Q: Dr. Eppley, I have been bothered as I’ve aged that I’ve lost the ability to show my teeth when I smile. Would you recommend any lip procedure to improve this, considering I already have a short upper lip and would likely not be a candidate for a lip lift or an internal lip lift? I was also curious regarding the suggestion of a mucosal or vermilion-mucosal reduction to someone on RealSelf. Thank you for your time and consideration.
A: If tooth show is the main perioral aging issue and a subnasal lip lift is not an option, then a horizontal vermilion smile reduction would be an option. If the maxilla came forward in an orthognathic procedure that would also improve the amount of tooth show. But removing a strip of vermilion at the lower edge of the smile line is the most effective method to expose more upper tooth show.
But in looking at your pictures, particularly when you smile, you actually have an upper lip deformity known as a double upper lip. This is an excess roll of mucosa that hangs down significantly when you smile and the upper lip is stretched out. Resection of the redundant or excessive upper lip mucosa is what is needed for a double upper lip reduction.
Dr. Barry Eppley