Your Questions

Q: Dr. Eppley, I found a picture below on your site, and i wanted to ask you what exactly has been done here.It looks like lip lift but it has been lifted not only in the middle, but on the sides too!I wanted to do a lip lift, but i always was aware that it lifts only the middle part, which makes lips look unnatural, but doctors who I’ve asked said that it is not true. You are the first one who confirmed my suspicions, so I kind of trust your opinion now.

A: You are correct about a lip lift, it can never do more than lift the central part of the lip. (cupid’s bow) It can look natural if it is not overdone. Some surgeons do overdo them because they believe that the more one pulls up in the center that it will somehow lift up the sides. But this, as you have surmised, is incorrect. The lady in the pictures had a lip or vermilion advancement which moves (‘lifts’) the entire vermilion or lip edge upward from mouth corner to mouth corner. This is done by removing a strip of skin at the lip edge.

The lip advancement is a close cousin to the lip lift but is much ore effective and is the only good lip enhancement option in very thin lips. The trade-off for its effectiveness is that it creates a very fine scar at the lip-skin junction. But in properly selected patients this does not turn out to be a concern.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a question on upper lip lifts. A little of my lower teeth is already showing when my lips are slightly apart. This is probably due to a chin reduction I had via the intraoral approach. I am concerned that the show / visibility of my lower teeth will be exacerbated if my upper lip length is reduced further. Can the upper lift length be reduced without increasing the show of the lower teeth? 

A: I am not aware that a subnasal upper lip lift ever increases the show of the lower teeth. It can increase marginally upper tooth show, perhaps by a millimeter or so in some cases. The further away a structure is from the point of pull, the less movement effect it has on it. In most lip lifts any increased tooth show is only temporary at best.

But if one wants to avoid any risks of tooth show in a subnasal lip lift, either the upper or lower teeth, no more than 1/4 of the measured philtral length in millimeters should be reoved. That is how you determine the amount of skin under the base of the nose to remove in a subnasal lip lift.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, My question is about the limits of a lip lift and the use of one in a postoperative Lefort patient. In most of the pictures I’ve seen it looks like a surgery that merely helps make the vermilion more visible but it doesn’t really “lift” the lip if it’s really hanging. I received orthognathic surgery years ago to make my face shorter and since then my upper lip has been hanging lower than usual. It also looks flat and dead instead of curled up and reactive to facial tension. I was wondering if a lip lift could help in this case and if one with muscle hemming (a technique that I rarely see talked about) would be a better option. Thanks.

A: Your correct in that a subnasal lip lift primarily exposes more vermilion (and reduces the skin distance between the nose and the lip) bit does not lift the bottom edge of the lip vermilion any higher. A subnasal lip lift is largely a static procedure not a dynamic one. Many upper lips after an intraoral vestibular incision used for a LeFort 1 procedure become somewhat less animated due to the stripping of the collateral muscle attachments. I can’t see, however, how a muscle hemming procedure of a subnasal lip lift would improve that problem. It would likely cause other adverse effects on upper lip movement and smiling which is why it is not written about much and is largely shunned today.

If you want to raise the upper lip with a subnasal lip lift it should be combined with a horizontal horizontal mucosal resection on the inside of the lip.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I have a lip lift question. I’m attaching pictures of myself with and without a smile. I don’t have a problem showing too little teeth when I smile, but when I am just speaking very little of my top teeth show at all. Do you think a lip lift will be of benefit for me?

A: With a very thin lip from one mouth corner to the other, a subnasal lip fit may likely create a pulled central upper lip but still leaving thin sides. This often looks unnatural particularly if one ask the lip lift to do too much. (over lifted) I think your lip is too thin for that procedure to produce an appreciable result and runs the risk of looking unusual. I would have to do some computer imaging to see what it looks like. More likely a lip advancement (vermilion advancement) would produce a more effective and natural looking result. It would also create a more even amount of increased upper tooth show.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am 32 but since I was born my upper lip has never had shape or definition. It’s quite flat. I want to know if it’s possible to have lovely Rihanna type lips. I know there are lots of different types of lip enhancement procedures but I don’t know what would work for me if any of them will.

