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

Thank you for sharing the phoros. You do, however, need a proper physical examination in order to get an accurate picture of the existing problems and provide you with an appropriate answer. Unfortunately, the photos you have included do not facilitate that. Nevertheless, reading your concerns, I would suggest staying away from the non-surgical options as they have clearly not helped you. Consider a deep pane lip lift or, alternatively, more permanent augmentation techniques, such as fat augmentation, that can address some of your concerns.

It’s great to hear that you’re recovering well and already thinking ahead — a well-planned aesthetic journey makes a big difference in long-term results.When it comes to combining or sequencing surgeries, timing is critical for both safety and healing.
Since you’ve recently undergone an abdominoplasty and breast implant exchange — which are significant procedures — your body needs adequate time to:
Complete early tissue healingStabilize inflammation and circulationAllow anesthesia and immune response to normalizeFor a facelift, which involves delicate facial tissues and microvascular structures, I typically recommend waiting at least 3 months after your previous surgery. This ensures your body has had time to rest and recover before undergoing another operation — leading to:Lower risk of complicationsBetter healingAnd more predictable resultsIf your recovery continues to progress well, your facelift consultation can happen soon — with surgery planned accordingly.Your enthusiasm and commitment to a staged approach is exactly what leads to the best outcomes.

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.