Background: The lips in women are a major focus of aesthetic attention as demonstrated by the infathomable number of lipsticks, glosses and other topical enhancement products. Injectable fillers serve as a major means of temporary increase in lip size in women. Injectable lip fillers in men, by comparison, is very rare. While men can have thin and less well-shaped lips, it is not a major feature of a man’s face and few men are concerned about them.
The most noticeable aesthetic lip deformity in men is that of a thin upper lip. Women do make comments in men about the thickness of the lips or those ‘pencil-thin’ lips. That is always in reference to the upper lip which has a short vermilion height and often an indistinct cupid’s bow. A thin upper lip in a man also has a long skin segment between the base of the nose and the top part of the vermilion. This long skin segment is what makes the upper lip long and drives the lip down covering up the maxillary front teeth.
Case: This is a 27 year-old male who recognized that his upper lip was aesthetically too long. He was well aware of the concept of an upper lip lift whose excision was done under the base of the nose. The philtral column distance (between the base of the nose and the height of the cupid’s bow) was 26 mms. The upper lip hung down and projected over the lower lip.
The subnasal lip lift is done by initially marking along the base of the nose. I don’t like to carry the excision line very far from the base of the nostril so that scar remains hidden. There is no lip lift benefit along the side of the nose. As a general rule, the vertical excision should not be more than 1/3 of the vertical length of the upper lip skin as measured along the philtral columns. Using ¼ distance is a completely safe amount if 1/3 looks too long. But one must remember that there will be some relapse with skin relaxation. It is a procedure that can be done on the office under local anesthesia. In this case, he had other procedures done so it was part of facial procedures done in the operating room under general anesthesia.
One of the most important aspects of a subnasal lip lift is to not take any underlying orbicularis muscle. Or to try and secure it to the nasal septum or pyriform aperture to prevent relapse. Both maneuvers affect the sphincteric action of the orbicularis muscle, stiffening the upper lip and affecting one’s smile.
The subnasal lip lift causes no pain, no bruising and some mild swelling. There will be some numbness of the upper lip, however, for weeks after surgery. Tiny dissolveable sutures are used which creates a very fine scar line. This is the appearance of his scar at just one week after surgery. Within several months the scar line will be invisible. About 20% to 30% relapse can be expected (1 to 2mms) and the result is completely stable at 3 to 4 months after surgery.
Case Highlights:
1) The long upper lip is the most common aesthetic lip concern in most men.
2) The subnasal lip lift shortens the distance between the base of the nose and the vermilion of the upper lip. Some increase in the vermilion roll (lip pout) is obtained.
3) The scar from the subnasal lip lift lies hidden into the skin crease at the base of the nose and heals inconspicuously. Slight over correction is needed due to some skin relaxation (relapse) in the first few months after surgery.
Dr. Barry Eppley
Indianapolis Indiana