1 year post failed lip lift - what treatment options will help with tightness and discomfort? (Photos)

Question

Hello, I would appreciate the opinion of surgeons experienced with lip lift procedures and revisions. One year ago, I underwent a SCAR RÉVISION from previous lip lift. Unfortunately, I am not satisfied with the outcome. My philtrum now measures approximately 8 mm and feels excessively short for my face. In addition to the aesthetic concerns, I experience persistent tightness, tension, and discomfort around my upper lip and mouth. What concerns me is that my result appears to have stabilized. When I compare photos taken about 2 months after surgery with my current photos at 1 year post-op, I see virtually no change. My main concerns are: * My philtrum is now approximately 8 mm long. * I have difficulty closing my lips comfortably at rest. * I constantly feel tension, tightness, and pressure around my upper lip and mouth. * I often feel as if the tissues are pulling in different directions. * These symptoms have remained essentially unchanged for the past year. I would like to ask: 1. Is an 8 mm philtrum considered unusually short for an adult over 35 years old following a lip lift revision? 2. Is it normal to see almost no change between 2 months and 1 year after surgery? 3. If significant tightness and tension are still present at 1 year, what are the most likely causes? Could this be related to internal scar tissue, deep permanent sutures, over-resection of tissue? What treatment options are available if a patient has persistent tightness, functional discomfort, and

Anna Chacon, MD, FAAD · Answer

What you’re describing is a situation we take seriously, especially because it’s not only about appearance, but also about function and comfort—lip mobility, resting position, and that persistent sense of tightness.

At one year after a lip lift revision, the tissues are generally considered fully matured and stabilized, so ongoing symptoms at this stage are less about “normal healing” and more about structural or scar-related factors that have become fixed.

1. Is an 8 mm philtrum unusually short after a lip lift revision?

An 8 mm philtrum is on the shorter end of the spectrum, particularly in adults over 35. That said, the issue is not just the number—it’s facial proportion and lip function together.

A shortened philtrum can sometimes:

increase upper lip tension at rest
reduce natural lip seal without effort
create a “pulled” or tight sensation if soft tissue was over-advanced or scarred

So yes, in the context of symptoms, that measurement can correlate with functional tightness, not just aesthetics.

2. Is it normal to see almost no change between 2 months and 1 year?

Yes—this part is actually expected.

By around 2–3 months post-op, most swelling has resolved and scar remodeling has already begun. Between 6–12 months, changes are usually subtle:

scars soften slightly
tissue becomes more pliable
but overall structure remains largely the same

So if your result looked similar at 2 months, it is not surprising that it appears unchanged at 1 year. At this point, the outcome is considered fully set.

3. What could be causing persistent tightness and tension at 1 year?

When symptoms persist this long, we typically think beyond normal healing and consider a few structural possibilities:

A. Internal scar tethering

Scar tissue beneath the skin can create:

pulling sensations
restriction in upper lip movement
a constant feeling of tightness even at rest

This is one of the more common causes.

B. Deep sutures or suture reaction

Occasionally, buried sutures (or residual suture material) can:

act as anchoring points
create focal tension
cause a sensation of “pulling in different directions”

Even if not infected or visible, they can still affect movement.

C. Tissue over-tightening or over-resection

If too much skin or soft tissue was removed or if closure tension was high, the lip can become:

functionally restricted
harder to relax at rest
associated with chronic muscular compensation

This is often described as a “constant tight band” feeling.

D. Muscular adaptation

The orbicularis oris muscle can adapt to altered anatomy, leading to:

overactivity or guarding
difficulty achieving a natural relaxed lip posture

This can contribute significantly to discomfort.

4. What options exist at this stage?

At 1 year post-op, treatment is no longer about routine healing—it becomes targeted correction of scar or structural tension.

Options may include:

Non-surgical approaches (first line for many cases)
Scar modulation therapies (such as intralesional steroid or 5-FU injections in selected cases)
Silicone-based scar management if surface component is contributing
Carefully guided neuromodulator use in very specific cases to reduce muscle tension (used cautiously in the perioral region)
Manual scar release techniques in select patients with fibrotic tethering

These aim to soften and reduce restrictive forces.

Procedural / surgical revision options

If symptoms are significant and persistent:

Scar revision with release of tethering bands
Removal or adjustment of deep sutures if present
Soft tissue rebalancing procedures to restore lip mobility

These are more definitive but require careful evaluation because the goal is improvement without over-lengthening or destabilizing the lip.

1 year post failed lip lift - what treatment options will help with tightness and discomfort? (Photos)

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