Background: Lip augmentation is one of the most popular non-surgical cosmetic facial procedures and is one of the most common sites for the placement of injectable fillers. But injectable fillers only add volume and in the vermilion deficient lip may create a very pouty lip or ‘fish’ lips. Without adequate vermilion height the filler merely pushes the lip forward and not up as well.
For the vermilion deficient upper lip, there are several surgical procedures to change the location of the vermilion-cutaneous junction. Such change is instrumental in getting a good and natural lip augmentation effect. These two well known procedures are the lip lift and the vermilion advancement. The subnasal lip lift is, literally, a lifting procedure of the lip by removing a segment of skin from right under the nose. It achieves two important effects, shortening the lip-nose distance and creating more of a central lip pout. In some patients and with enough tissue removed more tooth show may also result. (but the risk of excessive tissue removal and a ‘chipmunk look’ can be created with too much of a lip lift) It is equally important to appreciate that it is does not create a corner to corner lip change and only augments the portion of the nose that lies between vertical lines drawn from the sides of the nostrils.
There are several criticisms/concerns about the subnasal lip lift. Some feel that if only skin is removed there will be significant relapse.(recurrent lengthening) This has led to lip lift techniques that remove or tighten the orbicularis muscle which can lead to its own set of problems. (lip tightness, smile deformity) There is always the concern about the appearance of the scar right under the nose and whether it will deform the nostrils or the base of the columella.
Case Study: This 26 year-old female wanted a lip lift to shorten her lip to nose junction and provide some some additional central lip pout. She already had reasonably good vermilion fullness and did not need/want any direct vermilion augmentation. Given her greater skin pigment there was good presurgical discussion about the resultant scar.
Under local anesthesia, a subnasal lip lift was performed removing 25% of the distance of the philtral column. (4mms) Only skin was removed without any muscle manipulations. Only small resorbable sutures were used on the skin as she lived far out of town.
When seen one year later, the subnasal scar was barely detectable and there was no nostril/nose deformity. Comparing her immediate and one year pictures, the subnasal lip lift result has remained stable. (no change in the lip-nose distance or the amount of central lip pout)
The subnasal lip lift can be an effective procedure that has minimal risks if it is not overdone or involves muscle manipulation. It must be meticulously measured and executed to be both symmetric with a good scar outcome.
Highlights:
1) The subnasal lip lift is a surgical procedure for enhancing the central part of the upper lip and shortening the nose-lip distance.
2) The amount of relapse or recurrent skin stretching is 10% or less and is not that noticeable.
3) A skin excision (muscle sparing) subnasal lip lift is both safe and effective and has a very low risk profile.
Dr. Barry Eppley
Indianapolis, Indiana