The goal of lip augmentation, or to make the lips bigger, is to expand the visible vertical height of the dry vermilion. This is most commonly done by the use of injectable fillers. Fillers work well if there is enough initial vermilion that it can expanded up and outward. But even if injectable fillers work well their lack of permanence and the repeated need for needles into the lips make some seek alternative lip augmentation approaches that are permanent.
Surgical manipulations of the vermilion-skin edge are permanent methods of altering the size and shape of the lips. The most known of these procedures is the subnasal or bullhorn lip lift. By excising a segment of skin right under the base of the nose the subsequent pull raises the vermilion edge of the upper lip. But it does not move the entire vermilion edge from mouth corner to mouth corner as this is not possible because the end of the lip pull stops at the level of the side of the nostrils. It is primarily a cupid’s bow lift whose effect fades the more lateral one goes along the edge of the vermilion.
Because of this effect it is possible that an isolated subnasal lip lift can create a peculiar shape to the upper lip. If the central vermilion gets bigger but the sides of the lip vermilion keep the same height, in some patients a vermilion disproportion may occur. (rabbit appearance) Thus it is important to assess the patient’s lip shape before surgery. One test is to use the wooden end of a Q-tip and push up under the nose and see what the upper lip shape looks like. The other test is a visual one, if the sides of the vermilion fade away before they reach the mouth corners this will create the vermilion disproportionate look.
To avoid upper vermilion disproportion in the patient who is at risk, a lateral vermilion advancement can be simultaneously performed. But directly lifting the outer third of the vermilion edge with a subnasal lip lift a proportionate vermilion shape can be maintained from one mouth corner to the other. While this does create a fine line scar at the vermilion edge this scar line typically does very well.
If in doubt about the risk of vermilion disproportion do the subnasal lip lift alone and wee what it looks like when it heals. As a lateral vermilion advancement can always be done secondarily under local anesthesia.
Dr. Barry Eppley