Background: While lip enhancement has long been desired by women, it is not an exclusive female procedure. While men make up a relatively small minority of patients who undergo cosmetic lip procedures, it is not as rare in men as it once was. I see an increasing number of men who recognize that a thin upper lip is not attractive for them and desire a more appealing size.
While the procedures available for lip enhancement in men are no different than in women, there are several subtle differences. Injectable fillers are the most common form of lip augmentation and are highly successful, but it remains of little appeal to many men. Most men do not find the use of needles on a recurrent basis as very motivating. Men are often more interested in a one-time ‘fix’ to their concerns than the need for a recurring treatment. In addition because men do not wear lipstick, the use of the vermilion advancement procedure (even though it is very effective and affects the lip from one corner to the other) may be approached with extreme caution in them.
This leaves the subnasal or bullhorn lip lift as the only surgical option for lip enhancement in men. Putting the scar along the nasal-lip groove at the base of the nose places it in a relatively inconspicuous location in a natural skin crease. As the thin upper lip is almost always associated with vertical skin excess, some reduction in the upper lip skin length is also a benefit.
Case Study: This 50 year-old male wanted to improve his ‘weak’ upper lip. He felt his lip was very thin and it gave him a more aged appearance. Since he was undergoing numerous other facial procedures, he felt this was an opportune time to address his lip concerns as well.
Prior to surgery, subnasal markings for the lip lift were made with a calipers and a fine marking pen. Initially the vertical philtral columns were marked from the nose to the height of the cupid’s bow and measured. (18mms in length). A wavy incision in the subnasal crease was then made from one nostril to the other across the columella in the midline. At 5mms down from the crease along the philtral lines, the lowest extent of the planned excision was marked. The lower skin lip excision line was then marked paralleling the wavy line in the subnasal crease but in a feathering fashion as it came to join the upper incision at the sides of the nostrils.
At the completion of his other facial procedures under general anesthesia, the subnasal skin segment was excised sparing the underlying orbicularis muscle. The upper lip was then lifted and closed, creating an immediate cupid’s bow enhancement effect.
His postoperative course was typical for a subnasal lip lift procedure with minimal swelling and no bruising for the first week after surgery. Sutures were removed at one week after. By three weeks after surgery (as seen here) he looked non-surgical even though the scar was very slightly red. While somewhat visible in a picture taken with a flash, it was not visible in normal room lights or at a speaking distance. Full scar maturation takes months to completely fade.
Subnasal lip lifts can be done successfully in men without creating an abnormal appearance. The key to a natural looking result is to not remove too much upper lip skin. A safe amount of skin to remove in men is either 1/4 to 1/3 of the vertical philtral length presurgical measurement. It is always better to be conservative (1/4) as men have little tolerance for even a small amount of excessive central lip show even if it will settle down 4 to 6 weeks later. While no one wants to have revisional surgery, it is always better to have to do a second stage for further improvement than to remove too much skin which is an irreversible problem. It canc be striking how much difference 1 or 2mms can make in a lip lift.
Case Highlights:
1) The thin upper lip in the male has limited enhancement options, either injectable fillers or a subnasal lip lift.
2) The subnasal lip lift enhances the prominence of the cupid’s bow and shortens the skin distance between the nose and the lip.
3) A key to a subnasal lip lift, particularly in a man, is to not remove too much skin and avoid the’ chipmunk look’.
Dr. Barry Eppley
Indianapolis, Indiana