Lip lift (philtrum shortening): methods and what to consider

What is a lip lift?

In a lip lift, the length of the upper lip refers to the height of the skin that runs from the base of the nose to the border of the red part of the upper lip (vermilion) ^[2]. A 2023 systematic review explained that the vertical height of the upper lip increases with age ^[1]. When the upper lip becomes longer, less of the red part of the lip and the upper teeth show, which can change the overall impression of the lower face.

A lip lift is surgery that reduces this skin height. The most common method is the indirect lip lift, in which skin is removed along the border beneath the nose and the wound is then stitched closed; because the excision is shaped like a bull's horns, it is called the bullhorn technique ^[2]. The literature notes that when the skin height is shortened, more of the red part of the upper lip shows and the lip can look fuller ^[2].

Who is it considered for?

A 2022 review of the harmony between the teeth and lips listed the goals of a lip lift as reducing the height of the philtrum (the area between the nose and the upper lip), enlarging the red part of the upper lip, improving how much of the teeth show, and restoring facial proportions ^[5]. The same review named careful treatment planning as a prerequisite for these results ^[5].

In another 2023 systematic review, 92.4% of patients who had a subnasal lip lift were women, and they ranged in age from 21 to 65 years (average 36.6 years) ^[3]. It is also explained that in men, the height of the skin from the base of the nose to the lip border is noticeably longer than in women ^[2].

Whether to have surgery is not decided by the length of the philtrum alone. Lip height, the height of the red part of the lip, the width between the sides of the nostrils, skin type, how much of the upper teeth show, and the height of the upper jaw all need to be considered together, and it is stressed that patient selection is critical to the result ^[2].

How do the surgical methods differ?

The basic method removes only skin and then stitches the wound closed. A more advanced variation is based on the view that the superficial musculoaponeurotic system (SMAS) layer in the lip and the ligament around the bony opening of the nose (pyriform ligament) play an important role in lifting the lip, so the tissue is released and anchored at a deeper layer ^[4]. The publication that introduced this technique explained that it can be applied to patients of various ages, ethnicities, and skin types, but it did not directly compare results with other methods ^[4].

There are also nonsurgical methods. A 2023 systematic review analyzed 9 of 495 publications, of which 8 covered surgical methods and 1 covered a nonsurgical method ^[1]. Surgery tended to produce longer-lasting results than nonsurgical methods, while nonsurgical methods were less invasive but their effects were temporary ^[1].

Scarring and recovery

A lip lift leaves a scar along the border beneath the nose. A systematic review also summarized that surgical methods produce longer-lasting results but cannot avoid a scar ^[1]. The literature explains that precise measurement, removing only the planned amount of skin, and carefully aligning the skin when stitching are important for reducing a visible scar ^[2].

How a scar settles varies from person to person depending on skin type and constitution. Right after surgery there may be swelling and a feeling of tightness, so it is a good idea to get instructions on caring for the stitched area and the follow-up schedule before surgery.

How long do results last?

A 2023 systematic review of the subnasal lip lift included 4 of 464 publications in its final analysis; because there were no randomized controlled trials, 2 retrospective cohort studies and 2 case studies were included ^[3]. All of the included studies reported that the shape of the lips improved in terms of both measurements and patient satisfaction, and the length of time results were maintained varied between studies, from 12 to 59.1 months ^[3].

Another systematic review pointed out a lack of consistency because the studies measured outcomes in different ways, such as photo analysis, caliper measurement, and three-dimensional (3D) measurement ^[1]. There are reports that the results are maintained, but the evidence is still insufficient to generalize how much of the result is maintained or for how long. In addition, the research summaries do not state the ethnicity of the study participants, so whether the same results can be expected in Korean patients needs to be judged separately.

What to check during your consultation

With a lip lift, even a small change can alter the impression of the lower face, so planning is important. It is a good idea to check the following together during your examination.

• The current height of your philtrum and of the red part of your upper lip
• How much of your upper teeth show at rest and when you smile
• An incision design that suits the width of your nostrils and the shape of the area beneath your nose
• Where the scar will be and how to care for it during recovery
• The difference in how long results last with nonsurgical and surgical methods