Q: Dr. Eppley, I had a rhinoplasty revision a year ago which has ultimately resulted in a much longer appearance of my upper lip. Since you’re an OMFS and a plastic surgeon, I’d really be interested in consulting with you about a lip lift +/- autologous fat grafting. I’m definitely interested in the subnasal approach, and since I talk to people all day long and occasionally engaging in public speaking, I’m also looking to leave the orbircularis oris alone as well. I would greatly appreciate your expertise and evaluation.
A: The long upper lip implies too much vertical skin between the base of the nose and the upper lip, a small or diminished vermilion show at the cupid’s bow area, lack of adequate upper tooth show or any combination of these three effects. For most patients, the subnasal lip lift is almost always preferred because of the less visible location of the resultant scar in a natural skin groove. There never is any reason to manipulate the orbicularis muscle in a subnasal lip lift as that only causes animation problems and accomplishes no positive effect. Injectable fat grafting can be done in a lip lift if an enhanced cupid’s bow or the lateral vermilion down to the corners of the mouth is desired to be enhanced. Micrografting of fat in 0.1cc aliquots is the best method of injection in an area where fat retention is notoriously difficult.
Dr. Barry Eppley