A: I don’t know whether you could ever have lovely lips like Rihanna, since I don’t know what type of lips you have now. But procedures such as lip lifts, li advancements and other filler volumizing techniques (fat injections, lip implants, synthetic fillers) can go a long way to improving the size and shape of your lips. Depending upon how flat (lack of a cupid’s bow) your upper lip is, either a subnasal lip lift (if it is sort of flat) or a lip advancement (if it is completely flat) can help create a much more prominent cupid’s bow.

A subnasal lip lift can improve the prominence of an under projected upper lip cupid’s bow. If no cupid’s bow is present at all, a lip advancement can completely create a well defined cupid’s bow shape. Adding volume with these excisional lip procedures can complement the additional shape achieved.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a lip lift. I have very thin lips and a long upper lip. I want them to have more shape and size although I don’t want them to be too big. I have read about lip lifts but am not sure what I really need. I would like your opinion. I have attached a front and side view of my lips for your recommendations.

A: Thank you for sending the pictures. What they show to me is that unequivocally need a vermilion advancement and not a sub nasal lip lift. Your lips are very thing from corner to corner, has little cupid’s bow shape and there is a long distance between the base of the nose and the upper lip. This is a contraindication to a subnasal or bullhorn lip lift as it will only move up the central third of the upper lip but leave the rest of the lip behind, potentially creating an unusual and unpleasing shape. Only moving the physical location of the vermilion-cutaneous border, from corner to corner, of both lips can you make a significant improvement in the size and shape of your lips. I have attached an example of upper and lower lip vermilion advancements although this patient is older and she wanted a more dramatic change. The change from a lip advancement procedure is adjusted by the vertical size and shape of the skin excision and can be in any degree desired. The ‘test’ of the change a patient wants with a vermilion advancement is done by having them draw on the new border and shape of the lip with an eyeliner pencil. Then that becomes how much lip advancement is done.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a revision rhinoplasty, sliding genioplasty and a lip lift.  I was born with a unilateral cleft lip and I want my face to be more symmetric. What procedures do you think should be done?I have had one rhinoplasty and I have an L shaped implant. I would like for my nose to be more narrow and symmetrical. With the lip lift I want my lip to be about 15mm or shorter. I have a chin implant, but I think with the genioplasty it will make my chin balance out with the rest of my face. 

A: I have done some computer imaging done on your chin, jaw angles, lip and nose. I think it is fairly clear that your chin is fairly short even with the implant in place. This shows that the jaw is rotated up and back (short) and is why the jaw angles are high. A sliding genioplasty (possibly leaving the chin implant in place and moving it with the bone) may be needed to get the 12 to 15mms forward movement you need. Moderate jaw angle implants in the back will help fill give them some more definition. You don’t need your upper lip lifted by 15mms, that would be too much. Something like 5 to 7mms would be more appropriate. The question here is whether it should be done by a subnasal lip lift (lift only the central portion) or a vermilion advancement which moves the whole lip up. (probably better) The nose is challenging because of your very thick skin and the naturally thicker tip skin that many cleft patients have. To make a real difference, the implant ideally needs to be replaced by an L-shaped rib graft so you can get more of a push/lift on the skin and a sharper tip point. The implant just makes it rounder and still short.

The imaging done is to just figure out of these procedures are beneficial. The fine details of it and the degree of changes is an issue up for discussion.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, would a lip lift benefit my facial features and add more symmetry to my face?  Is there any other procedure that would make my features more attractive? How many of lip lifts do you do yearly? Do you have more before and after pictures of this procedure. How much increase in lip size would I achieve with this procedure given I have very thin lips? Thank you.

