Subnasal Lip Lift

Q: Dr. Eppley, Can a corner lip lift combined with a subnasal lip lift bring about the same results as a gullwing lip lift if you want to try to do avoid as large of a scar at the vermillion border as possible?

How much can alar retraction be corrected in millimeters? If oyu have an exceptioally severe case is it possible to do two operations the same way if someone wants exceptionally large breast implants they can get implants the first go around and then have the skin stretch, then replace implants later with larger ones? In the case of the nostrils, is it possible that the first time will not fit a large enough graft but this can be replaced later on down the road after the nostrils have adjusted? 

Is there a procedure that can correct  masculine and broad shoulders for a female that wants a more petite upper body? Something like clavicle reduction?

A:  A subnasal liplift combined with an extended corner of the mouth lift is a  way to create a similar effect as that of the lip advancement procedure. (gullwing lip lift) The subnasal lip lift substitutes for placing the excision of skin across the cupid’s bow area. Lateral vermilion advancements brought inward from the mouth corners is still needed but they do not encroach onto the more visible and delicate cupid’s bow area of the upper lip.

Alar retraction is treated by the placement of alar rim cartilage grafts. They will create a several millimeters of correction. More significant alar retaction may need to be treated by the placement of composite skin and cartilage grafts to roll out the inner lining. (which is where the skin portion goes. This it is not like your breast implant analogy at all.

There is no operation to reduce wide shoulders. A bony reduction is not possible because that impinges on the moveable shoulder joints.

Dr. Barry Eppley

Indianapolis, Indiana

Subnasal Lip Lift

Q: Dear Dr Eppley, After a rhinoplasty I was left with a big space between my nose and lips. My surgery was 6 days ago. Do you think this might still change and I should wait longer until considering a subnasal  lip lift? Thank you so much!

A: It would be entirely premature to judge what effect your rhinoplasty will have on your upper lip length at just six days after surgery. While it is unknown to me as to what type of rhinoplasty you have had, any rhinoplasty surgery that results in tip rotation and/or tip shortening is going to initially create the perception that the upper lip is longer. In reality it be now more exposed with the change (opening) of the nasolabial angle…or it is possible that it may have indeed become lengthened. But until all the swelling from the rhinoplasty surgery has resolved and the tissues have fully settled, any aesthetic judgment on upper lip length can not truly be appreciated. I would not perform an upper lip lift on a rhinoplasty until they are six months out from the procedure, not only because of the uncertainty of the aesthetics, but because of the intervening skin between an open rhinoplasty incision and that of the subnasal lip lift.

Dr. Barry Eppley

Indianapolis, Indiana

Will A Lip Lift Create More Upper Tooth Show?

Q: Dr. Eppley,  I would like to discuss lip aesthetics. I have noticed that in certain people, their lips in the relaxed, open mouth position, there is a nice exposure of the upper teeth. I would say that this is an attractive trait. 

I would like to posses this feature, but unfortunately, I don’t. When I relax my lips and hang them open slightly, I only feel the my bottom lip hangs and only the bottom row of my teeth show. My upper row teeth do not make an appearance because my upper lip doesn’t move when relaxed. Photos attached,

I have fairly thick lips for a male, so I am looking at getting lip reduction. My question is how to achieve that ‘upper teeth open mouth’ look? Would a lip lift help?

Is there a specific name for this look that I can Google?

A: The procedure yo are seeking does not have a specific name because it is a combination of two well known procedures to try and create the effect you are after. What you need is a combination of a sub nasal lip lift with an upper lip smile line reduction. The lip lift will raise up the central part of the upper lip. (ratio of about 4 :1, meaning for 4mm of skin removed under the nose it will move the smile line level of the upper lip 1mm) Then a horizontal reduction of the vermilion-cutaneous junction of the upper lip of about 4 to 5mms will help raise up the bottom of the upper lip. Together you should be able to develop some natural upper tooth show. The lower lip will, of course, need to be reduced by about 7 to 8mms to match better with the upper lip.

Dr. Barry Eppley

Indianapolis, Indiana

Can A Subnasal Lip Lifts and Lateral Commissuroplasties Be Done At The Same Time?

Q: Dr. Eppley, I am interested in the following procedures:
1) Lateral commisuroplasty
2) Bullhorn lip lift

My questions are:
1) Is it possible to have the procedures in the same setting?
2) Are the procedures done under local anasthesia or twilight sedation?
3) What are the costs involved with the procedures?

