Any decent alternative to a lip lift if I can't live with the scar? Have had many consultations with varying opinions (photo)

Question

28/f. My concern is that I dont have enough incisor show (approx 40% when smiling, none in repose). My upper lip is about 21-22mm, so right at the cusp of average. When smiling, my upper lip feels tight and forced and recedes into my mouth. oral surgeon said my bite looked fine and dont need orthognathic surgery, however I have mild hypoplasia. Is there anything besides a lip lift that I could benefit from? Frenulum cutting, premaxillary implants, epigenetic orthodontia/DNA appliance?

Toby Mayer, MD · Answer

The majority of the lip lift scar is a fine line at the base of the nose that is not seen normally. There is no good alternative that I know of to raise the lip. See a very experienced surgeon who does this frequently and see his patients in person.

Randal Haworth, MD, FACS · Answer

Thanks for your question and photos. Strategically placed filler, containing hyaluronic acids such as Juvederm, Restylane, and Volbella, can create fuller volume in the lips.  Indeed, it can even suddenly change the shape of the lip as well. However, if you have significant lip shape issues, such as a long upper lip or drooping corners, then you would need other surgical procedures in order for you to achieve your ideal lips.After performing thousands of upper, corner and lower lip lifts, the secret to unparalleled longevity and beautiful,  natural shape is stability. One must understand that like the hands, the lips move hundreds of thousands of times a day, eating, talking, expressing and other things that shall go unmentioned at this time. Therefore, for an upper lip lift to be successful in terms of beauty and longevity, it should not only resist the downward pull of gravity but also be stabilized against everyday movement (which contributes to re-stretching of the lip, obvious wide scarring and downward pull on the nose).
The OOS superficial muscle technique provides this very stabilization by anchoring the superficial layer of the muscle just below the dermis to the periosteum (or lining of the bone) below the nose. By stabilizing the lip in two directions bilaterally I am able to customize the curl and expression of the upper lip to make it not only youthful but sensual as well. The two direction approach is analogous to the way a marionette can come to life by the hands and strings which control it. The skin-only lip lift is a far simpler operation to perform and solely involves removing skin and sewing the skin edge of the lip to that of the bottom of the nose. The only thing holding the skin-only lip lift in position are the dissolvable stitches in the dermis which are no match against constant daily mouth movement and gravity's pull. 
 I can personally attest to the dramatically decreased longevity, unremarkable results, worse scarring and nasal distortion from the thousand or so skin-only lip lifts I performed in the 90s. Though the skin-only  recovery is easier, the current version of the OOS upper lip lift may allow the patient to appreciate results as early as 10 days. Not only does the OOS technique shorten the distance between the nose and lip but it also allows upper tooth show( that goes without saying really), subtle added rollout of the upper lip's pink vermilion, welcomed narrowing of the aperture of the mouth (that gets wider with age) and even noticeable reduction in the nasolabial folds. Contrary to some misperceptions, no muscle is removed and no cases of permanent numbness or any paralysis ever encountered.To get a complete assessment, a plastic surgeon needs to see you in person and also assess your upper lip against the backdrop of your upper teeth when your mouth is slightly parted.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. I suggest that you consult with a board certified facial plastic surgeon because injectables may be helpful. 
Best wishes,

Steve Laverson, MD, FACS · Answer

OMG, you have done a great deal of research and are quite the educated patient.  As implied by other responders, it's difficult to offer truly specific professional advice without seeing you.  In general though, the best alternative may be NO procedure at all for now.  You are young, and can always get something done in the future if it continues to be an issue for you.  The pre-maxillary implants I've placed leave no external scar and results are nice, long lasting, and more substantial than gel filler which is less structural than a solid implant.  Two examples in our gallery at link below.

Brent Moelleken, MD · Answer

Many refinements are possible, including volume augmentation (we prefer autologous grafts over fat injection/transfer); lip nose length reduction (often carried out at the same time as volume augmentation).
These techniques are highly artist and technique dependent, so choose wisely!

Kenneth D. Steinsapir, MD · Answer

The surgeons who are proud to this disfiguring scar are the same surgeons who think that their hairline forehead lift scars are wonderful-they are not.  You are trading a normal lip for a permanent and visible scar line at the base of your nose.  The surgeons who do these are unrealistic about the appearance of their scars.  Don't do this to yourself. An additional problem this the bullhorn lip lift is that it distorts the upper lip and that can't be corrected.  Consider trying a reversible lip edge filler.  No it does not quite accomplish what you have been searching for but you might appreciate the enhancement and it does not cause a permanent scar.

Jason Emer, MD · Answer

PDO nova threads can be used to provide lift and improve shape. Fillers combined with Botox is an alternative. I recommend getting a formal evaluation with a facial sculpting expert. Best, Dr. Emer

Johnson C. Lee, MD · Answer

Thank you for your photos. It appears that you are quite knowledgeable at this point about your options. Alternatives to a lip lift include using hyaluronic acid filler to help increase your upper lip width and improve your overall proportions between your lips. This can also help with the thinness or receding of your lip when smiling by adding volume. However, filler will not improve your incisor show at repose. Ultimately it depends on what your priorities are as each option has its pros and cons. It is best to have an in-office examination examination to determine which treatment plan is appropriate for your situation. Hope this helps!!Johnson C. Lee, MD Plastic Surgery@drjohnsonlee

Jeffrey Jumaily, MD · Answer

thank you for your question and photos. A lip lift may be a good option for you but it's hard to tell from these photos. We would like to see a photo without smiling. With you smiling, your upper lip to teeth relationship looks normal. The absolute measurement of 21-22mm does not mean much, what matters is the relationship. A consultation can help answer all these questions quickly and you'll have a good idea what to do. Best wishes.

Justin Harper, MD - Account Suspended · Answer

Lip fillers will be able to give you a nice full lip when you smile. Based on your pictures, I would tell you to make a free consultation with a trusted provider and see what they have to say.

Any decent alternative to a lip lift if I can't live with the scar? Have had many consultations with varying opinions (photo)

Answers (10)

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