As the face ages many changes occur around the mouth which are well known. Such structural changes include lengthening of the upper lip, loss of vermilion height and tissue thinning and a decrease of the nasolabial angle in some people. (due to dropping of the nasal tip) The combination of tissue lengthening and volume loss with some resorption of the underlying bony pyriform aperture is the culprit.
Many contemporary treatment strategies exist from injectable fillers, neuromuscular modulators to surgical lip lifts. The subnasal lip lift is often viewed as a last resort treatment approach but for some patients it should clearly be the first. There is no more effective method for shortening the long upper lip than the excision of skin. The subnasal technique in lip lifting is often chosen because of its more hidden scar even though its effects is limited to the central part of the upper lip.
In an effort to manage the change in the nasolabial angle during a lip lift, the technique of moving part of the de-epithelized skin into the base of the columella has been previously described. This creates an opening in the nasolabial angle as well as increases columellar length.
In the 2011 Brazilian Plastic Surgery Journal (volume 26), a paper was published entitled ‘Double Duck Nasolabial Lifting’. In this paper the authors describe a procedure designed to both shorten/lift the upper lip as well as change the nasolabial angle. The technique includes a transverse incision of nasal floor and alar margin skin, separation of the upper lip skin from the underlying orbicularis muscle down to the vermilion-cutaneous junction, the placement of a permanent transcolumellar suture between the nostrils, resection of upper lip skin using a trapezoid resection at the nasal floor and an elliptical pattern at the alar margins and final skin closure.
The authors report satisfactory results in 90% of the patients characterized by shortening of the upper lip, increased vermilion exposure (centrally) and opening of the nasolabial angle. They conclude that the “double duck” lip lift technique was effective with good concealment of the scars.
The term double duck lip lift comes from the pattern of the incisions used in the technique. While the pattern of the incisions is not necessarily novel, what is done with the mobilized skin is. Rather than resecting skin across the base of the columella as in the traditional subnasal lip lift, the skin is spared and moved up into the the base of the columella. (after columellar skin mobilization) This is what also creates the central lip shortening as well as the increase in nasal tip projection.
The double duck lip lift isn’t for every patient that wants/needs a subnasal form of lip lifting. But for the properly selected patient it can be an effective technique.
Dr. Barry Eppley
Indianapolis, Indiana