A: A lip lift can be aesthetically beneficial for those patients, women and men, that have a long upper lip with little accentuation of the cupid’s bow. As a general rule, about 1/4 up to 1/4 of the vertical skin distance can be removed. Women generally want p to 1/3 the distance while men are close to 1/4 to avoid to an over elevation of the cupid’s bow area. Lip lifts are very common in my plastic surgrey practice and I usually perform 1 to 2 lip lifts per month

In regards to other potential facial improvements, I have looked at a tip rhinoplasty with nostril narrowing and buccal lipectomies with perioral mound liposuction. There are are destined to help create a facial slimming effect as your face is naturally more round. I have included these in the attached lip lift imaging projections as well.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I think I am interested in a browlift. Recently I have seen major changes to my face. I have been very lucky to always have been told I look younger and more youthful than I am but time has finally caught up with me. As you can see my eyes look tired and I look puffy. I also have always had a duck lip! I tried fillers but as you can see it made it worst. I am looking forward to looking refreshed and as young as I feel. I have started a six month lifestyle change, going to the gym three to four times a week, cutting out sugar and smoking over the next couple of months and studying natural/ holistic food. I feel beautiful until I look in the mirror and I know the potential I could be with a few minor adjustments. I am interested in seeing if you can see this too! I never expect to be a model but would like that twinkle in my eye again. I am looking forward to reviving my youthful look. Looking forward to hearing your suggestions.

A: As all of us age the first changes that are seen are around the eyes. Excess skin develops on the upper eyelids, the lower eyelids become puffy and, for some, the eyebrows drop. Rejuvenation of the aging periorbital region could include upper and/or lower blepharoplasties and browlifts, depending upon which areas are of the greatest concern.

Based upon the one picture that you have sent, it is hard to say what the ideal procedure (s) is for around your eyes since it is only a side view. The upper eyelids shows a little bit of excessive skin, the lower eyelids may actually have some tear troughs and the brows may or may not be low since I have no idea what you looked like years ago. My suspicion is that maybe a browlift and little skin removed from the upper eyelid and fact redistribution on the lower eyelids may suffice…but a few more pictures would be helpful.

For the upper lip protrusion, I would have expected injectable fillers to have made it worse. You would be better served with an upper lip lift which would reduce the protrusion somewhat but also give the upper lip a little more fullness. But again a front view picture would also be helpful in deciding if a lip lift will really be beneficial or not.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I wanted to ask a rhinoplasty question. Since my primary motivation for getting any work done is to improve my smile. In a rhinoplasty where you reduce the nasal spine as we discussed, would there be a possible side effect of lengthening the distance between the nose and mouth? In my imagination, by eliminating some of the protruding cartilage in that area, the tissue and skin that currently exists there would be pulled back into that void, thus pulling up the lip slightly. However, I’m not sure if that’s even how the anatomy works. Is the tissue anchored to that area and would it need to re-anchor itself or would it just drape down further, thus lengthening the lip?

A: Your question is a good one. Theoretically by removing the nasal spine, your assumption is most likely correct that the tissue should be pulled back up into the removed area potentially lifting the lip somewhat. In reality, probably very little lip lift actually occurs. There have been a few reported instances where lips have lengthened as a result but that is not something that I have ever seen. One would not, however, try to anchor the tissues to the removed nasal spine area as that may potentially cause a tethering/tightness when one smiles. It is much better to let the area heal naturally rather than try to treat a potential problem which may never occur…and in the process create a whole new one.

The way I view your rhinoplasty, and is the reverse of the the concern of upper lip lengthening, is that the rhinoplasty is potentially setting up a subnasal lip. So whatever happens to the lip length (particularly if there is some lengthening) does not matter because you likely moving on to a lip lift anyway.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had  some facial feminization procedures done not too long ago. I had a sliding genioplasty as one of them. I now have the often present notch on either side of the osteotomy. I expressed concerns about minimizing this with the original doctor. The depressions are fairly evident. Also my infra orbital area is lacking. This lacking does not help with a feminine appearance. Over all I am having trouble determining what needs adjusting on my face because the face is the sum of its parts. I need an opinion so I can decide what to do over the next 12 months. I hope to improve symmetry also. I have to wait at least six months to undergo any further work since surgery was not to long ago. I have attached some pictures which hopefully are helpful although they are just one week after surgery.

