40 Lip Lift

Rod J. Rohrich, Stephanie E. Farber, and Paul N. Afrooz

Abstract

Perioral aesthetics play a central role in creating a youthful facial appearance. For this reason, interest in perioral rejuvenation has been growing. Lip lift is a surgical procedure intended to decrease lip ptosis, increase eversion of the vermilion, and increase incisal show—all characteristics of a youthful periorbital region. The operation involves the excision of a strip of skin and muscle just inferior to the nose at the superior-most aspect of the upper lip. This intervention effectively rotates and raises the upper lip for an improved facial aesthetic. Here, we characterize the appearance of a youthful lip and perioral region and discuss technical variations of the lip lift procedure.

Lip – lip lift – periorbital rejuvenation – facial aging – facial rejuvenation – lip augmentation

40 Lip Lift

Key Points

The periorbital region is not adequately addressed by other commonly performed surgical or nonsurgical procedures that aim to create a more youthful appearance.
Lip lift is a surgical procedure intended to treat periorbital aging by decreasing upper lip ptosis, increasing vermilion eversion, and increasing incisal show.
Noninvasive procedures such as lip augmentation and skin resurfacing can be combined with lip lift to act as a comprehensive perioral rejuvenation strategy.

40.1 Preoperative Steps

40.1.1 Anatomy of the Youthful Lip

The upper lip aesthetic unit includes the dry vermilion and cutaneous upper lip bordered by the nasal base and nasolabial folds.
An attractive upper lip subunit is characterized by a short philtrum, a prominent cupid’s bow, and a full, everted vermilion.
Philtral height should be approximately 18 to 20 mm, with an upper lip height of 7 to 8 mm, or about 25% of total upper lip height.
The upper to lower lip relationship is characterized by an upper lip that protrudes 1 to 2 mm past the lower lip and is 75 to 80% of the volume.
Other characteristics of the youthful upper lip include a slight superior tilt to the commissure and 1 to 3 mm of incisal show.

40.1.2 Characterizing the Aging Lip

The aging lip is characterized by elongation of the upper lip, flattening of the vermilion, descent of the commissures, and loss of definition of cupid’s bow.
Patients who have undergone a facelift, necklift, or other facial rejuvenation operation may complain of a persistent, aged appearance that can sometimes be attributed to the lips and perioral region. Therefore, lip procedures can more thoroughly address facial aging.
Other procedures in the perioral region can impact upper lip aesthetics and result in a more aged appearance. For example, fillers injected into the nasolabial folds and piriform aperture can cause lengthening and stiffening of the upper lip due to the downward push of the filler on the lip tissue.

40.1.3 Determination of Surgical Plan

A systematic approach can be used to classify senile deformities of the upper lip and determine the best suited interventions by measuring philtral height, labial height, and dental show.
An abnormal philtral height can be corrected with lip lift, while an abnormal labial height can be corrected with lip augmentation. If both measures are abnormal, a combined procedure should be used.

40.2 Operative Approaches

See Video 40.1 and Video 40.2.

40.2.1 Central Lip Lift

The central lip lift is performed most commonly.
Markings are designed in a bull’s horn pattern with the superior border drawn just inferior to the columellar base and nostril sill and extending along the alae to the alar-facial grove, allowing for more lift laterally (Fig. 40.1). The inferior border is marked based on the amount of desired tissue excision, keeping in mind the aforementioned aesthetic ideals (lip length, incisal show, etc.) and noting any asymmetries.
A full-thickness excision is made including skin and subcutaneous tissue with or without partial thickness excision of the orbicularis (Fig. 40.2).
The incision is closed in layers and any autologous fat or fillers are injected at this time (Fig. 40.3).

Fig. 40.1 Markings are designed in a bull’s horn pattern with the superior border drawn just inferior to the columellar base and nostril sill and extending along the alae to the alae-facial grove, allowing a for more lift laterally.

Fig. 40.2 A full-thickness excision is made including skin and subcutaneous tissue with or without partial thickness excision of the orbicularis.

Fig. 40.3 The incision is closed in layers and any autologous fat or fillers are injected at this time.