Lower lip projects more than upper lip - how to fix Rickett’s line? (Photo)

Question

Due to lip incompetence and overbite, I have mentalis strain and my lower lip projects more than my upper lip when forcing lip seal. I’m receiving orthodontic treatment to fix this; however in the meantime what can I do to increase upper lip projection to align with Rickett’s line? Would lip fillers, Botox lip flip, or threading be options? If braces don’t fix it, would a lip lift or repositioning? I have a short philtrum already and don’t want huge lips; just want alignment not a size increase.

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful and detailed question — you’re absolutely on the right track by addressing the skeletal and dental foundation first with orthodontics. Lip projection and balance with Rickett’s line can indeed be influenced by both structural and soft tissue factors.

In the meantime, here are a few strategies that can help improve upper lip projection without creating an unnatural or overly full look:

Strategic Lip Filler Placement:
A small amount of hyaluronic acid filler placed precisely along the vermilion border and philtral columns can help enhance projection without adding excessive volume. The goal here is contouring and alignment, not fullness. A conservative approach will prevent distortion, especially since you already have a short philtrum.

Botox Lip Flip:
This can be a nice adjunct to gently encourage the upper lip to evert and appear slightly more projected. While subtle, it works well for patients who are looking to improve lip posture during speech or at rest without changing volume. It may also help with some mentalis overactivity temporarily.

Thread Lifting or Lip Threading:
This can offer mild elevation and contouring of the lip area. However, in most cases, filler or neuromodulators like Botox provide more predictable results for projection.

Mentalis Botox (Optional):
If mentalis strain is pronounced while sealing your lips, a microdose of Botox in the chin area may help reduce that tension and balance the lower lip’s appearance. This must be done very carefully to avoid interfering with natural movement.

If Orthodontics Alone Aren’t Sufficient:
Once your braces are off and facial growth and bite are more stable, you can reassess the need for further interventions. A lip lift may be considered, but given your short philtrum, this would need to be approached very conservatively. Lip repositioning surgery is another possible option, but it is typically reserved for cases where functional or aesthetic concerns persist after dental correction.

Ultimately, a customized approach—often combining minor filler with conservative Botox—is ideal in your case. I’d be happy to help assess your facial balance and design a plan tailored to your proportions and goals.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. To enhance your upper lip projection and align it with Rickett’s line while undergoing orthodontic treatment, lip fillers can be a highly effective option. Dermal fillers, specifically hyaluronic acid-based ones, can provide immediate volume and lift to the upper lip, helping to create a more balanced appearance. By strategically injecting filler into the cupid's bow and the body of the upper lip, you can achieve a more pronounced projection that complements your facial structure. This approach can help counterbalance the appearance of the lower lip, particularly during the interim period of your orthodontic treatment. Lip fillers are versatile and can be adjusted based on your desired look, allowing for a natural enhancement that aligns with your aesthetic goals. The results typically last several months, giving you the opportunity to reassess after your orthodontic treatment progresses. I hope this helps and best of luck!

Camille Cash, MD · Answer

You can consider adding a little filler to the upper lip to increase the volume.  Naturally the bottom lip is fuller than the upper.  HA fillers are a good option for you since you may notice changes as you progress through your orthodontic treatment and lip fillers are temporary.  See an expert injector to learn more.

Leonard Grossman, MD · Answer

People with upper lip protruding beyond the lower lip, and vice versa is kind of divided half-and-half amongst the population. It does not mean that it requires any kind of correction. However, if it bothers you a great deal, I would recommend having some filler placed into the upper lip for better projection or more projection as I should’ve said. Your chin is also quite small and I would recommend having a chin enlargement as well in order to improve general facial proportions. I hope this helps and good luck from New York City plastic surgery, Dr. Leonard Grossman

Mats Hagstrom, MD (license on probation) · Answer

It’s normal for the lower lip to be larger than the upper lip. And most people, the lower lip also projects slightly more forward.
The relationship of the lips to each other is directly related to the dental position or occlusion.
Individuals who have a significant overbite typically have an insufficient mandible in relationship to the maxilla.
This leads to the upper lip often having more forward projection than the lower lip.
Almost all facial soft tissue issues related to aesthetics are based on facial skeletal structure.
Issues related to the lower, 1/3 of the face are therefore usually related to the shape and size of the mandible.
Facial aesthetics are not only based on the relationship between the maxilla and the mandible, but both skeletal structures can be over projecting or under projecting.
I find oral surgeons, especially those Who are involved with cranial facial surgery a really good at making a quality assessment based on fundamental bone structure.
Oral surgeons tend to be more bone oriented while plastic surgeons tend to be more soft tissue oriented.
That’s a plastic surgeon. I used to see things in terms of soft tissues because that’s what I was taught to do and the tools I had were almost exclusively related to soft tissue manipulation.
 The more time I spend doing this kind of work convinced that almost all facial aesthetic issues have as a fundamental problem, a skeletal origin. 
On your profile picture, the mentalis region of your mandible is slightly backward sloping. you have a shallow (small) labiomental sulcus. When that’s the case, shin augmentation is often ideal.
The chin can be successfully enhanced, using fillers, a chin implant, or a sliding genioplasty.
All of these treatments have advantages and disadvantages and treatment is better than the other. Enhancing or augmenting your chin would be the easiest way to improve your Rickett’s line.
Ultimately, the lack of projection of your midface can only be treated surgically. Cranial facial surgery isn’t for everyone.
Even though someone may not consider a Le Fort type surgery it can be helpful to get a Complete facial skeletal assessment.
Even if treatment options are not directed at the Primary underlying cause it can help to understand why soft tissue manipulation is going to give a partial improvement. 
Having a good understanding of the underlying cause can be helpful in making decisions of procedures or solutions.
Facial aesthetics is a complex field and different providers will definitely have a different views.
The longer I practice the more convinced I am that facial skeleton structure is at the underlying cause of almost all facial aesthetic issues, other than direct aging.
Those who age well tend to have strong, skeletal foundation to support the soft tissues.
In regards to your question, I don’t think the problem is with your lower lip and its projection, but rather the lack of projection of the upper lip. The issue if you want to call it that is in the Maxilla. 
Best,
Mats H
In my next life, maybe I’ll be an oral surgeon.

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