Shelf Like Upper Lip - do I have more filler to dissolve? (Photos)

Question

Hi, I would really appreciate some advice. I naturally have thin lips, years ago, i started filling my lips and dissolving. I would love the look of them at the start, but then the upper lip filler would dissolve into the skin and I would remove then re fill then repeat. I had my filler removed a few years ago, I then had a rhinoplasty due to the size of my nose. Also, I have always had a horizontal line above my lips when I smile, due to excess volume in the skin above my lip, despite having small lips. The rhinoplasty did not address this. I am also due to have Invisalign braces, as my top teeth have an overbite, not sure if this is relevant but I’m sure it’s not helping. I have attached 4 photos of my lips now, 3 up front and one from the side. I also a while ago tried a Botox lip flip, I have also attached 3 photos of my lips after this, which I think helped. I have also attached 1 photo of my lips when they were filled, even though there’s obvious migration, I feel they look more attractive. Is it possible I still have undissolved filler in the skin above? Do I 1) get them dissolved again and ask them to focus on skin above 2) keep getting Botox above 3) keep getting filler although this I feel will make the shelf appearance worse. are there other options? Will the braces help? Thank you

Anna Chacon, MD, FAAD · Answer

Thank you for sharing such a thorough history and photo references. Based on your description, there are several possible contributing factors to the “shelf-like” appearance of your upper lip:

Residual Filler or Scar Tissue: Even if filler was previously dissolved, it’s possible that small amounts remain, especially if there was frequent filling and dissolving over the years. Hyaluronic acid fillers can sometimes integrate into the surrounding tissue or result in fibrotic changes, which may give the appearance of lingering volume or shelfing.

Anatomy & Structural Changes: Your natural lip shape, perioral volume, and the presence of an overbite can contribute to the appearance you're noticing. The horizontal crease above your lip when smiling may be related to both soft tissue volume and muscular dynamics, not just filler.

Effect of Rhinoplasty: While rhinoplasty may balance facial proportions, it typically doesn't address soft tissue volume or the muscle dynamics around the mouth. However, changing nasal structure can sometimes change how we perceive the area around the lips.

Botox Lip Flip: Your photos seem to show a positive response to the lip flip. Botox can help relax the orbicularis oris muscle, softening the curl of the upper lip and sometimes minimizing that shelf-like projection—though it’s temporary.

Orthodontic Factors: Your upcoming Invisalign treatment could help with lip posture, especially if your overbite is prominent. By adjusting your bite and moving your teeth inward, there may be subtle improvement in how your lips and surrounding tissues rest.

Recommendations:
Ultrasound Evaluation or Expert Palpation: If available, ultrasound or a skilled injector may help determine if filler remains above the lip. If so, a focused round of hyaluronidase may be beneficial.

Botox Lip Flip: Given that you responded well to the Botox lip flip in the past, this is a good non-invasive way to improve the appearance without adding volume or exacerbating the shelfing.

Avoid Further Filler for Now: Until the issue is clearly defined (residual filler vs tissue structure), adding more filler could worsen the bulk above the lip.

Lip Lift or Skin-Tailored Procedures: If volume above the lip persists despite dissolution and the Botox effect is minimal long-term, a surgical lip lift or subnasal tissue adjustment might be considered. These can address excess skin or lengthened philtrum.

Monitor Invisalign Effects: Your braces may help re-balance the lip posture, especially as the overbite improves. Wait to reassess once treatment is underway.

In summary, it’s likely a combination of residual filler, past treatment history, anatomical volume, and bite dynamics. Conservative approaches like Botox and possibly targeted dissolution are ideal first steps.

Shelf Like Upper Lip - do I have more filler to dissolve? (Photos)

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Shelf Like Upper Lip - do I have more filler to dissolve? (Photos)

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