Combined bullhorn and corner lip lift. Thoughts? (photos)

Question

I’m 47. My philtrum has become longer and it’s started to bother me. I will have a bullhorn lip lift to shorten it and a corner lift at the same time. I need reassurance . My philtrum is definitely long but my front teeth ARE already visible “at rest”. A little more tooth show would be OK, but I don’t want to come out of it looking like a mouth breather... What do the experts here think?

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. My preferred surgical technique is called the Elelyft, which is a version of the bullhorn approach.
The ideal candidate for the Elelyft, or upper lip lift, is someone with a philtral length of 15mm or longer, no upper dental show, and/or a thin upper lip. The nasal base to mouth width ratio needs to be taken into consideration to avoid leaving the lip corners down.
In your situation, you appear to be a good candidate. I would advise against a corner lip lift in your situation. An elelyft would lift the entire upper lip in equal proportions. A corner lip lift risks excessive scarring in a very visible location. 
Gary Linkov, MD
Lip Specialist
Manhattan

Miguel Mascaro, MD · Answer

The key in your case is not to get overly aggressive. The length of your philtrum is long, so as long as you remain somewhat conservative (less than a third) the impact on final tooth show won't be too severe. This will also keep the center from going too high and the upper lip from overpowering the lower lip. I hope some of this helps! Best of luck.

Farhad Rafizadeh, MD · Answer

You do show some teeth at rest, but your philtrum is too long and you would benefit from a lip lift to shorten your philtrum and increase your teeth show but 2 more millimeters. The design of your lip lift is critical. I would design it to remove more on the sides and less from the center. I would also hide the scars in the nostrils. I don't think you need a direct corner lift.

Barry L. Eppley, MD, DMD · Answer

As long as your subnasal lip lift is not too aggressive (more than 25% of your vertical philtral length) the additional tooth show will only be about 1mm when it settles down.

Gaby D. Doumit, MD · Answer

Thank you for sharing your concerns
It is ideal for women to have 1-3 mm of teeth show on repose.Your upper lip is long, hence a conservative lip lift is advised to avoid a gummy smile (as you already have a teeth show). I usually extend my lip lift around the corners of the nostrils to avoid a corner lift
Sincerely
GD

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