had transaxillary, periareolar, and inframammary incisions used in her previous augmentation and subsequent revisions, putting her at risk for ductal transection, implant colonization with biofilmproducing organisms, and subsequent chronic inflammation, which may have led to squamous metaplasia and subsequent dysplasia. There is no mention of incision type in the other case reports, but this information would be useful to document. Our patient's most recent revision surgery was in 2016, at which time there was periprosthetic fluid and a mass on her capsule at the same site where her SCC ultimately developed. This was reported as benign on biopsy but no pathology report was available for our review. A unique factor in our patient's case was her concurrent pregnancy. To our knowledge, this is the first report of a gravid woman with BICA-SCC. Given the paucity of data surrounding this pathology, we are unable to draw any conclusions regarding whether our patient's pregnancy contributed to her disease development in any way.Breast implant capsule-associated squamous cell carcinoma is a rare but aggressive disease whose etiology remains unclear. Further study of this disease is needed to better classify risks, treatment, and outcomes. Plastic surgeons should remain vigilant in the follow-up of patients who have undergone placement of breast implants. A differential diagnosis of breast implant capsule-associated squamous cell carcinoma in patients presenting with late-onset breast edema, particularly with a history of previous capsular contracture or revision surgery, should be maintained. A similar approach to diagnosing BIA-ALCL should also be applied to diagnosing this disease: aspiration of any periprosthetic fluid collection for cytologic analysis and biopsy of any mass present. 9 The surgeon should include the possibility of breast implant capsule-associated squamous cell carcinoma when discussing the possible risks of breast implant placement with patients before surgery.