The subnasal or bullhorn lip lift is the most well known of all the surgical lip reshaping methods. It is a true lip lifting procedure given that its excisional location is at the nasal base-lip crease which results in a superior pull when closed. The length of the upper lip is shortened and with that movement comes some elevation of the smile line and increased tooth show. (although there is not a linear relationship between the amount of skin removed and the tooth show that results)
One of the most appealing aspects of the subnasal lip lift is the scar location. Located at the junction of the nasal base and upper lip, it has the potential to heal in a fairly discrete fashion. But despite being at a favorable location this does not always guarantee that it will be an undetectable or even a good scar. There are a lot of reasons that such adverse scarring can occur from the closure technique used, how much skin has been removed, the pattern of the closure line to the patient’s skin pigmentation.
Despite the relatively small length of the subnasal lip lift scar it is in an unforgiving aesthetic location. Any deviation from the nasal base-lip crease, scar widening or asymmetry of its excision is easily seen. Often the defining element of the subnasal lip lift scar is how it appears between the philtral lines across the base of the columella…the area of greatest skin excision and tension of closure. As it crosses this area it is important that it is not a straight line. Like the bullhorn pattern implies it has to have a flattened m-shape, which not only follows the natural shape of most nasal base-lip creases but also creates more of a broken line closure.
When revising the visible subnasal lip lift scar the entire scar must be excised in a non-linear fashion. This usually means that at least 3mm of excision needs to be done which for many patients a little more upper lip shortening may be acceptable.
Meticulous closure is needed with emphasis on more of a curvilinear closure. While I would not say that small resorbable sutures should never be used but 6-0 or 7-0 permanent sutures are best IF the opportunity to remove them can be done 5 to 6 days after the procedure. If not 6-0 plain (nothing longer lasting) can also be used if postop suture removal is not possible.
There are some patients that have a poor subnasal scar because they may not have had a favorable nasal base-lip junction initially. Such patients usually lack a well formed nasal sill with a wide open pathway into the lower end of the nostrils.,,,having no crease line to hide a scar. Scar revisions in these patients may not have optimal results.
Dr. Barry Eppley