A long upper lip, whether from aging or natural development, can be a source of aesthetic concern. An increased distance between the base of the nose and the upper lip increases the midface length and disrupts the balance between the facial third proportions. In addition to facial imbalance it also creates a perception of aging.
While there are two excisional surgical procedures that can shorten the long upper lip, the subnasal lip lift is often preferred because it avoids a scar line at the vermilion-cutaneous junction. (even though the procedure only shortens the central third of the lip) While the traditionally described lip lift used an incision across the entire base of the nose, several modifications have been subsequently describe that avoid an incision line across the base of the columella. (e.g., Italian lip lift) This is avoided by redistributing the central upper lip skin up onto the columella.
In the March 2019 issue of the journal Plastic and Reconstructive Surgery, an article was published entitled ‘Subnasal Lip Lifting in Aging Upper Lip: Combined Operation with Nasal Tip Plasty in Asians’. In this paper the authors describe a short scar subnasal lip lift technique that is combined (partly out of necessity) with a closed tip rhinoplasty in a series of thirty (30) Asian patients. The subnasal lip lift technique consists of bilateral excision of nasal base skin leaving the base of the columellarskin intact. (albeit undermined along with that of most of the upper lip skin) At the same time the columellar and nasal tip skin was also undermined and released. A small piece of orbicularis muscle is removed at the base of the columella. The central part of the excess skin of the upper lip is ‘removed’ (pushed up onto the columellar which creates part of the tip pasty) through suturing of the upper edge of the orbicularis muscle to the base of the nose. In closure of the base of the nose incisions, part of them has been moved now up along the sides of the columella intranasally. The removed skin segments are then de-epithelized and used as onlay tip grafts.
Their results showed high patient satisfaction. Besides the central upper lip shortening effects the nasolabial angle was opened an average of almost 15 degrees. The increased vermilion upper lip show was demonstrated by the angulation of the upturned vermilion edge.
Beyond that the patient examples shown in the paper have a much less impressive nasolabial angle opening that the number in the paper reports and the one dramatic change in vermilion show of one patient was enhanced by injectable fillers, this technique does have value in the Asian patient who is in need of increased tip projection as well. Such is not the case for most Caucasian patients. Also, this subnasal lift technique can not be performed on men because it will transfer beard skin onto the columella. For men the traditional subnasal lip lift is needed.
Dr. Barry Eppley
Indianapolis, Indiana