How to fix overhanging lip - hidden smile? (Photos)

Question

Im not sure how to fix my smile - my upper lip overhangs my upper row of teeth. My teeth hence look very small. Before I had lip filler my lips were very thin but you could see my full smile, I don’t want to have small lips again but I’m unhappy with my diminished smile. Should I get a lip lift (Elelyft) or instead look at composite bonding to enlongate my teeth, as I’m unsure if they are just in fact small.

Gary M. Horndeski, MD · Answer

I recommend an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Carl Truesdale, MD · Answer

The 'hidden smile' appearance happens when the upper lip is long (distance from nostril base to lip vermilion) and covers more tooth than ideal. Two procedures address this from different angles.
Subnasal bullhorn lip lift:The most common solution. A small incision is made under the nose, a strip of skin is removed, and the upper lip is lifted up. This shortens the philtrum (skin between nose and lip) AND increases tooth show at rest and when smiling.
Recovery: 7 to 10 days for visible swelling. Scar hides in the natural shadow under the nose, typically nearly invisible at 6 to 12 months.
Best for: patients with a long philtrum (over 15mm in women, over 18mm in men) and reduced tooth show.
Upper lip reduction:A different procedure that removes a strip of tissue from inside the upper lip (where the lip rolls inward at the wet-dry border). This reduces the vertical bulk of the upper lip itself, making the lip appear less heavy or overhanging.
Best for: patients whose issue is a thick or bulky upper lip rather than a long philtrum.
How to tell which you need:Measure the distance from the base of your columella (between your nostrils) to the cupid's bow of your upper lip. If it's over 15 to 18mm depending on gender, you have a long philtrum and a lip lift is the right tool. If your philtrum is normal length but your upper lip is just thick or heavy looking, lip reduction is the answer.
Sometimes both:Patients with both a long philtrum AND a heavy lip benefit from a combined approach in one session.
What to consider:
The 'no tooth show' appearance is normal aging in many patients &mdash; the upper lip elongates over time and tooth show decreases. Lip lift restores the more youthful proportion.
If you've already had a lip lift and it wasn't enough, a revision with slightly more aggressive resection can be done, but only after 6 to 12 months of healing.
Common mistakes to avoid:
Aggressive lip lift in young patients without true philtrum length issue &mdash; creates an unnatural short upper lip.
Lip reduction by inexperienced surgeons &mdash; can create asymmetry or wet-dry border irregularity.
Best move: see a facial plastic surgeon who does both lip lift and lip reduction. Bring photos of your smile from your 20s if you have them &mdash; useful baseline for what's changed vs always been the case.

How to fix overhanging lip - hidden smile? (Photos)

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