Upper Lip Lift (Upper Lip Shortening)
An upper lip lift, also known as upper lip shortening, is targeted to patients who are unhappy with the length of their upper lip area. This procedure is also referred to as a subnasale lip lift, a subnasale upper lip lift and/or a bullhorn upper lip lift.
In terms of this procedure, the upper lip refers to the area between the base of the columella (the middle column of the nose) and the reddish pink of the lip. Throughout plastic surgery, the ideal length of this area is said to be 12-15 millimeters. However, this range may vary based on the location of the individuals’ surrounding facial features. An upper lip extending significantly beyond these measurements often appears to be abnormally long.
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?
During the upper lip lift procedure, excess skin is removed in the upper lip area to shorten its vertical length. To achieve the desired measurement, one of two techniques can be performed. The first involves an incision made along the red lip border (lip roll), where a small section of the skin is then removed. As a result, the upper lip is elevated and shortened. However, this technique can cause a scar to be prominent in some patients.
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.
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.
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