Best solution for my lip incompetence and high upper lip - rhinoplasty, genioplasty, Botox, or something else? (photos)

Question

I struggle with lip incompetence. My lips don’t close naturally at rest, and I have visible strain in my chin (mentalis muscle) when trying to close them. My nose appears short and high, with visible nostrils and an upturned tip. When I pinch my nose or pull the columella downward, my upper lip rests in a better position, and my lips close more easily. Is this issue caused by my nose (e.g., a high nasal tip or tension on the columella) or something else, such as my jaw or lips muscles?

Eric M. Joseph, MD · Answer

Sometimes lip incompetence is due to the way your jaw comes together. I believe a maxillofacial surgeon would be the best specialist to evaluate you and provide information that may be beneficial for you moving forward. I hope this helps. Sincerely, Dr Joseph

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. Based on your photographs, you may benefit from rhinoplasty and a chin implant performed at the same time. In regards to your nose, placement of extended spreader grafts to help derotate your tip will give you a better appearance with less nostril exposure.  With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

George Lefkovits, MD · Answer

You need to have your nose and lips examined. You may need to have some release measures taken to release the upper lip to a more comfortable position. Your nose needs to be lengthened as you indicated. You should consult with a Board Certified plastic surgeon with lots of experience performing nasal surgery.

Mats Hagstrom, MD (license on probation) · Answer

Fundamentally facial aesthetics I almost entirely based un facial skeletal structure.
In your case, your midface or your maxilla, most likely is successively in the vertical direction. 
This intern determines the position of your nose and how the soft tissues drape your skull. 
To get a quality assessment regarding facial, skeletal structure, consider consulting with oral surgeons or plastic surgeons who have formal cranial facial surgery backgrounds.
Even if you opt for solutions, which are based on soft tissue manipulation, I believe it’s very helpful to understand the underlying primary problem which in your case is ultimately based on bone structure, not soft tissues.
You may opt for a soft tissue solution, but recognize that soft tissue solutions for problems which are based on skeletal structure can only give partial improvements.
Plastic surgeons tend to be primarily soft tissue oriented in assessments and surgical application.
Oral surgeons tend to be much more skeletal structure oriented.
Whenever the problem is complex, expect people to have different opinions.
This is often the case when there is no one single best treatment. 
I highly recommend relying exclusively on in person consultations, and having several consultations before considering any permanent irreversible surgical treatment.
Best,
Mats Hagstrom MD

Best solution for my lip incompetence and high upper lip - rhinoplasty, genioplasty, Botox, or something else? (photos)

Answers (4)

Answer: Understanding the problem

Answer: Understanding the problem

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Best solution for my lip incompetence and high upper lip - rhinoplasty, genioplasty, Botox, or something else? (photos)

Answers (4)

Answer: Understanding the problem

Answer: Understanding the problem

Browse related questions

Recommended reading

Everything you need to know about Rhinoplasty

Our mission is to create a world where every investment in modern beauty is Worth It.