Clinical Factors Influencing Cosmetic Lip Reduction Recommendations: A Comparative Study of Orthodontists and Oral and Maxillofacial Surgeons

Introduction: The esthetic lip morphology is influenced by soft-tissue characteristics, dental relationships, facial profile, and patient-related perceptions, which may contribute to differences in recommendations for cosmetic lip reduction.This study compared clinical factors and treatment recommendations between orthodontists and oral and maxillofacial surgeons using standardized written clinical scenarios.Materials and methods: This cross-sectional comparative questionnaire-based study included 110 clinicians, comprising 55 (50.0%) orthodontists and 55 (50.0%) oral and maxillofacial surgeons.The participants evaluated six standardized clinical scenarios incorporating variations in lip fullness, lip prominence, dental protrusion, lip competence, strain, and facial characteristics.The questionnaire assessed the importance of clinical factors, scenario-based recommendations, treatment preferences, and clinical decision-making.Internal consistency was assessed using Cronbach's alpha.Between-group differences were evaluated using independent t-tests, Mann-Whitney U tests, chi-square tests, or Fisher's exact tests, as appropriate, with Holm-Bonferroni correction for multiple comparisons.Results: Oral and maxillofacial surgeons assigned greater importance to lip-centric factors than orthodontists (p = 0.013), whereas orthodontists assigned greater importance to dental/skeletal and patientrelated factors (both p < 0.001).Surgeons provided significantly higher recommendations for cosmetic lip reduction in five of the six standardized scenarios, whereas no significant difference was observed after the completion of orthodontic treatment (p = 0.113).Significant differences were also observed in treatment preferences, referral practices, multidisciplinary decision-making, objective facial analysis, orthodontic correction before surgery, and confidence in the recommendations.Questionnaire reliability was good, with Cronbach's α=0.85 for clinical factors, 0.88 for case assessment, and 0.79 for treatment preference.Conclusion: Recommendations for cosmetic lip reduction differed between orthodontists and oral and maxillofacial surgeons, with the latter demonstrating a greater tendency to recommend reduction across several clinical scenarios.Orthodontists placed greater emphasis on dental and skeletal factors and orthodontic correction, whereas surgeons emphasized lip-related characteristics and objective facial assessments.These findings support individualized and multidisciplinary assessments before irreversible cosmetic lip interventions.