Your Questions

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