Smile Line Lift

Q: Dr. Eppley, Thanks for your email and all the helpful advice. A lot of what you told me was new information to me and I attempted to do further research for myself but, for instance, in regard to a mucosal smile line reduction, all the relevant info posted online that I could find was written or published by you, and pretty much you exclusively. Since you seem to be an authority on this procedure and if you don’t mind, I have a few questions.

Some of the things I had questions about were as follows: 

-In regard to the smile line lift, how does this compare to a lip lift? How would a procedure like this affect the way my lips/smile look, ie, would they appear bigger, smaller, etc? 
Would it affect at all the aesthetics of the rest of my face? Do you have any photos that you are able to share with me that would demonstrate this?
 What do you think the chances of getting results of showing more upper incisors would be, and do you feel that this would be the best way to improve the cosmetics of my smile/face as opposed to some other operation, such as orthognathic surgery, or a totally different issue that needs addressed other than lack of incisor show, etc?
-In regard to a midface deficiency, I also have dark circles under my eyes that seem premature. 2 years ago my sister died and then last year my lifelong best friend died as well, and since those events I’ve noticed the darkness appear to get darker accompanied by fine lines, which I’m presuming had to do with a combination of stress and the natural aging process in my 20’s. Do you think I would benefit from either malar implants or fillers in my cheek area? Do you think I am too young or otherwise not an ideal candidate for a lower blepharoplasty, as from what I’ve seen online it seems to have good results for preorbital discoloration like mine. Furthermore, IF you do recommend cheek implants, do you suppose that it would affect my smile in itself by pulling the skin upward or would the anatomy not be affected in this way?
I’ve attached a few additional photos with this email that specifically show my smile/teeth from a front as well as side view should you find it helpful. 

Thank you so so much for all your helpful insight, it is very useful for me to get an idea of what my best options would be, and much appreciated

A: In answer to your questions:

  1. A smile line lift will, by definition, make your upper lip look smaller and will not change the vertical distance between your nose and upper lip. Conversely, a subnasal lip lift shortens the vertical distance between the nose and lip, makes the central upper lip look bigger as well as increases tooth show.
  2. Due to patient confidentiality I do not pass patient’s surgery results by email.
    Lip lifts and orthognathic surgery are done for completely different reasons, they are not comparable procedures.
  3. At your young age you need to either try injectable fillers or fat first for under the eyes and/or cheeks. Implants are only a consideration based on those injectable and reversible outcomes.

Dr. Barry Eppley
Indianapolis, Indiana