The philtrum is located between the nose and upper lip, from the bottom of the columella to the upper margin of the procheilon, and its length varies along with individual face shape (1.8–2 cm on average). With the physiological functions of connecting the nose and upper lip, an exceedingly long philtrum is prone to expose the defects of upper palate prominence or upper lip droopiness and is unable to expose teeth or tooth crevices on smiling, which makes people appear serious or senile. A long philtrum even affects the proportion of the midface and results in an exceedingly long midface, so philtrum reduction is considered. The causes of a long philtrum are numerous, such as congenital upper palate prominence (mouth protrusion), excess development of midface skeleton, retracted or too short columella, or philtrum skin laxity due to orthognathic surgery. Nevertheless, not all long philtrums can be redressed by philtrum reduction, and patients should confirm with the physician about the cause and feasibility of improvement before the operation.
Simple philtrum reduction is also called upper lip lift as the surgery not only shortens the philtrum but also elevates the upper lip angle to sculpt a youthful appearance of a mildly projected lip. An incision is made at the connection between the alar margin and the columellar bottom, with proper skin excised (usually about 0.5-0.8cm), and then, the distal skin of the resection close to the upper lip is advanced upward and stitched to the ala nasi and columellar base. Thus, the upper lip, including the mouth corner, can be lifted upward, which not only effectively shortens the philtrum but also sculpts the projected lip and maximally conceals the scar at the bottom of the nose. Nevertheless, the surgical incision is relatively long and induces scarring afterword, and both ends of the stitches can be stretched by tension from speaking or squeezing, which affects the columellar angle, or even cause nostril exposure or alar deformation in overdone cases. Therefore, the nose shape of the patient should also be factored in during preoperative evaluation. Patients with a congenital snub nose or nostril exposure are recommended to first undergo rhinoplasty or alar reduction before philtrum reduction, which conceals the scar at the shadow of the nasal base.
Modifications of Endonasal lip lift :