Unsure Whether I Need a Lip Lift Operation or a Rhinoplasty to Achieve Balance (photo)

Hi,

I can see why you are displeased with the final results, the alar base is certainly widened and the lip is asymmetric.  I agree with many of my colleagues, however, that you should be very conservative in your approach because you do still have very nice features and all you really need is refinement...nothing drastic.

For the nose, alar reduction via lateral wedge or internal (sill) reduction will likely work best to reverse the cause (which you correctly pointed out is due to your maxillary procedure and the release of the normal nasal attachments).  The lip is best addressed with hyaluronic acid injections every 6 months (conservative) or micro-injection of fat.  If you were a member of my immediate family, I would push more strongly for just the HA injections (like Juvederm).

Remember, though, that although these things may improve your areas of concern, the orthognathic surgeries you have had do change your appearance (not worse or better, just different) and this takes some time to get used to.  You have to go through the psycholigic hard work of accepting your new look, which involves letting go of some of the areas that bother you.  I wish you all the best!

The answer is neither. Your face and nose look fine and normal. You can always find someone to operate. You are pretty as you are!

Maxillary osteotomies very commonly widen the width of the nostrils due to the intraoral vestibular incision and muscle release. The width of your nostrils can be reduced by a simple alar wedge procedure which can be done in an office setting under local anesthesia. I would leave your upper lip alone. Any form of a lip lift, while shortening the vertical length of skin between the nose and lip, will increase your tooth show at rest and further distort your lip shape.

First off, you have a great looking face. 

You could improve your lips simply and reliably with filler.  I wouldn't to much else.

If your nose flares/flattens a bit with smiling you could do an internal nasal base reduction via your mouth behind the upper lip.  Your issue, though mild to moderate, does occur after maxillary/midface surgeries (Le Forte) so when I perform these I do a little nasal base reduction via intraoral route (same incision used for the maxillary osteotomies) in anticipation of this.  When you do this transoral route for the base reduction you can incorporate some soft tissue plication of the upper lip where it will bunch up a little and hopefully give you your previous look back, though it's not a definite result.  So you could do all that with no external  incision but I gotta tell ya, you really have a pretty face so keep it as simple and concervative as possible.

Best of luck

Dr. Chase Lay

Oh!  Don't do the lip lift.

I don't think you need a lip lift or rhinoplasty.  You may consider fillers for slightly augmenting the upper lip.  Making it about 20% fuller would look nice and still natural.  A nice result would not make your lips look too big, but slightly fuller.  This will also help with the amount of dental show.

Looking at your photos, a lateral view would be helpful. As far as your lips, a lip lift procedure is the last thing you need as you already have excess dental show and that procedure would only exacerbate it. Adding some volume to the central part of your upper lip would help with this. A rhinoplasty could refine your nasal tip and a conservative alar base reduction may help.

You are very pretty as is and I think pushing the cosmetic envelope too far is risky physically and psychologically

I would not recommend any addiional surgery to your lips and limit any nasal surgery to slight narrowing of the nasal base by decreasing the flare of your nostrils. I'm suggesting minimal refinement.

IMHO, not so much of an upper lip lift but a lip augmentation as the upper lip itself is quite small and thin.  Both lips should be fuller, IMO.  Alloderm, is the best semi-permanent solution for lip augmentation.  The nasal tip could be thinned with a Closed Rhinoplasty that would add further aesthetic improvements.

In looking at your photos, I think the aesthetics are fine. One rule in plastic surgery is "The Enemy of Good Is Better"  That is, if you have a good result and keep trying for better the odds are high you will just wind up ruining the good result.