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Background: The center part of the upper lip has the most complex anatomy of the perioral region. With vertical philtral columns and a horizontally oriented Cupid’s bow, there is a ‘valley’ that lies between them. This upper lip concavity does not have a specific name but can be called the philtral dip or the central prolabial concavity.

The depth of the philtral dip can be affected by various factors including the height of the philtral columns and the thickness of the central lip tissues. While not a common aesthetic lip concern, I have seen patients who feel that their philtral dip either lacks prominence or is too deep. There is not an aesthetic norm for how much concavity should exist between the philtral columns. But if the patient feels it is too deep…then it is.

Augmentation of the deep philtral dip can most easily be done by injectable fillers or fat. But for the patient that seeks a permanent and more assured method, the placement of allogeneic dermis offers such grafting option.

Case Study:  This female had prior lip reshaping procedures and wanted additional efforts in the perioral area. One of her concerns was the deep philtral dip which she wanted more shallow.  She was going to have some secondary efforts at reducing the prominence of the peaks of the Cupid’s bow and this would provide an entrance site for graft placement.

Under local anesthesia she had a right Cupid’s bow lowering. Through this small excisional site,  the augmentation material was to be placed. A 2mm thick allogeneic dermal graft (Alloderm) was cut to size. After undermining the skin between the philtral columns and up to the base of the columella, the graft was passed through the small vermilion-cutaneous excision site and oriented into position. Closure was done with small 6-0 plain sutures.

One unique area of lip augmentation is the central part of the non-vermilion upper lip. A reliable method of philtral dip augmentation is a sheet of dermis placed between the skin and orbicularis muscle.

Case Highlights:

1) The depth of the concavity between the philtral columns of the upper lip is open to personal interpretation.

2) A permanent method of such philtral augmentation is the placement of dermal sheet grafting.

3) A minimal incision is needed at the vermilion-cutaneous junction along the Cupid’s bow.

Dr. Barry Eppley

Indianapolis, Indiana

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