Will skin graft help to fix scars and make philtrum longer? (Photo)

Question

hi more than a year ago I had a very unsuccessful lip lift I was left with a huge wide scar on one side deep and. very short distance between the nose and the lip 10 cm in the middle and 9 on the side and I understand that if I remove the scar then the lips will not close. I am thinking of skin grafting in place of the scar but I am not sure if this will give a good result I would like to have a 12 cm philtrum and remove scar. What can be done?

Anna Chacon, MD, FAAD · Answer

Thank you for your message and for providing background on your case. I'm sorry to hear about the challenges you've faced following your lip lift procedure. Addressing both a significant scar and shortened philtrum length after a lip lift is complex but not impossible. Here are some considerations:

1. Skin Grafting
Skin grafting may technically help to restore length to the philtrum and replace scarred tissue, but it’s important to understand:

Color and texture mismatch is common, especially in central facial areas.

Grafted skin may not blend seamlessly with surrounding tissue, which can affect aesthetic outcome.

Mobility and contour of the upper lip could also be altered depending on graft placement and healing.

2. Tissue Expansion or Local Flaps
In select cases, local tissue rearrangement (flaps) might be more favorable than full-thickness skin grafts.

These use adjacent skin with similar color/texture for a better match.

This can sometimes help reconstruct the philtrum while minimizing new scars.

3. Scar Revision Alone
Scar excision and re-closure might be possible if tension can be redistributed and if the surrounding skin allows for some advancement.

However, as you mentioned, lip closure and function must be carefully preserved.

4. Realistic Expectations for Philtrum Length
Lengthening the philtrum from 10 mm to 12 mm surgically is limited by your natural anatomy and available soft tissue.

Overcorrection may lead to functional or aesthetic compromise, such as difficulty with lip seal or abnormal lip motion.

5. Multidisciplinary Input
Complex facial revisions often benefit from a collaborative approach involving:

A facial plastic surgeon (ideally with reconstructive experience)

A dermatologic surgeon (for scar and grafting expertise)

In some cases, a prosthodontist or maxillofacial surgeon if skeletal support is involved

Summary:
While skin grafting is a possible solution, it may not offer the most aesthetically ideal result, particularly on the central face. A customized reconstructive plan—potentially involving scar revision, local flap techniques, or soft tissue fillers for camouflage—may yield a better outcome. The philtrum can potentially be lengthened slightly, but a 2 mm increase should be approached cautiously to preserve lip function.

Please let me know if you need help interpreting treatment options you've been offered or would like product-based recommendations to improve scar appearance in the interim.

Ramin Behmand, MD, FACS · Answer

Skin grafts on the face tend to be quite noticeable, and since your lip has a normal appearance and functions well, grafting may not be the best solution due to its poor aesthetic outcome. However, addressing the visible scar from the upper lip lift could be helpful. If there’s concern about shortening the upper lip further, not all the scar needs to be revised at once. On the side where the scar extends too far, a revision could hide it better within the nostril sill, breaking up the appearance of a continuous scar.

Another option to consider is avoiding scar revision altogether and instead exploring treatments like CO2 or Erbium laser resurfacing. This could create a more uniform skin texture and reduce the scar's visibility without further surgery. In either case, it’s important to consult a highly experienced surgeon who can take the time to carefully evaluate your situation and recommend the best approach for your needs.

Dr. B.

Gary M. Horndeski, MD · Answer

A skin graft will look very mechanical and be unattractive.  You would be better off with a scar revision.  The scar can be broken up by repositioning into the alar sill rather than directly below the nose.  The middle section is reformed.  It is unlikely that this will prevent you from closing the lips.

Best Wishes,

Gary Horndeski, M.D.

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