A: Based on these even very early pictures, your chin is now too vertically short for your face. You have a longer thinner face and now the lower third (chin height) is too short. That is what is throwing off your facial proportions. Also as part of a longer thinner face, the cheek/infraorbital area is flatter. Thus I would recommend a chin bone lengthening (opening back up the osteotomy), infraorbital rim implants, and a subnasal lip lift. This will bring your face into better proportion and balance.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I was considering a lip lift.  If I send you my photo would you be able to advice me if the lip lift would be a good solution. I had open bite and orthodontic treatment and so my upper teeth moved back a bit and the top of my lip is not as full or not lifted up as it was before resting on my teeth which were slightly protruding. I was considering either fat injections or lip lift. I don’t know if fat injections applied skillfully can also reshape the lips adding volume in the centre part, making cupid arch more prominent. The teeth on my side tend to show more when i smile only slightly, the upper lip has a shape which is rising where my third tooth is and going slightly down where the very front tooth is. I do not seem to have very long upper lip, it’s just rising up in the wrong place. I think an upper lip lift may correct it since the corners go down a bit it may look slightly surprised unhappy look and if I shorten the lip too much the lips will not close completely. Could i reshape my upper lift with fat injection so they turn up more in the centre or would the lip lift be more advisable? I greatly appreciate your advice. Also,  how long do the results of lip lift and lipofilling last?

A: I am afraid that you find yourself in the midst of a quandry, which is not that uncommon with lip enhancement procedures. While a lip lift will create the greatest amount of central lip pout that will be maintained, it is not really an appropriate procedure in someone who does not have a long upper lip. Conversely, fat injections will not really reshape the cupid’s bow and their take is always suspect. When one finds themselves in such a quandry, it is always best to do the one with least risks first (fat injections) and let those results prove that a lip lift would be needed.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in a lip lift procedure and I have attached some pictures. I have several questions and concerns about the procedure. Is my columella retracted? Do I have an acute nasalabial angle? I am concerned about visible scarring. I read you use dissolvable sutures for out of town patients. I want to look great for my daughter’s wedding, which is Oct 7 this fall. Can you schedule me soon enough?
I’m in excellent health.

A: In Answers to your questions:

1) Your columella is veryretracted with an acute nasolabial angle.

2) Although most subnasal lip lift scars do very well, scarring is always a risk particularly in patients with pigmented skin. Your retracted nasal base does help with the potential scarring visibility.

3) With less than six weeks before the wedding, I would not advise it to be done that close to an important date. That is about the time a scar, anywhere on the body, will likely be looking its worse long before it has adequately matured. I wouldn’t do this procedure any sooner than three months before an important social event.

Dr. Barry Eppley

Indianapolis,Indiana

Q:  Dr. Eppley, I had a gullwing upper lip lift two years ago. I am very unhappy with the resulting scar. The surgeon who did the procedure said that the scar would end up invisible…it did not. The scar sits 2mm above my vermilion line and is very indented so even if I try to cover the scar with lip liner and concealer it still shows. The surgeon cut very deep and used only eight sutures on the whole of the top lip. Please give me your honest thoughts and whether it can be improved by scar revision. I have attached a picture of my upper lip so you can see how bad the scar is.

