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