Injections Above Upper Lip (Philtrum)

I went to a plastic surgeon because my upper lip is very thin! He told me my case is difficult for various reasons and that my philtrum is a bit long and that it would not work just to put filler in my top lip. Then he said that I would benefit from him injecting filler into my philtrum, which would then lift my top lip, making lip bigger and reducing the length of the philtrum. Is this right? Or would I need a lip lift? Would lip lift look good? Cant find anything on filler in philtrum!

Doctor Answers 4

Lip Lift- Los Angeles

Hello and thank you for the question.

Although the photographs you provided do no present your upper lip concerns in their entirety, I get the sense from looking at that photo that you may have a long upper lip. I would need to examine you first-hand to make that determination, as there are several factors which may contribute to a long upper lip, some of them not easily addressable.

A long upper lip may be managed by an upper lip lift in the right patient population. The procedure involves surgical excision of upper lip soft-tissue, with the scar line lying along the caudal aspect of the nasal border. In careful, experienced hands, the results can be exceptional and re-create a youthful upper lip appearance with appropriate amount of upper incisal show, which is lost with long upper lips. This procedure is often performed in conjunction with fat-transfer to the lips, if required for volumization and loss of generalized lip shape.

As a consequence of having an long upper lip, the the delineation of the philtral column may often times be diminished and in some cases nearly-completely obliterated. Because loss of a pronounced, youthful philtral column is considered a silent cue of aging, re-establishing this anatomic feature of the upper lip can create the appearance of a youthful lip. This can accomplished with the use of HA-based fillers such as Juvederm or Restylane. As you suggested, recreatiion of the filtral columns with fillers will also tend to draw the lip up ( to a certain extent), giving the appearance of a shorter upper lip.  I commonly employ this technique with my lip rejuvenation procedures in patients who have lost their philtral column demarcation. The results are typically very satisfying. 

My recommendation is that you consult with Board Certified Plastic Surgeon or Facial Plastic Surgeon who is experience in peri-oral rejuvenation and the various techniques that can be employed to provided optimal results.


Kindest Regards,

Glenn Vallecillos, M.D., F.A.C.S.

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 21 reviews

Lip fillers in the philtral columns - Los Angeles

The philtral columns can sometimes benefit from volume enhancement and this would have to be determined in examination. This is a common practice in most circles.

Raffy Karamanoukian MD FACS

Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
5.0 out of 5 stars 75 reviews

Small thin lips

It is from my experience I have observed  that thin long lips are very difficult to correct with injecting any type of filler.

The anatomy of the upper lip especially is more difficult to correct. Specifically the older you get the more difficult it becomes.

If the philtre is flat it could be augmented with a filler but that correction is in the vertical aspect of the lip.

In difficult cases it is often better to undergo a surgical procedure that removes skin and soft tissue from the are under the base of the nose ( Ala, columella, nostrils) in a gull wing shape. That will create a lift to the upper lip and increase the size of the dry and wet vermilion. It comes with a price scars from surgery.

Good luck!!!

Lip lift vs filler in the philtrum

Thank you for your question and sharing your photo. Lip lifts can be an extremely rewarding procedure that can increase the fullness of the upper lip, give you a little more lip show. The amount of lift does depend on the starting length of the upper lip skin and the desired look afterwards. The incision is hidden at the border of the upper lip skin and base of the nose and spans the width of the nose. I perform these procedures under local anesthesia, but it can also be done with sedation or general anesthesia.

As for fillers in the philtrum column, you can get a modest lip lift using this technique.  I usually prefer using a stiffer filler product such as Voluma or Restylane Lyft (formally known as Perlane) and perform this technique quite routinely when lip augmentation using dermal fillers is part of my facial rejuvenation plan.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.