Lip Advancements after Lip Implants

Q: Dr. Eppley, ; I am a young male patient. I contacted you about a month ago asking questions about lip advancements. I just wanted to elaborate further. 

I feel like my lips are a difficult case. Like I said previously, my lips are quite full already and I have 5mm Permalip implants in the top and bottom lip. The only thing I’m afraid would be a problem is that my lips are very close to my nose already, however I really would like bigger lips and increased vermillion height and size. My nose is really close to my lips due to a hanging collumela (a result of my nosejob). The hanging collumela is not very visible from the sides, but its very visible from the front view. It gives the look of a very droopy tip. I’m wondering if lifting my columella a bit would give some more distance between my nose and lips and, therefore, make a vermillion advancement more aesthetically pleasing? 

I know that a collumelar correction is quite a simple procedure and I would eventually want to get both the vermillion advancement and columellar correction done together. 

I really don’t like lip fillers and I really would want something permanent that would increase vermillion height. I am very aware that my lips fit my face well, however I have had them bigger and I really love the look of them larger. 

I have attached a picture of my lips from front and side views. I have also attached photos of my desired goal. 

A: Thank you for sending your pictures. In answer to your lip advancements questions:

1) I would not view a columellar reaction procedures as ‘ simple’. It may not be as complex as a full rhinoplasty but getting the columella up to any significant degree is not easy or predictable. And you do not have a true hanging columella so I would view that procedure for you as probably not very productive.

2) You have described your lips as a ‘difficult case’ and that would be correct given what you are trying to accomplish. You can’t have a vermilion advancement without shortening the distance between your nose and upper lip…and any significant columellar retraction is not likely to occur.

3) While it is important to have surgical goals, your ideal goals are not going to be achievable given your anatomic limitations. Something has to give so to speak.

Dr. Barry Eppley

Indianapolis, Indiana