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

It seems that the left peak of my philtrum has healed crookedly where the stitches were located. The peak is split half way up by a depressed line. The top half is disconnected and askew from the bottom half by a few millimeters. Also, the lines and folds of my upper lip that occur through natural facial expression now seem to pull toward the lines of the scar. What are my options for correcting the appearance of my upper lip and minimizing the appearance of the scar which includes atrophic and hypertrophic sections?

Doctor Answers 4

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

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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!

Scottsdale Plastic Surgeon
5.0 out of 5 stars 28 reviews

Hypertrophic scar, upper lip philtrum

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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.

Jan Zemplenyi, MD
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

Upper Lip Scar

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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. 


Dr S

Travis L. Shaw, MD
Richmond Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Upper Lift Scar And Abnormal Shape

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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.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

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.