A: Thank you for sending your pictures. I think without a doubt that the scar and the upper lip shape can be improved. The indentation is so visible because the natural shape of the white roll (where the skin of the upper lip and the vermilion meet) is everted not inverted. While the eversion of the white roll is lost in every lip advancement, it should be flat and not inverted. I suspect that deeper sutures were not used in the closure so that inversion resulted. In addition, I see no definition of the cupid’s bow of the upper lip, which is one of the main benefits that a lip advancement can achieve. In looking at your before pictures, I think you had the wrong lip enhancement procedure from the beginning. You would have been better served with a subnasal or bullhorn lip lift not a vermilion or gullwing lip advancement.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  Dr. Eppley, The problem with my face is it’s very skinny when I don’t smile. When I smile I have the biggest fattest face ever! I have these fat pockets around my nose. And instead of a smile I look like I’m sneering. I was in an auto accident and it caused nerve damage to my left lip. I want to fix my smile so its even again and you can see more of my teeth. I also have a brow that I hate and would like to get rid of. I also would like some work done on my chin because I hate the way that looks. And also when I smile I have “jowls” and I’d like to get rid of those and my double chin. My double chin is hereditary and being tall and skinny this looks very strange. I would also like to get a nose job because I have my fathers nose and I think it looks very masculine. Overall what I am trying to achieve is a slimmer face, with more feminine features and a better more applying smile. I don’t feel like my face goes with my personality, and how I feel. Also anything else you see that needs to be done please let me know.

A:  Thank you for sending your pictures. In looking at your face and reading your objectives I would consider the following procedures. A rhinoplasty is needed to make your nose thinner and less wide, particularly in the tip. I would also recommend buccal (cheek) fat pad removal (subtotal) and small cannula liposuction of the fullness above the nasolabial (lip-cheek) grooves. A lip lift (vermilion advancement) done with differential skin removal (left greater than the right) will help with better lip symmetry and overall fullness. A submental chin reduction is needed to decrease the amount of chin prominence and protrusion. Liposuction can be done in the neck and jowls to remove fat in these areas.

Unfortunately, I can only do limited computer imaging because your pictures are inadequate.  Smiling photos make a lot of facial feature distortion.

You mentioned a dislike for your brows but I am uncertain what specifically you do not like about them. Until I know more, I can not make any recommendations on whether they can or cannot be favorably changed.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I had a lip lift performed several months ago. I have attached some before and after pictures. As you can see the incision isn’t on the borderline and its now indented and puckers. I’m really so unhappy and paranoid with the scar and am now so desperate for revision. I was so impressed with your website you actually used 48 stutures on the womens top lip,  I did count 🙂 In my surgery the surgeon only used 8 stiches.  as you can see in the pics. In you lip lift proceedure do you actually cut right through all the skin lares? Only when I had my lip lift surgery the surgeon did numb my upper lip with a dental block, but the pain was still horrendous.  Also as I wasn’t having my bottom lip operated on it wasn’t numbed, therefore I actually felt my actual top lip resting (flipped over) onto my bottom lip.  Is this normal procedure to actually sever top lip so completely that it is able to flap over like that? What I’m asking really is do you cut so deep and if so do you place internal stiching of any kind? Its all a bit complex for me but I really need to know the whole procedure. Thank you in advance and looking forward to your reply.

A: Thank you for sending your pictures. Technically, what you had done is known as a lip advancement or vermilion advancement. A true lip lift is done with an incision under the nose. I prpare patients with a dental block first and then inject directly into the upper lip once one is numb. It should be a virtually painless procedure to go through after the dental blocks and local infiltration. During the procedure, only full-thickness skin is removed and no underlying muscle. There is a two -layer closure with some deeper sutures for the dermis and fine sutures for the skin closure.

Your scar is a bit wide and indented compared to a typical result lip advancement result in my experience. That could easily be improved and a little more skin removed and more of a cupid’s bow made to get a better result.

