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?
A: 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