My main concerns with my mouth are as follows:
1) my mouth is too small (horizontally)
2) the gap between the my nose and upper lip is quite long which i also dont like.

The result I am wanting to achieve is a more aesthetically pleasing, youthful looking mouth. I want to create a fuller appearance to this area of my face to create a balance in my face. Thank you for your time.

A: A subnasal lip lift (aka bullhorn lip lift) and lateral commisuroplasties (mouth widening procedure) can be done at the same time under local anesthesia. These are common office-based procedures done without the need for general anesthesia or IV sedation. They have minimal recovery in regards to pain, swelling and bruising. The scars do take some time to fade sufficiently but can be covered with make-up in the interim. (four to six months)

Dr. Barry Eppley

Indianapolis, Indiana

Can I Have A Subnasal Lip Lift With Braces On?

Q: Dr. Eppley, I’m wearing braces and the distance between my upper lip and nose is short maybe 1.2 cm now. But I know that if I take off the braces the distance will increase to 1.4 or 1.5cm. I don’t want to do lip augmentation. I want the lip lifting procedure and I want to do it wearing braces. Is that possible?

A: Having orthodontics appliances in place does not impede the ability to do a subnasal lip lift. The question is whether one can tell how much to remove so as not to end up with an overdone result. Subnasal lip lifts that have had too much skin removed have no recoverable strategy…you can’t put back the skin that was removed without a very visible graft under the nose. If your calculations are correct you would do a 3mm skin resection for your subnasal lip lift. If you have do do the lip lift before your braces are removed just make sure it is a conservative amount of skin removed. Removing your braces ma result in the lip lengthenng a few millimeters. But since you have not done that test (remove your braces and measure it), assume that maybe no change in lip length will occur.

Dr. Barry Eppley

Indianapolis, Indiana

Do I Need A Corner Of The Mouth Lift After My Lip Lift?

Q: Dr. Eppley, I recently had a subnasal lip lift which I am pleased with the lift in the center of my lips. Now however, it seems to accent the thin corner of my liplips. Aesthetically to balance out the look, I think this is something that should have been done too. Can a corner lip lift be done with local anesthesia?

A: The subnasal lip lift in the right patient is a very effective lip augmentation procedure but it will only affect what lies within the skin excision pattern. By dropping down a vertical line from the sides of the nose to the lip, the lip area improved will only lie within. In essence, it shortens the amount of vertical skin between the base of the nose and the upper lip and only provides accentuation of the cupid’s bow of the upper lip. It would not be rare to a have a lip lift patient turn their focus to the sides of the lip and the mouth corners thereafter.

Corner of Mouth Lift in Indianapolis Dr Barry EppleyThe key question about changing what was not improved by the lip lift is defining the exact area of outer lip deficiency. This could be either an isolated corner of the mouth lift or an extended corner of the mouth lift that extends further up along the sides of tails of the upper lip. This distinction is critical to understand. An isolated corner of the mouth lift will just change the angle of the corner of the mouth and will not make it thicker. A extended corner of the mouth lift or an outer lip advancement will make the sides of the lip fuller.

I would need to see a picture of your lip to help you decide what is the correct lip augmentation procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Will A Subnasal Lip Lift Scar Be Visible In An Upturned Nose?

Q: Dr. Eppley, I would like to explore a lip lift and corner lip lift. I have an unusually long upper lift (distance from bottom of nose to top lip) and would look much more balanced if that distance could be shortened. However, I have an over rotated upturned nose from previous rhinoplasty. This means there is no crease or space in the shadow of a nose that a scar could hide and it would mean that if there was nostril distortion, it would be very visible and unattractive. Given how little room for error my nose allows for this lip lip and corner lip lift, should I consider this surgery or let it go?

A: When it comes to a subnasal lip and corner of the mouth lifts, the most important issues are the potential scars and not overdoing either type of lift. Prominent scars or an overcorrection (which is virtually impossible to correction since you can not add back skin) are aesthetic tradeoffs that one needs to avoid. While I have not seen a picture of you, you may have answered your own question…if there is little to no room for error…why take the chance? I have never seen nostril distortion and have only rarely revised a subnasal lip lift scar but your concerns do have merit.

