Horizontal crease under nose after rhinoplasty. Should I get a lip lift? (Photo)

Question

3 yrs since revision, now have deep line when I smile + feel feel tension pushing down. Wanted "minor touch up" for drooping due to gravity/age, didn't want any change to tip (but it now appears under projected, pinched w/increased philtrum length). Asked my Dr. if Septi muscle was cut or if it's the new Columellar strut, but he just said it was probably there before + I didn't notice. Had other MD consults since, tried botox/filler but made worse. Considered lip lift but concerned w/ scarring.

Ricardo L. Rodriguez, MD · Answer

I have been doing Lip Lifts for over 15 years, and I have noticed that many patients complain of upper lip lengthening after rhinoplasty. I have long suspected it is because the depressor Septi nasi gets disrupted at the base of the columella and detached from it. Since this muscle connects to the muscle that is around the mouth (obicularis Ori), the lip muscle complex loses its connection to the nose and gets dragged down with repeated mouth muscle contraction. This may also be why the columella seems to have lengthened- it got dragged down with the lip.There are also many women who have this fold even without rhinoplasty. Curiously when they pick an upper lip length they like, it almost invariably coincides where that fold is. Like you, I think the fold is related to the "DSN" although I cannot prove it. Regardless, I think the lip lift will do wonders for you because it will accomplish many of your goals, i.e. shorten the lip, get rid of the fold, and restore the columella to its proper position (we fix the lip margin to septal cartilage, restoring the "dsn" to its proper relation to the septum).

Jason Emer, MD · Answer

lip fillers, botox , and threads help this. my patients like to use lip plumpers and exfoliators to make the lips look better too (see link). Best, Dr. Emer.

Gary Linkov, MD · Answer

There are surgical and non-surgical approaches to lip augmentation. Non-surgical approaches include botox (slight lift, reducing gum show) and filler (volume restoration). Surgically, you can have two separate incisions under the nose (italian), one incision under the nose (bull horn), one incision at the red/white upper lip junction (gull wing) or two separate incision at the corners, or a combination, depending on your desired look and anatomy. My preferred surgical technique is called the Elelyft, which is a version of the bullhorn approach. 
The ideal candidate for the Elelyft, or upper lip lift, is someone with a philtral length of 13mm or longer, no upper dental show, and/or a thin upper lip. The nasal base to mouth width ratio needs to be taken into consideration to avoid leaving the lip corners down.
In your situation, the horizontal line is very difficult to correct, including with the lip lift. But a shorter philtrum will make the line less noticeable. 
Consult with an experienced lip surgeon for a complete range of options that are appropriate for your situation.
Gary Linkov, MD
Lip Specialist
Manhattan

Lesley A. Rabach, MD · Answer

You could definitely benefit from a lip lift. This would remove some skin from your philtrum, hopefully decreasing the lines you see. This would also expose more of your lip at rest as well as expose more of your teeth when your mouth is open. There should not be a noticeable scar as your surgeon will be able to tuck it in the fold of the lower nose. Long term, there are no negative side effects of a lip lift. I would recommend consulting a board-certified facial plastic surgeon to discuss your options

Horizontal crease under nose after rhinoplasty. Should I get a lip lift? (Photo)

Answers (4)

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