Background: Rejuvenation of a long upper lip can only be reliably done by removing skin somewhere between the nose and the upper lip. The most common procedure to do so is known as the subnasal lip lift. It is more popular and commonly done than its cousin the upper lip advancement due to the less risky scar location along the base of the nose.
But the subnasal lip lift is often misunderstood at to its effect on the upper lip. It is important to realize that this is a central lip enhancement procedure. It will have no effect on the size or shape of the upper lip outside of the cupid’s bow region. This is understandable as the horizontal length of the skin excision at the base of the nose is no wider than the width of the nostrils.
This limited subnasal lip lift effect must be appreciated before surgery to prevent a vermilion fullness imbalance developing across the upper lip. While the height of the vermilion at the cupid’s bow region is always higher than that at the sides, thin lateral upper lips may look even thinner when the central upper lip vermilion becomes fuller.
Case Study: This 44 year-old female wanted to shorten her long upper lip, give the cupid’s bow more of a pout and show a little more upper teeth. But in demonstrating the effect of the upper lip lift, it was a revelation to her that the sides of the upper lips did not change. A concurrent strategy of increasing the height of the vermilion directly at the sides of the upper lip with the lip lift was planned.
Her upper lip enhancement procedure was done under infraorbital nerve blocks with direct local anesthesia infiltration into the base of the nose and the sides of the lips. A subnasal lip lift was done that reduced the skin distance of the upper lip from 18mm to 13mm along the length of the philtral columns. This was combined with a 4mm lateral vermilion advancements from the corner of the mouth to almost the cupid’s bow.
Her immediate result showed a total lip enhancement effect of shortening her long upper lip and increasing the vermilion show at the sides of the lip
A subnasal lip lift can not change the sides of the upper lip no matter how it is designed. A simple but often overlooked strategy for a more complete upper lip effect when doing a subnasal lip lift is the lateral vermilion advancement. This avoids a scar along the vermilion-cutaneous junction across the cupid’s bow area where it can be potentially more noticeable.
Highlights:
- A subnasal lip lift shortens the vertical distance between the base of the nose and the central upper lip only.
- A subnasal lip lift does not increase the height of the vermilion at the sides of the lip.
3. Lateral vermilion advancements are needed with a super lip lift to create a total lip enhancement effect.
Dr. Barry Eppley
Indianapolis, Indiana