What type of lip lift would I need for my long philtrum, downturned corners? (Photo)

Question

I'm 60, and in relatively good health. My skin is oily, and I have mild acne and mild rosacea, controlled with meds. I want to get a tip plasty first, and then a lip lift. What kind if lip lift would I need for my long philtrum, downturned corners, and to show more vermilion on both sides of my upper lip?

Gary M. Horndeski, MD · Answer

I recommend an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Michael P. Morrissette, DDS, FACS · Answer

I would recommend a traditional central lip lift as well as simultaneous corner lifts. The entire lip should be elevated to achieve the best results. It appears that your central lip is very long. The amount of skin removed is critical and the surgeon should take away any skin in excess of 13 mm. The distance between your upper lip vermilion and base of the nose following surgery should be around 13 mm.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. For a long philtrum and downturned corners of the mouth, I recommend DAO (depressor anguli oris) Botox as a first-line, minimally invasive approach. By relaxing the DAO muscles at the corners of the mouth, Botox can lift the mouth corners slightly, reduce the downward pull, and improve the overall appearance of a long philtrum without surgery. It’s subtle, temporary, and allows you to see results before considering more invasive options like a surgical lip lift, which would shorten the philtrum and elevate the vermilion but carries more downtime and permanence. For many people, carefully placed DAO Botox combined with a bit of filler in the marionette line region can create a natural, refreshed effect without the risks of a surgical procedure.

Nelson Lee Novick, MD · Answer

Before jumping into expensive, aggressive, invasive surgeries with their prolonged healing downtimes, you might wish to consider the use of an entirely nonsurgical approach that typically yields immediate, on-the-spot improvement and engenders little to no significant downtime. 
At least from the photo provided, an appropriate medium viscosity HA filler can be used to enhance lip volume and projection-- and establish greater harmony and proportionality-- between the upper and lower lips. Additionally, a low viscosity, malleable, cohesive HA filler can be injected along the lengths of vermilion borders of the upper and lower lips, which, in the case of the upper vermilion, would help to diminish the appearance of the elongated vermilion. 
Finally, a robust HA lifting filler can be used to elevate and smooth the down-turned angles of the mouth. 
In experienced hands, all of the foregoing can be achieved in about a twenty-five minute treatment session.
You would be wise to consult with an experienced, board certified cosmetic dermatologist filler injection expert and best of luck.

Guray Yesiladali, MD, FEBOPRAS · Answer

Based on your goals and typical patterns in cases like yours, the plan usually focuses on three levers: shortening the philtrum, improving vermilion show,and gently lifting the oral commissures.
Procedures to discuss• Subnasal bullhorn lip lift to shorten the philtrum and increase upper tooth show at rest• Corner lip lift to address downturned corners, sometimes combined with the bullhorn in the same session
Sequencing with tip plasty• Do the tip plasty first, as you are olanning, then reassess lip length and tooth show once early swelling settles• Final lip lift measurements are taken after your surgeon sees how the columella and upper lip sit in relation to the refined tip
Assessment details that guide the choice• Incisor show at rest in millimeters, smile dynamics and true philtrum length• Degree of corner descent and lateral vermilion fullness• Skin behavior with rosacea and your scar history to tailor aftercare
The information here is not enough for a precise plan. A deeper analysis with standardized photos, tooth show measurements and medical history will define the safest choice and the exact amount of lift. Our coordinators can help collect these details through a complimentary conversation when you feel ready.
I hope this gives you a clear roadmap and wish you a smooth journey toward a balanced, confident smile.Güray Yeşiladalı, MD

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your question and details — they’re very helpful in understanding your goals. Based on what you’ve described, it sounds like you’re seeking both more upper lip visibility and improvement in the downturn at the corners of your mouth, which are common aesthetic concerns, especially when the philtrum (the area between the nose and upper lip) lengthens with age.

In your case, a subnasal “bullhorn” lip lift would likely be the most effective technique to shorten the philtrum and increase the amount of visible vermilion (the pink portion of the lip). This type of lift removes a small strip of skin beneath the base of the nose, elevating the central part of the upper lip for a more youthful and balanced appearance.

To address the downturned corners, a corner lip lift can be done at the same time or later. This procedure subtly raises the outer edges of the lips, helping soften a resting frown or “sad” expression while maintaining a natural look.

Since you’re also planning a tip plasty, it’s excellent that you’re thinking ahead about sequencing — it’s usually best to have nasal procedures done first, then allow the area to heal before performing a lip lift, as nasal shape changes can slightly influence the philtrum-lip relationship.

Overall, your oily skin and mild rosacea shouldn’t interfere with surgery, but those factors are good to discuss with your surgeon for the best healing plan.