Z-Design Scar-Concealing Lip Lift (Philtrum Shortening)

What is Lip Lift (Philtrum Shortening)?

Lip Lift (Philtrum Shortening) is a surgical procedure that reduces the distance between the nose and upper lip (philtrum height) by excising skin directly below the nasal root (columellar base and alar base). Precise design of the excision amount simultaneously achieves elevation of the mouth corners, increased exposure of the lip vermillion (red lip), improvement of Cupid's bow morphology, and natural tooth visibility (dental show).

It is well known that the philtrum lengthens with age, resulting in loss of youthful appearance around the mouth. Conversely, even in younger patients with congenitally long philtrum, concerns arise such as "flat impression," "aged appearance," and "pointed-looking mouth." A systematic review in Aesthetic Plastic Surgery (2023, doi:10.1007/s00266-023-03302-5) demonstrates that surgical lip lift achieves superior long-term elevation effects compared to non-surgical methods (such as hyaluronic acid injection) and shows high patient satisfaction.

Characteristics of Z-Design Scar-Concealing Lip Lift

In our lip lift procedures, the incision line is precisely designed to follow the nasal cavity and alar margin as closely as possible. After incision, appropriate handling of the orbicularis oris muscle is performed, and fixation at the muscle layer as well as the skin level minimizes relapse. Plastic & Reconstructive Surgery (2024, doi:10.1097/prs.0000000000010735) positions lip lift as "The Missing Link in Central Facial Rejuvenation," emphasizing the importance of surgical planning based on deep-plane anatomy rather than simple skin excision.

Furthermore, recent reports have documented the effectiveness of improved techniques using a deep-plane approach. The Tri-Lift suspension technique published in Maxillofacial Plastic and Reconstructive Surgery (2025, doi:10.1186/s40902-025-00459-8) reported that 78.7% of 193 patients responded "very much improved," significantly exceeding the traditional bullhorn technique (43%). This technique achieves high patient satisfaction while minimizing scar formation through triple suspension sutures that provide multilayered support to subcutaneous tissue.

Procedure Overview

The procedure is performed under local anesthesia with an estimated duration of approximately 60–90 minutes. First, consultation includes precise measurement of philtrum height, vermillion height, and dental show to determine the width and shape (bullhorn or custom design) of the skin to be excised. After incision, excess skin and a portion of the orbicularis oris muscle (if necessary) are removed, followed by layered suturing along the alar base and columellar base. Surface suturing combines absorbable sutures for dermal closure and non-absorbable sutures for epidermal closure to distribute wound tension.

Downtime and Postoperative Course

Postoperatively, swelling and bruising persist for approximately 1–2 weeks. Suture removal is typically performed 5–7 days after surgery. Redness and firmness of the incision gradually subside over 3–6 months. Daily activities can resume the next day, but please avoid strenuous exercise and alcohol for approximately one week. Once the incision stabilizes, it becomes less noticeable with makeup. Final results should be assessed approximately 3–6 months after surgery.

Asian Lip Aesthetics and Lip Lift

In Western countries, lip lift has primarily been performed as a rejuvenation surgery for age-related changes (philtrum lengthening), but in Asia it is notably common for younger patients to desire philtrum shortening for aesthetic reasons. Plastic and Reconstructive Surgery Global Open (2025, doi:10.1097/GOX.0000000000007230) clarifies that in Asia "shorter philtrum = more attractive" represents an aesthetic standard and discusses the indication for lip lift in younger patients. The paper reports that among 17 patients who underwent lip lift following skeletal assessment, high patient satisfaction was achieved in all cases.

Important Preoperative Evaluation Points

Multiple factors affect the outcome of lip lift. It is essential to comprehensively evaluate not only philtrum height but also nasal shape (upturned nose and columellar base position), degree of tooth exposure, skeletal structure (presence or absence of mandibular or maxillary protrusion), upper lip thickness, and Cupid's bow morphology. During consultation, frontal and lateral photographs are measured and the excision amount is designed within safe limits. Excessive excision risks over-elevation of mouth corners or a "gummy smile-like" appearance with excessive tooth visibility at rest; therefore, conservative design and staged approach are the standard.