Why patients with a long philtrum aren’t always suitable for lip filler. My explanation…⁣

⁣

The philtrum is the area between the base of the nose and the cupids bows. Most people have a bit of ‘pink lip’ show at rest, even if it’s small. There are however, a percentage of people who present with almost no pink lip show at rest. This can be either genetic or as a result of the ageing process where the philtrum elongates and pulls the entire pink lip under (see pic 1)⁣.

⁣

Normally when the philtrum is elongated and the pink lip is nearly completely obscured, filler is rarely going to give an aesthetically pleasing result. The result is most likely to be projection and bulk rather than lifting of the lip due to the weight of the longer philtrum. Projection is the notorious heavy ‘duck beak’ look (see pic 2).⁣

⁣

When an elongated philtrum caused by ageing is accompanied by perioral/smokers lines, the temptation is to fill the lines with a lot of filler. Often this is what patients request. Because there is no pink lip to provide structure or definition, filling often leads to a top heavy almost simian look, especially when it doesn’t soften the lines enough for the patient and they seek further filler. ⁣

⁣

I see this problem frequently in ladies of a certain age where their injector has given into pressure, overfilled the lines, and created a bulky Homer Simpson look. Laser resurfacing or RF should be explored as an alternative to filler in those at risk of a heavier, bulky result. ⁣

⁣

The best and unrivalled solution to a long philtrum and disappearing top lip is a surgical lip lift. Before you recoil in horror, a lip lift is a straightforward 45 minute operation under a local anaesthetic. Having filler often leads to a disappointing result which looks obviously ‘done’. A surgical lip lift provides a result that filler can’t and is what I would always advise for this problem (see pic 3). Fillers have limitations. It’s up to your injector to be transparent about them.