The most dramatic method of increasing the size of the upper lip is the lip advancement procedure. To expose more pink of the upper lip (which can dramatically increase its size), skin is removed from just above the pink portion of the upper lip. This cut out pattern is made like a ‘cupid’s bow’ (which is often necessary given that many small upper lips have little definition and are quite ‘flat’) which provides nice shape to the upper lip in the central most pouty area. This procedure, however, is not that commonly done as injectable fillers do very nicely for most people and do not leave a scar. They are, of course, not permanent. However, in those with a very thin upper lip particularly older patients who also have some upper lip lines and wrinkles, the lip scar may well be a reasonable trade-off ffor the permanency of the result.
Another option to lift the upper lip is not to place the scar at the upper lip but to place it beneath the nose. This is called a subnasal lip lift. In this procedure, the cutout of skin is done right under the nose (resembling a bullhorn shape), so when it is closed, the scar lies in the natural groove at the base of the nose. This does hide the scar well. As the width of the cutout of skin is just the width of the nose, only the central portion of the upper lip (cupid’s bow area) actually gets lifted. The sides of the upper lip stay the same as they get no effect of the central upward pull from the skin cutout. This is the other difference that distinguishes the subnasal lip lift from the more traditional upper lip advancement. Which operation is best depends on what upper lip problem the patient has and where they can ‘deal’ with the scar placement.
Dr Barry Eppley