Dr. John Hilinski
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Upper Lip Lift (Upper Lip Shortening)

An upper lip lift procedure is also known as an upper lip shortening procedure. Others refer to this as a subnasale lip lift, a subnasal upper lip lift and/or a bull horn upper lip lift. An upper lip lift procedure is targeted for those patients who feel as if their upper lip is excessively elongated – or simply too long.

An upper lip that is considered too long is best appreciated on the frontal view of the face. In the context of this discussion, the upper lip refers to the portion that extends from where the columella of the nose ends (the column in between the nostrils) down to the red (or pink) portion of the lip. Some plastic surgeons feel that the ideal length of the upper lip is somewhere between 12-15 millimeters (mm) as measured in the vertical direction. Obviously there is some variability in this measurement based on the surrounding facial features. If the upper lip is significantly longer than average though, it can draw unwanted attention to this area and may benefit from an upper lip lift or lip shortening procedure.

Patient Presentation

Many patients interested in an upper lip lift, or upper lip shortening, are clearly bothered by an excessively long upper lip when looking straight on in the resting state (meaning without movement of the lip). This is demonstrated in the adjacent photo where you can easily appreciate that the upper lip in this female patient is too long for her lower face. In fact, the length of her upper lip in the vertical direction almost appears as long as the lower lip-chin length. This feature alone is sufficient to consider an upper lip shortening procedure to create more harmony and balance.

Other patients are more bothered by the excessively long upper lip hiding too much of their teeth during facial animation, such as smiling. When we smile, for instance, it is normal for the upper lip to pull upward and out, revealing a good portion of your teeth. If the upper lip is excessively long, it can drape over the dentition to the point where even smiling will not allow sufficient visibility of the teeth. Some patients and plastic surgeons refer to this as insufficient incisor show, which is another frequent indication for undergoing an upper lip lift procedure.

What is an Upper Lip Lift?

An upper lip lift is a procedure where the excess skin is removed in a strategic manner to create a shorter lip as measured in the vertical dimension. There are two different types of an upper lip lift. The first involves making an incision along the vermillion border of the lip, which is the junction of where the red (pink) and white lip meet. The vermillion border has also been referred to as the lip roll. A segment of skin is removed from immediately above the vermillion border then sutured closed very carefully. In doing so, the upper lip is effectively pulled upward and shortened. Unfortunately, the scar from this incision can be quite visible in some patients making this approach for an upper lip lift much less desirable.

The second and more popular approach involves making an incision under the nose where it meets the upper lip. This is called a subnasale upper lip lift since the incision is placed below (sub) the nose (nasale). This type of lip lift has also been commonly referred to as a bull horn upper lip lift based on the shape of the actual incision used for the lift. This is shown in the adjacent photo diagram as indicated by the red outline. As you can see, the upper limb of the incision follows the natural contour of the upper lip just below the nose. The lower limb approximates a mirror image of the upper limb and determines the amount of skin that will be removed. Once the excess amount of skin is removed, the upper lip is lifted by suturing the cut edges together. It is real important to close the incision in layers – meaning it is vital that sutures are placed deep underneath the skin to provide adequate strength for the lip to maintain proper shape. Once the deep sutures are placed, the skin edges are then meticulously aligned to make the incision as least visible as possible.

Recovery from an Upper Lip Lift

Recovery from a subnasale lip lift varies between 5-7 days before you look more publicly presentable. There is usually a moderate amount of swelling the first 72 hours, which can be controlled with cold compresses over the upper lip. Pain is controlled with low dose narcotic medication, such as Vicodin. The sutures are typically removed around 5 days out from the surgery. There is normally some degree of what is called wound eversion, where the incision looks raised up slightly like a ridge.

The adjacent photos show what a typical upper lip lift (upper lip shortening) patient looks like before and then around 5 days after surgery when the sutures were going to be removed. As you can see prior to the subnasale upper lip lift procedure, her upper lip was notably elongated as measured from just under the nose down to the pink border of the lip. A subnasale upper lip lift was performed to shorten the upper lip so it did not appear as long. In addition, the upper lip lift was going to create more upper lip ‘show’ – meaning there would be more visibility of her pink upper lip as seen from the frontal view. This translates into a more enhanced, feminine looking upper lip given the increase in volume that can be seen. A standard incision was made around the base of the nose (where it meets the upper lip) to help conceal the scarring. A good amount of upper lip skin was then removed using a gull-wing shaped incision. The remaining upper lip was then lifted toward the nose and the incision line closely carefully. As you can see in her actual post-upper lip lift photo, there is still some swelling of the upper lip region, but it is not overwhelming. The blue suture threads are visible as they come out of the skin on either side of the base of the nose. What you can also tell from the 5 day post upper lip lift photo is that her upper lip is now much shorter. Overall, it looks more feminine and in better balance with her surrounding facial features. You can also see from the photo to the right that there is more pink lip show with enhancement of her natural cupid’s bow (red curved lines) – a great by-product of having a subnasale upper lip lift.

This initial swelling and tissue distortion can take another few weeks to settle down. Ultimately, like any incision, it can take upwards of one year before the scar fully matures and fades away.

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Other Examples of Subnasale Upper Lip Lift

The following are photo examples of subnasale lip lift patients of Dr. Hilinski. To see our full gallery of subnasale upper lip lift patient examples use this link here. Note in each case how the upper lip has been shortened using the subnasale approach discussed above. Also notice how the incision is hidden in the natural contours of the upper lip. In some cases you can still see some evidence of the healing incision, which continues to fade away with the tincture of time. You will also appreciate that in many patients the red (pink) portion of the upper lip rolls outward to provide even more enhancement of the upper lip region.