How do I reduce my puffy philtrum? (Photos)

Question

I had a lip lift in October 2023 which went poorly, so I underwent a lip revision which addressed most of my concerns except it gave me noticeably puffy philtrum which sticks out more than I'd like. Are there any solutions for flattening the outward projection? Thank you.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concern. I know how frustrating it can be when you go through a procedure hoping for improvement and end up with a new feature that bothers you. Lip lift and revision surgeries can sometimes change the contours of the upper lip and philtrum in ways that take time—and sometimes additional refinement—to address.

After a lip lift, a puffy or outward-projecting philtrum can occur for several reasons:

Residual Scar Tissue or Tissue Thickening

One of the most common causes is scar tissue formation beneath the incision line. Even when the surface scar looks healed, the deeper tissue can remain slightly thickened or firm. This can create the appearance that the philtrum is fuller or pushing outward. Scar remodeling can continue for 12–18 months after surgery, so some improvement may still occur naturally over time.

Structural Changes from the Lift

A lip lift shortens the distance between the nose and the upper lip by removing skin and elevating the lip. In some cases, this changes the angle of the philtrum, making it appear more projected even if the tissue itself isn’t significantly swollen.

Swelling That Lingers Longer Than Expected

Although most swelling resolves within a few months, some patients experience subtle persistent swelling or lymphatic congestion, particularly after revision surgery.

Possible Treatment Approaches

Depending on the underlying cause, there are several approaches that may help soften the projection:

1. Scar-modulating treatments
If scar tissue is contributing, treatments such as intralesional steroid injections, silicone scar therapy, or gentle laser treatments may help flatten and soften the area.

2. Small amounts of hyaluronidase (if filler is present)
If any filler was used during or after revision, dissolving a small portion can sometimes help reduce fullness.

3. Subtle contour refinement
In some cases, experienced surgeons can use very conservative filler placement in adjacent areas to balance projection and create a smoother transition between the upper lip and philtrum.

4. Minor surgical scar revision
For persistent contour issues, a small scar revision or debulking procedure performed by an experienced facial plastic surgeon may help reduce thickness of the tissue beneath the scar.

A Reassuring Note

Many patients become very aware of small contour changes after facial procedures, but over time scar tissue softens and blends more naturally with surrounding tissue. Improvements can continue well beyond the first year after surgery.

Your concern is understandable, and fortunately there are several ways specialists approach this issue depending on what is causing the projection. With thoughtful evaluation and conservative management, the area can often be improved so that it appears more natural and balanced.

How do I reduce my puffy philtrum? (Photos)

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