What is a lip lift surgery? How it shortens the philtrum and the reality of scarring

A lip lift is a surgery that removes and sutures the skin below the nose, shortening the distance from the nose to the upper lip (philtrum). As the upper lip is lifted upward, the visible area of the red lip increases, and the visibility of the front teeth when the mouth is closed also changes[1][2]The effects last a long time, but scarring below the nose is inevitable, and the appearance of the scar determines satisfaction[3][4].

What is being done below the nose?

Skin is removed along the base of the nasal septum and nasal wing in a bovine horn shape (bullhorn pattern) and sutured together. Textbooks explain that by removing and closing skin in a mustache-like or bovine horn shape below the nose, the lip is shortened while being rolled upward and forward.[1]The most widely performed is this type, and reviews summarize it as surgery that removes skin at the base of the nose and advances the upper lip upward.[2]The amount of skin removed determines the height of the lip peak (Cupid's bow), and the amount of muscle removed determines the visibility of the front teeth.[5].

How much shorter does the philtrum become?

In reports, it shortens by an average of nearly 5mm. In a 6-month study of 20 people, the height of the upper lip changed from an average of 21.80mm to 16.95mm, and the thickness of the red lip increased from 2.10mm to 5.65mm.[6]The visibility of the front teeth when the mouth is closed also changed from 0.25mm to 2.00mm.[6]However, this is a study that selected individuals with a long philtrum (24mm or more for men, 22mm or more for women), and the amount of tissue removed is determined individually.[6].

Textbooks suggest that the minimum philtrum remaining after surgery should be 10-15mm as a guideline.[1]At the same time, the literature notes that this figure is merely a guideline, and the decision should also take into account tooth visibility, lip thickness, and overall facial balance.[1].

Who is it suitable for, and who is it not?

It is suitable for those with a long philtrum, thin-looking lips, and minimal front tooth visibility.[2]Not only those whose philtrum has lengthened with age but also younger people seeking a shorter philtrum often undergo this procedure, and this trend is reported to be more common in Asia.[5][7].

It is not suitable for those whose philtrum is not sufficiently long. Textbooks list it as a contraindication, stating that performing it on lips with limited vertical space may result in excessive front tooth visibility and difficulty closing the mouth.[1]For those with skeletal causes such as a protruding upper jaw or a vertically elongated face, skin surgery alone may result in unnatural front tooth visibility, and it is reported that skeletal evaluation should be performed first.[5].

Where and how do scars remain?

Scars remain along the edge of the base of the nostrils. In a systematic review of surgical methods, while surgical approaches provide longer-lasting effects compared to injections or threads, scars are unavoidable.[3]To minimize scar visibility, textbooks require careful design of the incision line with fine curves and tapering, and warn that a simple arc incision below the nose results in poor aesthetics.[1].

One report shows that with a small incision following natural skin depressions and minimal-tension suturing, the scar assessment score improved from 5.10 at 1 week postoperatively to 2.40 at 3 months.[6]This scar assessment is on a 13-point scale, with 0 being no scar.[6].

Where does dissatisfaction come from?

The main focus of dissatisfaction is the scar. In a study analyzing 25 posts expressing dissatisfaction after surgery, 60% were scar-related complaints, with 6 people reporting nostril or nasal wing deformity and 5 people reporting lip asymmetry.[4]This study only collected dissatisfied posts and does not show overall proportions, but it serves as material for understanding what can happen.[4].

In a report comparing conventional surgery with a modified technique combining threads to lift the nose and lip, the modified approach showed a higher percentage answering "significantly improved," demonstrating an aim to reduce scarring issues.[8]However, this is a report by a single surgeon of their own method.[8].

What should be measured during a consultation?

You should have measured the length of the philtrum, the visibility of the front teeth when the mouth is closed, the thickness of the lips, and the skeletal structure. The amount of skin to be removed is determined by working backward from the desired philtrum length and front tooth visibility.[1][5]If the cause is skeletal, skeletal evaluation should be obtained first, as lip surgery alone cannot achieve proper balance.[5].

The scar location and design, and any past experience with keloids or raised scars, should also be communicated during the consultation. If too little skin is removed, results will be underwhelming; if too much, it cannot be reversed. Sharing the target length with your doctor in numerical terms can provide peace of mind.