Lip lift (philtrum shortening): Which incision method should you choose? Differences in scarring and results

With lip lift (philtrum shortening), the most significant difference depends on where the skin is incised. The standard approach is under the nose, cutting in a mustache-like shape from the base of the nasal septum to the root of the ala, because the scar tends to be hidden in the shadow of the nose[1][2]. There is also a method of incising along the vermillion border, but since the scar is more visible and affects lip movement, it is chosen in limited situations[3].

Why is the standard incision made under the nose?

Because the scar can be hidden in the shadow under the nose. Textbooks describe cutting the skin in a mustache-like shape from around below the nasal septum and suturing it to shorten the upper lip, causing it to move upward with a curled appearance. This technique is also called subnasal lift and is used to shorten the elongated upper lip and expose the vermillion border.[1]. This method is also called subnasal lift and is used to shorten the lengthened upper lip and reveal the vermillion border.[1]. Reviews have also documented that the method of cutting skin at the base of the nose is the most widely used.[2].

What is difficult about incising along the vermillion border?

The scar ends up in a noticeable location. There is a method of cutting the skin in a seagull-wing shape along the vermillion border and advancing the lip forward.[3]. However, this incision technique leaves a scar at the lip edge, and reports indicate it can affect lip movement and the appearance of the color boundary, limiting its applications.[3]. The reason the subnasal incision method is considered first is because of this significant difference.[3].

Are there ways to reduce the amount of tissue removed?

A less invasive technique of dividing the subnasal incision into two separate incisions has been reported.[3]. Because the amount of tissue removed can be reduced, it is considered suitable for younger individuals and those from Asian populations.[3]. An advantage is that it makes it easier to avoid over-shortening the upper lip. The scarring remains positioned under the nose, with only the amount of tissue removed being reduced—this design concept makes it easier to understand.

When is cutting skin alone insufficient?

When there is significant laxity in deeper layers and when skeletal structure is involved. A modified technique that elevates and suspends the deep plane has been reported as a countermeasure for the increased visibility of subnasal scars.[4]. Rather than relying solely on skin excision, the concept involves moving deeper tissues to refine the final result.[4]. When the cause of upper lip appearing long is related to the maxillary skeletal structure, there are cases where jaw surgery is combined.[5].

Some patients undergo this at the same time as nasal surgery. A review summarizing simultaneous nasal surgery and lip lift notes that it is performed to balance the overall facial appearance, but attention must be paid to the fact that overlapping bleeding, swelling, and delayed healing are more likely due to proximity of the incision lines.[6].

What is different about non-surgical methods?

The length of the philtrum itself does not change. There is a method using hyaluronic acid and a technique called 'lip flip' where a small amount of botulinum toxin is injected along the upper lip vermillion to extend the lip outward.[7]. Textbooks introduce a technique of injecting shallowly along the vermillion border of the central upper lip, with 6 units as a guideline.[8]. For those wanting to avoid surgery, this becomes an option, but the quality and duration of results differ from surgical shortening by cutting skin.[7].

What should be confirmed during consultation?

The first thing to confirm is whether there is enough excess tissue on the upper lip to cut. Textbooks list this procedure as contraindicated in patients without sufficient vertical excess, as the front teeth may appear overly protruding or the mouth may be difficult to close.[1]. The way the line is drawn also influences the result, requiring precise line marking including subtle curves and taper.[1].

Complications include excessive cutting, inadequate cutting, wound separation, and upper lip swelling for several days after surgery.[9]. It becomes easier to make a decision if you have your surgeon explain where and how much will be cut and where the scar will be located, applying this plan to your own nose and lip shape.