Dr. Barry Eppley

Indianapolis, Indiana

How Can I Avoid An Unhappy Subnasal Lip Lift Result?

Q: Dr. Eppley, I am interested in a subnasal lip lift proceure but I must admit that the procedure worries me. There seems to be lots of unhappy results, in which columella has gotten longer, nostrils became wider, and people end up looking like rabbits etc . My local surgeon says that in his experience, after the lip lift,  is that with time the lip always goes back to its original position, due to the weight. Do you use a special kind of suture and/or technique that would prevent the lip from pushing back down?

Subnasal Lip Lift Indianapolis Dr Barry EppleyA: While the subnasal lip lift procedure is relatively simple to do from a surgical standpoint, it is a procedure that has no tolerance for error. From selecting the right patient, to the design of the skin removal area and to the method of closure, all impact what the final result will look like. There are several key points to a successful lip lift result. The first is to recognize that its effects are on the central or cupid’s bow area of the lip and does not extend to the mouth corners. Secondly, the excisional pattern of design should mimic exactly the curvatures of the lip-nasal base junction and should not extend around to the side of the nostrils. Third, the amount of vertical skin excision (as measured at the philtral columns) should never, and I repeat never, exceed 25% in a man and 33% in female. Lastly, no attempt should be made to prevent some after surgery relapse by sewing muscle, removing muscle or otherwise trying to secure the skin down in a tightened fashion.

If you add up all of these points together, one can see that the key to a happy subnasal lip lift result is to not try and over do it. Overcorrection and lack of attention to detail makes for most of unhappy subnasal lip lift results.

It is important to recognize that in the first six months after surgery there will be some ‘relapse’ of the initial result. This is due to natural skin stretching from lifting any type of tissue upward. (no different than a browlift or facelift) My observations have been that it is about 25% to 33% vertical change in the first six months after the procedure. But trying to overcorrect to factor in this after surgery lengthening is a mistake. It is far better to have a natural looking lip result that a patient wants to secondarily revise (about 10% do) than to have an initial overdone too pulled up look that the patient is waiting months for it to settle down and drop.

Dr. Barry Eppley

Indianapolis, Indiana

What Are The Details Of Doing A Subnasal Lip Lift?

Q: Dr. Eppley, I am interested in a subnasal lip lift. When you perform them, how is the healing of the scar? I know the scar is placed at the base of the nose, but I have seen some horror stories where the incision is just below the nose and thus is very visible. Do you also pull the muscle or just the skin with the lip lift? I have a 21mm gap between the base of my nose and my upper lip. After my rhinoplasty (which I am having first) I am presuming this gap will stretch to approximately 23mm- in any case I am hoping to have a 15mm gap.

Subnasal Lip Lift Indianapokis Dr Barry EppleyA: The key to a good subnasal lip lift scar is two-fold; place it exactly in the nasal-lip crease and it should follow the shape of the nasal base (wavy) and not a straight line. You never manipulate the orbicularis muscle in a subnasal lip lift, that is an assured way of causing tightness and smiling animation deformities. With a 21 to 23mm lip to nose distance and using a 1/3  distance reduction (amount of skin excised), you should be reduced to a 15mm vertical length.

Dr. Barry Eppley

Indianapolis, Indiana

How Much Skin Can Be Removed In A Subnasal Lip Lift?

Q: Dr. Eppley, I am interested in a subnasal lip lift. I have a long upper lip and I think it would make my face more balanced and attractive. I have not read anywhere on how one determines the amount of skin that can be removed between the lip and the cupid’s bow. I want the maximum to be removed but I still want it to look natural and not be overdone. I want to increase the size of my upper to the maximum as it is basically non-existent now. Also, will the subnasal lip lift increase the size of the whole upper lip and not just the cupid’s bow directly underneath the nose? Thank you.

A: In a subnasal lip lift, you do not want to remove more than 1/4 to 1/3 of vertical distance as measured along the philtral columns. Whether that is 6 or 8mms is a judgment between aggressiveness but also wanting to avoid an unnatural and potentially irreversible overdone result. Applying the principle that it is easier to remove more later but you can’t reverse it, I would take no more than 6 to 6.5mms of skin. Also a subnasal lip lift will not change the amount of exposed vermilion out to the mouth corners, it will only change the upper in teh middle third or within or under the nose area.

Dr. Barry Eppley

Indianapolis, Indiana