Q: Dr. Eppley, Can you please tell me the cost of a subnasal lip lift? I am not interested in having surgery on the muscle. I only want the lip lift where the skin is removed.

A: A subnasal lip lift should never have the muscle manipulated in any way. That leads to problems such as tightness, columellar base retrusion and an unnatural upper lip movement and smile appearance. In my hands, it is always a skin only procedure. While this may be associated with a 1 to 2 mm relapse in some cases over the first six months after the procedure, it does not in any way affect how the upper lip moves or alters one’ smile.

A subnasal lip lift for most patients is done as an outpatient procedure in an office setting under local anesthesia. The typical cost would be in the $2,200 range.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am serious about getting a bullhorn lip lift. I am a model and, although I am considered very attractive, I do not feel my mouth area looks the best. My lips are reasonably full but my upper lip is too long and I don’t show any teeth even when I smile. That is why I think a lip lift would enhance my appearance. I have attached some modeling photos for you to see what I mean. What do you think?

A: Thank you for sending your excellent photos. While you do have a very nice shape to your upper lip, I can see your concerns that it is vertically too long between the base of the nose and the upper lip vermilion. I think you would be a good candidate for the subnasal lip lift as it would decrease this vertical skin distance, give more pout to the central cupid’s bow portion of the upper lip, and has a chance of increasing some tooth exposure between the canines.

This is an office procedure done under local anesthesia. (infraorbital nerve blocks and direct infiltration into the base of the nose) The key is to have a wavy excisional pattern for the lift so the scar blends in along the base of the nose. As an out of town patient, I would use tiny dissolveable sutures for the final skin closure so no postoperative visit is necessary. There is always about a 20% to 30% relapse of the lip lift over the first six months after the procedure so it is a little ‘over-corrected’ in the beginning to compensate for that event. However, it is very important to never remove too much lip skin as there is no way to reverse that problem. You can always take more if needed so undercorrection is always better than overcorrection.

Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, I am interested in a subnasal lip lift. I have had other minor plastic surgery procedures which were done with very good results, little scarring and very little down time. My upper lip is my greatest area of facial concern due to the length of my upper lip. It actually seems to be getting longer as I get older. It was always a little long even when I was younger but time is not making it shorter! I can send you pictures if you like. I live out of the states so please let me know if  this procedure is something that could be accomplished with an out of town surgery visit. Thanks so much!

A: Thank you for your inquiry. A subnasal lip lift is a relatively simple procedure that can be performed in an office setting under local anesthesia. It is a delicate and precise lip procedure but the process to do it and the recovery is the simple part. It is a common procedure that patients from far away come into Indianapolis for me to perform. There is no physical recovery required with minimal swelling and virtually no bruising. One could have it done and leave for home whenever they want. There is no reason to stay here afterwards. I always use tiny dissolveable for the skin closure so the patient has no need to return for their removal. Please send me a picture of your lips for my assessment to determine if a subnasal lip lift procedure is for you.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am interested in getting a subnasal lip lift as my upper lip is way too long and is getting worse as I age. I have several concerns about the procedure, hwoever, and wonder what could be done if undesired results happen. I had a previous rhinoplasty dne through an open rhinoplasty several years ago that I am quite happy with. Since the subnasal lip lift puts an incision at the base of the columella could that stretch or distort the space between my nose and lips and make it appear freakishly short? I know initially it may look a little short and that it does relax and stretch out somewhat later, but what if it doesn’t. Can any secondary correction be done if things didn’t resolve on their own? Thanks for your opinion.

A:  Your concerns about overcorrection in a subnasal lip lift, also known as the bullhorn lip lift, are very valid and it is something I think about every time I do this procedure. This is because of it is overcorrected, too much lip skin removed, there is no recovery from it. There is no aesthetic method of putting skin back once too much is removed. It is for this reason that it is always better to be more conservative than aggressive with this procedure. My rule of thumb on subnasal lip lifts is too never remove more than 1/3 of the vertical distance of skin as measured from the based on the columella down to the height of the cupid’s bow along the philtral column. Sometimes I may only remove 1/4 of that distance. Yes it is too true that it may relax and be undercorrected in some cases later. But it is always easy to repeat the procedure, it is impossible to reverse it if too much is removed.

Dr. Barry Eppley

Indianapolis Indiana