Aging of the Upper Lip: Part II. Evidence-Based Rejuvenation of the Upper Lip—A Review of 500 Consecutive Cases

Background: Findings from photometric analysis of soft tissue on cranial magnetic resonance imaging demonstrate that the aging upper lip shows significant lengthening, thinning, volume loss, and deepening of the nasolabial folds. In this study, these findings are implemented in a review of 500 cases of upper lip rejuvenation to propose an evidence-based strategy for surgical rejuvenation of the upper lip. Methods: The charts of 500 consecutive surgical perioral rejuvenation patients treated by the senior authors (P.L.T. and A.M.V.) from 2014 until 2018 were reviewed. The surgical methods of lip lift and fat grafting were described in relation to the cases and the metric data. Results: Of the 500 patients, 51 had an isolated procedure such as a lip lift (3 percent), lip augmentation (3 percent), augmentation of the nasolabial folds (2 percent), or skin resurfacing (2 percent). The remaining 449 patients underwent combinations of lip lift, augmentation of the lip and nasolabial fold (32 percent), lip lift with augmentation of the lip and nasolabial fold with resurfacing (30 percent), lip augmentation and resurfacing (14 percent), or lip lift and resurfacing (14 percent). Conclusions: Rejuvenating the upper lip needs to address both lengthening and volume loss. This requires a combination of surgical shortening of the upper lip by a precisely designed lip lift and a differential filling of certain upper lip regions by microfat grafting. The combination of these two modalities works synergistically. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.