What are my options for correcting upper lip (philtrum) appearance and minimizing a scar after an accident (photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

The Cupid's Bow, philtrum, and vermilion are very cosmetically sensitive areas that are noticeable readily at conversation distance.  When injured or incised, great attention should be taken to reapproximate these landmarks perfectly.  Your photos demonstrate some scarring down to the underlying soft tissue/muscles, which is causing some indentation to the area.  I agree, your philtral column is not well-aligned as well.  The good news is that your scar hides within the hair-bearing area and may be hidden.  Depending upon how long ago your injury occurred makes a difference for recommendations.  If greater than a year ago, the only thing that would likely ameliorate your concerns would be for a scar revision to fix the aforementioned things.  If more recently, I would continue with scar massage to hopefully soften, disrupt scar tissue, and hopefully produce the finest scar that you can, given the injury.  Scar revision still may be in order afterwards, but theses conservative measures will help.Thank you for your question and photos.  Hope that this helps!  Best wishes!

You may need to undergo a lip augmentation procedure, one I do changes particuarly the cupid's bow area and is called a subnasal lip lift.  However, the scar you have may need to be revised either with surgery or a combination of surgery and laser +/- fillers.  I would seek a plastic surgeon or dermatologic surgeon with expertise in scar revsion.  I wish you the best of luck, Dr. Emer.

My review of your photo reveals a widened, depressed, oblique scar across the left philtrum. You will benefit from a scar revision designed to re-oriented the scar (Z-plasty technique) and evert the edges. This can be performed under local anesthesia by many cosmetic surgery providers (facial plastic surgeons, plastic surgeons, cosmetic dermatologists) as long as they are meticulous in the technique of scar revision. Depending on your healing you may then benefit from injection(s) of fillers to increase the height of the philtrum. Laser resurfacing or micro-needling may be use to improve the texture of the scar and to diminish the suture marks, but in my opinion, you need to undergo a surgical scar revision first. Best of luck.

Dear Jacob:It looks like whatever original repair you had did not reorient the muscle fibers along your philtrum, and also inverted causing the central depression. When you smile, the muscle known as the orbicularis oris is likely pulling at an improper angle, causing the pull toward the scar direction. A couple of options to improve the scar: A surgical option would be what is known as a Z Plasty. The goal would be to re-orient the muscle and the deep tissue to its normal position, then evert the edges of the wound so that you no long have a depression. A nonsurgical option would be the Lumenis Utraplus laser using Total FX. The goal would be to remodel the depression with new collagen and then resurface the overlying skin so that the actual line is gone. This laser has been extremely effective in scar treatment by a process known as wound remodeling. Though filler can be excellent for some scars, I am not confident that filler would be of great benefit in this type of scar. If the scar is adherent to the underlying muscle which is pulling at an oblique angle, the filler will have a difficult time achieving a good result and correcting the depression. BestDr S