PracticalDermatology

About 99 percent of the time lip enhancement involves making lips bigger, usually with fillers. For a significant number of patients, making the upper lip smaller via a lip lift is the more appropriate aesthetic procedure.

Much of what we consider female beauty concerns the amount of the central incisor teeth that show when the mouth is at rest and during various animations. Normally, an attractive female shows several millimeters of incisal edge in repose. In the same situation, this patient would show several millimeters of gingiva when smiling. Patients who do not show any incisor at rest or gingiva when smiling realize that their aesthetics are skewed but are not sure why.

A lip lift procedure can improve lip and smile aesthetics in several ways. First and foremost, it shortens the lip. Younger patients usually have shorter lips that are plump and curvaceous, while older patients frequently have elongated upper lips and tend to lose volume in their lips with advancing age. This elongation and volume loss is a result of maxillary and mandibular bony changes, atrophy of the skin, mucosa, perioral musculature, and parenchymal glandular tissue, as well as attrition of the teeth.

The goal of the lip lift procedure is to shorten the upper lip and evert the vermilion, which results in a more volumized “rolled-out” lip. When measuring the lip from the bottom of the philtrum to the top of the vermilion, excessive length is generally considered more than 20mm.

Figure 1. This image shows the final closure and the excised skin overlying the operative site.

Figure 2. This patient is shown before and after lip lift. Note the shorter and everted lip and aesthetic scar.

Lip Lifting Procedure

The actual lip lift procedure takes about 30 minutes and can be performed with local anesthesia; I usually operate with IV or general anesthesia. The crux of this procedure is to remove excessive upper lip skin just beneath the nose (a “bullhorn” pattern is used). The procedure is described in my article in Modern Aesthetics® magazine, available online at ModernAesthetics.com/2018/10/.

Although the average patient heals with a very acceptable scar, I tell all patients that I can laser the scar at six weeks for superior blending and include this in the cost of the procedure. Patients report high satisfaction with the results of this procedure, as it addresses their true aesthetic concerns and makes a pronounced difference in their facial appearance, when in repose and when smiling.