Injections Above Upper Lip (Philtrum)

Question

I went to a plastic surgeon because my upper lip is very thin! He told me my case is difficult for various reasons and that my philtrum is a bit long and that it would not work just to put filler in my top lip. Then he said that I would benefit from him injecting filler into my philtrum, which would then lift my top lip, making lip bigger and reducing the length of the philtrum. Is this right? Or would I need a lip lift? Would lip lift look good? Cant find anything on filler in philtrum!

Raffy Karamanoukian, MD, FACS · Answer

The philtral columns can sometimes benefit from volume enhancement and this would have to be determined in examination. This is a common practice in most circles. Raffy Karamanoukian MD FACSLos Angeles

Gary Linkov, MD · Answer

There are surgical and non-surgical approaches to lip augmentation. Non-surgical approaches include botox (slight lift, reducing gum show) and filler (volume restoration). Surgically, you can have two separate incisions under the nose (italian), one incision under the nose (bull horn), one incision at the red/white upper lip junction (gull wing) or two separate incision at the corners, or a combination, depending on your desired look and anatomy.
Filler can be used for your upper lip, but I would not place it in the philtrum. Placing it in the philtrum will not shorten the philtrum, if anything it will add weight and a heaviness to your upper white lip and result in an unnatural appearance. I would consider putting filler in your upper red lip, or a lip lift is something to consider.
Best of luck.
Gary Linkov, MD

James M. Pearson, MD, FACS · Answer

Thank you for your question. The Lip Lift procedure is performed to accentuate the size and/or shape of the upper lip by removing skin from the region underneath the nose. As the distance is decreased between the nose and the lip, the red lip is 'lifted'. In appropriate individuals, shortening this distance may impart or restore a more favorable balance to lips and face. In most cases, injectable volumizing fillers do not enable a significant 'lift' at all. Most patients seeking shortening of this area find non-surgical options insufficient to achieve their aesthetic goals in this regard.

Jed H. Horowitz, MD, FACS · Answer

Whether you’ve noticed
your lips thinning over time, or simply want fuller lips, JUVÉDERM® Ultra XC or
RESTYLANE SILK  can give you natural-looking results that lasts more than
9 months.   In fact, 78% of people treated experienced improvement in
satisfaction with the look and feel of their lips 1 year later!
The cost
of a single 1ml syringe will vary within $50-$100 between competitive
practices. We suggest finding a reputable practice with expert injectors for
the blend of science and artistry!
#lipenhancement    #JuvedermUltra
 #RestylaneSilk

Larry S. Nichter, MD, MS, FACS · Answer

Whether you’ve noticed
your lips thinning over time, or simply want fuller lips, JUVÉDERM® Ultra XC or
RESTYLANE SILK  can give you natural-looking results that lasts more than
9 months.   In fact, 78% of people treated experienced improvement in
satisfaction with the look and feel of their lips 1 year later!We suggest finding a reputable practice with expert injectors for
the blend of science and artistry!
#lipenhancement    #JuvedermUltra
 #RestylaneSilk

Young R. Cho, MD, PhD · Answer

Thank you for your question and sharing your photo.  Lip lifts can be an
 extremely rewarding procedure that can increase the fullness of the 
upper lip, give you a little more lip show.  The amount of lift does 
depend on the starting length of the upper lip skin and the desired look
 afterwards.  The incision is hidden at the border of the upper lip skin
 and base of the nose and spans the width of the nose.  I perform these 
procedures under local anesthesia, but it can also be done with sedation
 or general anesthesia.  As for fillers in the philtrum column, you can get a modest lip lift using this technique.  I usually prefer using a stiffer filler product such as Voluma or Restylane Lyft (formally known as Perlane) and perform this technique quite routinely when lip augmentation using dermal fillers is part of my facial rejuvenation plan.

Karan Chopra, MD · Answer

Hi @LisaThanks for the question. The image is not at a standard angle so it's hard to say exactly but you do seem to have a long upper white lip and a diminutive red lip.If your white lip (the area from the nose to red lip) is over 18mm then you would benefit from a lip lift. Philtral injections would bolster the philtral columns and give a nice touch.See an expert.

Greg Bran, MD, PhD · Answer

Hi there and thank you for the photo. Injections into the philtrum, more precisely the two philtre columns are common practice to accentuate the changes of light and shadow above your upper lip. By adding an additional, natural looking focal point, the overall aesthetics of your lips will improve. 
According to your photo the distance between your nose and the upper red lip seems to be a bit elongated. Discussing with your Plastis Surgeon the alternative of a Liplift procedure is advisable.

Tal T. Roudner, MD, FACS · Answer

It is from my experience I have observed  that thin long lips are very difficult to correct with injecting any type of filler.

	The anatomy of the upper lip especially is more difficult to correct. Specifically the older you get the more difficult it becomes.

	If the philtre is flat it could be augmented with a filler but that correction is in the vertical aspect of the lip.

	In difficult cases it is often better to undergo a surgical procedure that removes skin and soft tissue from the are under the base of the nose ( Ala, columella, nostrils) in a gull wing shape. That will create a lift to the upper lip and increase the size of the dry and wet vermilion. It comes with a price scars from surgery.

	Good luck!!!

Glenn Vallecillos, MD, FACS · Answer

Hello and thank you for the question.

	Although the photographs you provided do no present your upper lip concerns in their entirety, I get the sense from looking at that photo that you may have a long upper lip. I would need to examine you first-hand to make that determination, as there are several factors which may contribute to a long upper lip, some of them not easily addressable.

	A long upper lip may be managed by an upper lip lift in the right patient population. The procedure involves surgical excision of upper lip soft-tissue, with the scar line lying along the caudal aspect of the nasal border. In careful, experienced hands, the results can be exceptional and re-create a youthful upper lip appearance with appropriate amount of upper incisal show, which is lost with long upper lips. This procedure is often performed in conjunction with fat-transfer to the lips, if required for volumization and loss of generalized lip shape.

	As a consequence of having an long upper lip, the the delineation of the philtral column may often times be diminished and in some cases nearly-completely obliterated. Because loss of a pronounced, youthful philtral column is considered a silent cue of aging, re-establishing this anatomic feature of the upper lip can create the appearance of a youthful lip. This can accomplished with the use of HA-based fillers such as Juvederm or Restylane. As you suggested, recreatiion of the filtral columns with fillers will also tend to draw the lip up ( to a certain extent), giving the appearance of a shorter upper lip.  I commonly employ this technique with my lip rejuvenation procedures in patients who have lost their philtral column demarcation. The results are typically very satisfying. 

	My recommendation is that you consult with Board Certified Plastic Surgeon or Facial Plastic Surgeon who is experience in peri-oral rejuvenation and the various techniques that can be employed to provided optimal results.

	 

	Kindest Regards,

	Glenn Vallecillos, M.D., F.A.C.S.

Injections Above Upper Lip (Philtrum)

Answers (10)