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The subnasal lip lift is a commonly performed upper lip reshaping procedure. Its primary indication is to shorten the long upper lip which an injectable filler can not do. By removing tissue from under the base of the nose the upper lip is truly lifted and shortened. As a sequelae of the lift the central upper vermilion will exhibit more fullness. That fullness or amount of increased vermilion show is not on a 1:1 ratio…meaning the amount of subnasal tissue removal does not create an equal amount of increased vermilion fullness due to the distance between the two.

Where one has to be careful with the subnasal lip lift is when the smile line (bottom edge of the upper lip vermilion) is not even. Usually this presents as the central smile line is higher than the sides. When this is lip shape is preoperatively present the subnasal lip lift will either not improve that appearance or will make it worse.

One technique to treat this central upper lip smile line deficiency is by adding volume. Injectable fillers and fat can be effective and easy to do although their permanence is not assured. A more reliable technique, albeit surgical, is the V-Y mucosal advancement. By rolling out he inner mucosal tissue using an established tissue rearrangement technique the central smile line will be lowered. In doing so the V limbs of initial mucosal cut start at the widest part of the smile line deficiency and taper in towards the maxillary frenum.  A V-shaped flap of mucosa is raised from the frenum outward allowing the released mucosa create the smile line lowering. This creates a Y-shaped mucosa closure with interrupted resorbable sutures.

With the V-Y closure completed the total upper lip is reshaped. The upper lip is shortened and increased cupid’s bow fullness occurs and the smile line is lowered for a fuller and more uniform upper lip vermilion shape. The V-Y mucosal advancement creates a lot of central upper lip fullness, which initially can seem over done, but when the swelling subsides and the mucosa shrinks down it will assume a less exaggerated appearance.      

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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