Dr. Barry Eppley

Indianapolis Indiana

Q: I am unhappy with the shape and length of my upper lip. It bulges out right under my nose. I would like to meet with a Doctor who has experience with lip lift surgery to see if my upper lip could be made to look better and to get rid of the bulge right under my nose. Here are some pictures of my face. My wife took the pictures and we were trying to show how my upper lip bulges out in the middle under my nose. All I want is to have the bulge removed or maybe even have it to where my lip would be more concave right under my nose. I really don’t even care if my lip is lifted or made shorter, just as long as the bulge is gone and made smooth or even hollowed out some. Thank You.

A: Thank you for your inquiry and sending the pictures. They illustrate well the bulge underneath your columellar area of the nose in the upper lip area. Interestingly that bulge is likely not just excess lip tissue alone. Undoubtably your anterior nasal spine is excessive in length and size as well. You may not be familiar with this small area of nasal bone that juts out undereneath the base of the nose. I have attached some anatomy pictures of where it is, and when it is excessively long in combination with the front of the nasal septum, how it can contribute to an upper lip bulge. I suspect that this small piece of bone and cartilage is making some contribution to that bulge along with some excessive lip soft tissue. That can be immediately confirmed by simply feeling under the upper lip as well as pushing down on the bulge at the same time.

Therefore, I would propose that he best solution for your upper lip bulge is a combination of a modified lip lift (use the incision to remove some soft tissue and muscle underneath bulge and only do a 2 -3 mm lift) and an anterior nasal spine resection. Anterior nasal spine reductions are commonly done in rhinoplasty surgery so its effects and benefits are well known.

Dr. Barry Eppley

Indianapolis Indiana

Q: My main questions are in regards to the permanent lip options available to me.  I could send you my picture so you can get a better idea.  I have tried a few injectables and am not really happy with results in terms of size and longevity.  I understand there are also options for implants vs. v-y surgery. (most permanent?) What are the complications, risks and costs of these options.  Also, do you use Alloderm or Gortex implants, or is it based on cases by case basis. What is the longevity of Allodem?

A: I choose which permanent lip enhancement option on a case to case basis. That could include lip advancement,lip lift, v-y advancement or Advanta lip implants. There are different reasons for using any of these based on the existing size and shape of one’s lip. Pictures would be of great help in determining what may be best for you. Alloderm has not proven to be a permanent lip implant material so it is no longer used.

If you have not had good success with injectable fillers, then the concept of putting in any permanent material will likewise be unsuccessful. Your lips are not big enough or have the right shape to merely be ‘inflated’. This would indicate that you need more vermilion exposure through some form of excisional procedure such as a lip advancement or possibly a tissue shifting approach with an internal V-Y advancement.

Dr. Barry Eppley

Indianapolis Indiana

Q: Dr Eppley, How long does it take for a bull horn lip lift scar to fade? I read that a lot of people experience bumps and track marks from the sutures. Also, looking at some pics, it looks like a crack or line between the nostrils that the make-up is not hiding very well. Can you advise? (I’m interested in the procedure) Thanks.

A: Like all facial scars, it takes 3 to 6 months for it to either fade completely or be headed that way significantly. I would equate the lip lift scar to that of facelift incisions in terms of how they mature over time. The thickness and pigmentation of one’s skin and one’s age will also influence the time to scar fading. Thicker skin will take longer than thinner skin, older skin fades quicker than younger skin.

I have not seen the bumps or track marks that you refer to in lip lift scars. The bumps are typical reactions to buried sutures as they dissolve and may appear many weeks after the surgery. I use very small internal buried sutures, such as 5-0 and 6-0 monocryl,  and probably explains why I haven’t seen them. Track marks along any suture line is the result of using skin sutures that are too large or left in too long. I use either a buried subcuticular running 6-0 monocryl or interrupted 7-0 prolenes, neither of which will result in any visible track marks. For out of town patients, I use a running 6-0 plain for the skin suture which also will not leave any track marks.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I was very impressed by your comments on lip lift. I feel confident that you understand more about this procedure and the possible things that can go wrong than other plastic surgery websites I have seen. Since I have had two prior rhinoplasty surgeries, will this procedure affect my nose? Some surgeons have said that I would need another operation on my nose if I were to have a lip lift. I really don’t want to touch my nose again. I’m happy with it and just want to leave it alone. If a lip lift will alter the shape of my nose, then it’s probably not the best option for me.  In terms of why I need the lip lift. I’m only 30 but have always had a VERY long lip lift. My lips themselves are very full and attractive, but even when smiling, you can’t see ANYTHING of my upper teeth and I feel that it’s quite a big thing and stops me looking as attractive as I otherwise could be.

