My philtrum is completely flat and I'm wondering if it's possible to create a philtrum dimple with surgery?

Creating philtral columns in cases where they have been lost (i.e. become flat) with the passage of time, or, as seems to be the case here, when they are not naturally pronounced or well delineated, has become a rather routine procedure these days. It literally takes only small amounts of injectable filler material and only five minutes to create the columns of the philtrum and to ensure the appropriate and desirable "dimple" between them. Belotero Balance is my filler of choice for creating or enhancing the philtrum. When performed properly, the lips themselves should not be effected.It would be wise to seek out an experienced injector and be sure to ask to see his/her before and after photos.

I agree with the other doctors in this forum that the risks of surgically trying to alter this area is too great.  Injecting the philtral columns would not necessarily cause your lips to protrude any farther if it is done in a conservative manner.  A short lasting filler like Belotero could give you the best idea of what things could look like and would be gone in 4-6 months.  Then you could proceed with a longer lasting filler like Juvederm or Restylane.  Filler is the safest option with the least amount of risk.

I would not recommend a surgical procedure to try to enhance the philtral columns or create a dimple there. The risk of that procedure failing to create improvement or creating a new problem is too great. Despite the fact that you do not want filler to change the appearance of your lips, dermal fillers such as Juvederm tend to be the most effective method of creating a more youthful philtrum shape. Filler can be placed only in the philtral columns and, if performed properly, should not change the appearance of the lip itself. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Sometimes starting with the most conservative treatment is best when an unfavorable outcome from surgery could be a possibility. The use of dermal fillers are temporary and reversible. This treatment would provide you with a result that you could see immediately and is relatively safe. Thank you for sharing your photo and question. Best wishes.