Dr. Sam Lam Plastic Surgery Forum

Dr. Lam,

I am currently scheduled for a consultation for a bullhorn lip lift with an orthognathic/plastic surgeon in Florida with a tentative surgery date in April of this year. My philtrum is 2 cm long, I'd greatly prefer 1.1 cm.

But, I have seen your botox video and also the results from a paper on botox injection to correct for masseteric hypertrophy, which greatly softens the contour of the chin. I was wondering if something similar could be done to shorten the philtrum, if it is possible to strategically inject the orbicuaris oris to shorten the philtrum combined with injections to lift the corners of the lips to get a similar but less invasive effect. I can send a pic by PM.

I thank you in advance for your great work and for doing your part in educating all of us.

thanks for the question. botox can lift the corners of the mouth but to shorten the philtrum, doubtfully. but it does not last long so it has no comparison to a surgical procedure. here is a video of lower face anatomy and botox techniques:
http://lamfacialplastics.com/gallery2/v ... _Face.html
you probably know that i am staunchly opposed to lip lifts in about 98% of people. i only do it in older women (60 plus) with skin damage and a very thin upper red lip. any way those are my opinions.
best,
sml

watch this video on lips too if you haven't yet:
http://www.lamfacialplastics.com/galler ... +Lips.html

ok, i reviewed your photos. here are my thoughts:
1. as you said, you have a nice full lip. the problem with a lip lift is that it may shorten the philtrum but it will lift the red lip upward. my opinion this almost always looks funny in a younger patient such as yourself. that is something you have to like the doctor's work, and if so, then proceed. however, i simply hate 95% of lip lifts, and as i said i wind up doing one a year in older women who have a non-existent upper lip and a very long philtrum. i personally do not consider yours long enough to do it.
2. as far as scar, yes you will have one. however, in most cases makeup should cover it. that is what i always tell my patients is that you could possibly see the scar without makeup. maybe your doctor thinks differently. second, i believe that keloids are almost impossible on the face. however, hypertrophic scars due to bad incisions can happen or just luck.
3. as you may have seen, i am totally opposed to how most women see their face, i.e., they need something done on the upper lip. all surgeons and physicians have inherent biases and also an aesthetic perception that color their worldview. my opinion is that working on the top lip is fraught with making people not look as good as i would like. that is my opinion. we all have opinions. that is why you must just choose the "artist" that you like the most. nothing wrong with liking a fuller upper red lip but i think they look a bit done in my opinion.
best,
sml

Thanks again for your thoughts. I can see it having an abnormal-looking outcome in a young person, and being a more suitable procedure for the older patients who aim to look younger as opposed to more beautiful without distortion, which seems to me the more difficult goal to reach. Certainly the literature has focused on older women as patients. One paper I read recently listed 3000 older satisfied patients. But a photo of one woman in the paper showed a severely distorted nostril at 7 years post-op (Weston et al., Aesthetic Surg J 2009;29:83–86, figure 4E). I'd rather not have to deal with that. You have certainly given me food for thought.

yes, there is obviously a risk of pulling down the nose. that is another reason i don't prefer to do it. but that is minimal as a risk compared to seeing the flipped up lip look in my opinion. it is funny because i am now on round 5 of silicone to the bottom lip for a lady who had a lip lift just to make the bottom lip almost in balance (it will never be but i am getting closer), and i just saw her today so i thought of this post.
best,
sml