A: I do not know of, nor have I ever seen, any problems with a lip lift affecting the shape of the tip of the nose. A lip lift is a simple removal of skin at the base of the nose. It does not, and should not, remove any muscle from the subnasal area. In theory, I can see how it is possible with too much skin removal to pull down on the columella causing distortion of the nasal base. But the skin resection should never be greater than 1/4 to 1/3 of the vertical skin height along the philtral columns. Since there is no recovery (replacement) of too much skin removal, it is always best to not be too aggressive in the lip lift procedure.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Hi Dr. Eppley, I need help with my nose and lips. Four years ago I had a rhinoplasty. While no work was done on my lip it changed after surgery. My upper lip seems longer than before.  My upper lip was long to begin with but now it covers my upper teeth and rests heavily on my lower lip when at rest.  My nasolabial angle changed so that it is more of a 90 degree than tethered as it was before.  I am a female 32 years old and was wondering if these problems can be fixed.

A: It is unusual for one’s upper lip to change after rhinoplasty but it is theoretically possible. If the base of the caudal septum, where there are muscular attachments at the anterior nasal spine, is resected to change the nasolabial angle, it is possible that there may be some release of the upper lip as well. If one had a longer upper lip to start with, then the risk of lip lengthening is greater.

Regardless of how it may have happened, a longer upper lip can be shortened by a procedure known as a subnasal lip lift. That can be very effective at reversing your lip lengthening that has occurred and can even make it shorter than were you were prior to your rhinoplasty. As a general rule, an upper lip lift can remove up to one-third of the skin length between the nasal base and the height of the cupid’s bow along the philtrum.

Changing of the nasolabial angle can also be done. While it is far more common to open up the nasolabial angle during rhinoplasty with caudal septal resection, the reverse can also be done.  This would require a septal cartilage graft attached to the caudal septum which is so placed that it pushes back down on the nasal tip cartilages.

Dr. Barry Eppley

Indianapolis, Indiana

Q : I am 52 years of age and my upper lip seems to be getting longer. When I was younger my upper lip didn’t seem to be as long. When I smile I barely show any upper teeth at all anymore. Is there some form of lip surgery  that can help me?

A: A long upper lip can develop in some patients due to the natural process of aging. The upper lip can literally lengthen due to shrinkage of the vermilion (pink portion of the lip) which gets smaller and actually rolls inward. These age changes of the lip can be accentuated by tooth loss. Loss of lip volume combined with other falling facial features makes the skin portion (between the base of the nose and the vermilion) of the upper lip a bigger percentage of upper lip length.

There are two specific procedures for shortening the upper lip. Both involve removing skin in a horizontal fashion at either the top or bottom skin portion of the lip. The subnasal lip lift, also known as the bullhorn lip lift, removes skin from right under the nose and truly is a lifting procedure. Removing skin just above the pink lip line is known as a vermilion or lip advancement. This advances the pink part upward directly. Both result in fine line scars although the subnasal lip lift places the scar in a more hidden location in the crease under the nose.

While both of these procedures are effective at creating a slightly shorter upper lip, both will increase the amount of vermilion show. The subnasal lip lift is limited to increasing only the central pout of the upper lip with lip shortening. The vermilion advancement moves the entire pink portion upward from one corner of the mouth to the other.

Which procedure is best for any patient depends on the anatomy of their upper lip, specifically the shape and thickness of the vermilion.

Dr. Barry Eppley