Your Questions

Q: Dr. Eppley, I found your website researching the vermilion advancement or gullwing lip lift and  wonder if you could help me. I had a subnasal or bullhorn lip lift procedure done a month ago in order to show upper teeth when keeping my mouth open. I have always had a long philrum. Before surgery it was 20mm in length and now it is 13mm. Just like before, however, I do not show any upper teeth when my mouth is open or when I talk or when i smile. I do not have any more swelling at this point so I know this result is final and am considering a revision. Do you think a gull wing lip lift help me show my upper teeth?

A: With a central reduction of upper lip length from 20 to 13mms, that is a 1/3 reduction which is about the limits of this centrally-based upper lip shortening procedure. It is surprising that you have not made even a little upper tooth exposure with that reduction. But your anatomy and direction and vectors of lip movement may be working against you to achieve any better dental show. I would not be optimistic that a lip advancement would produce the desired dental uncovering. Lip advancements are great at making the lips bigger but I have never seen them result in any increased dental show of either the upper and lower lip. Lip lifts (bullhorn) are more effective at that than lip advancements. (gull wing) It may be possible but is not the primary intention of that procedure.

I would have to see pictures of your lips, both at rest and smiling,to give you a more qualified answer. It is also possible that you may benefit by an internal mucosal reduction which provides the ‘missing link’ in complete upper lip shortening.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have some questions about the lip lift. I know that this procedure is quite controversial in cosmetic medicine. The plastic surgeons in my area will not perform it. However, after doing some research I have found that there are ways for it to be done successfully without cutting the orbicularis  muscle. What is your opinion and experience with this procedure?

A:  When you say lip lift, I will assume you are referring to the subnasal lip lift. (aka bullhorn lip lift) This is where skin is removed from under the nose to lift up the central third of the upper lip and shorten the long upper lip. Despite a lot of hesitancy from plastic surgeons to perform this lip enhancement procedure, I have found it to be very straightforward and uncomplicated. There is no reason whatsoever to remove any orbicularis muscle when shortening the upper lip. This is fraught with problems if done including a tight upper lip and an abnormal smile. While muscle resection probably does prevent any vertical relapse, it causes irreversible lip problems. Relapse is a much more easily treatable ‘problem’ so only skin should be removed. As a general rule, no more than one-third the vertical distance along the length of the philtral columns should be removed. One can expect 1 to 2mms of relapse in the first few months after the procedure.  

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi, I live in the UK and am interested in a gull wing lip lift. I have a few questions. How bad can the scar be? Do you have any photos of ‘worst case scenario’ ? Also can there be tightness or loss of feeling afterwards? Why do so few plastic surgeons do this operation? If I have a lower lip increase as well as upper would I have increase bottom tooth show? (which I don’t want). Lastly, how soon after can I fly back to the UK?  I could get a surgeon here to remove stitches if necessary.

A: Thank you for your inquiry. Having done a lot of subnasal lip lifts, I have never seen a bad scar and not a single patient has ever complained about any scar issue. While there may be some temporary upper lip tightness, it passes quickly and no patient has ever told me that it is a long-term problem. Patients do say that they have some upper lip numbness for a period of time which has always surprised me but it is a consistent finding. No sutures are placed that need to be removed as they are all dissolveable. One can return home the very next day. There are no restrictions after surgery.

While you will have some increase upper tooth show (1 to 3 mms), which is desired, there is no increase in lower tooth show. That is controlled by the lower lip position not the upper lip.

I don’t know why so few plastic surgeons do lip lift or advancement procedures. In the right patient they are extremely successful with no significant problems.

Dr. Barry Eppley

Indianapolis, Indiana