Lip Lift Surgery as An Essential Procedure to Achieve Good Facial Aesthetics

Lip Lift Surgery as An Essential Procedure to Achieve Good Facial Aesthetics | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lip Lift Surgery as An Essential Procedure to Achieve Good Facial Aesthetics Ahmed Ali, MD This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7076739/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background With aging, gravity forces the upper lip to fall downward, leading to facial aesthetic dissatisfaction. Unfortunately, fillers might result in problems, such as persistent, non-resorbable products and an alteration to host defences. Hence, it is important to focus on surgical techniques to avoid or minimize complications. Therefore, this study aimed to evaluate the facial aesthetics of lip lift surgery. Methods This prospective cohort study was carried out on 25 cases aged > 18 years old, both sexes, undergoing senile upper lip repair by sub-nasal lip lift (SNLL). The frontal and lateral photos of each subject were captured from the same location (1.5 m). The average height of the upper visible vermilion, philtrum length, patients’ satisfaction, and complications were documented. Results The length of the philtrum was significantly lower postoperative than preoperative (P value < 0.001). The height of the visible upper vermilion was significantly higher postoperative than preoperative (P value < 0.001). The patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients. Complications (infection, sad appearance abnormality, gummy smile, keloid formation, hypertrophic scarring) did not occur in any patient. Conclusions Inspiring anthropometric measurements, satisfaction rates, and absence of complications reveal the vital role of surgical lip lifting in facial aesthetics. Plastic & Reconstructive Surgery Lip Lift Aesthetics Facial rejuvenation Figures Figure 1 Figure 2 Figure 3 Introduction The lips are the most prominent aesthetic feature of the bottom part of the face and a crucial component of an ideal smile. Increased patient interest in lip rejuvenation has stemmed from the recent growth in the popularity of less invasive face cosmetic approaches. With aging, gravity forces the upper lip to droop downward, leading to an increase in the lip's vertical height and philtrum, reversed Cupid's bow, vermilion reduction, as well as the tooth concealing [ 1 , 2 ] . In the previous research, several ways for upper lip lifting have been documented, including injectable fillers and lip lifting surgical procedures, including removal of subnasal skin, sub-nostril cutaneous excision, or vermilion expansion [ 3 ] . However, filler treatments have the potential to cause problems such as it is permanent non-resorbable products and modified host immunity. Therefore, it is essential to focus on surgical techniques to avoid or minimize complications [ 4 ] . The lip lift is one of the most acceptable and frequent surgical approaches used to improve the shape and curves of the upper lip. A lip lift may confidently be used for the reduction of the philtrum height, expansion of the upper vermilion, enhancement of the dental show, restoration of face aesthetic proportions, and development of an attractive smile with a comprehensive management plan and skilled surgery [ 5 , 6 ] . Conventional subnasal bullhorn lifts are effective for face feminization in people who are suitably chosen. Various excisions and other techniques with fewer scars have now attracted attention. Nevertheless, it is uncertain if they have the same effects, and accurate measurement data is lacking [ 7 , 8 ] . The lip lift reduces the distance from the nasal base to the vermilion border by removing skin and advancing tissue. Even though the operation results in a slight alteration, it may significantly lead to lower-face feminization. There are several procedures for achieving an upper lip lift, but the advantages and disadvantages of each treatment remain unclear [ 9 , 10 ] . Therefore, this study aimed to evaluate the facial aesthetics of lip lift surgery. Patients and Methods This prospective cohort study was carried out on 25 cases aged > 18 years old, both sexes, undergoing senile upper lip repair by sub-nasal lip lift (SNLL). All patients provided written consent based on their knowledge. The research was conducted with the agreement of the Assiut University Hospitals Ethical Committee (approval code: 04-2023-300300) from …… to ……. Exclusion criteria were inherited facial malformation, oral and maxillofacial illness, an abnormally small upper lip (less than one-ninth of the face's vertical length), hypertrophic or keloid scarring history, significantly downturned lips' corners, underwent another cosmetic method including the nasal or perioral areas, underwent previous lip lift procedures. Preoperative procedures : Before therapy, patient data, including age, the etiology of the lengthy philtrum, and the aim of treatment, were documented. The frontal and lateral pictures of each subject were taken at the same distance (1.5 m) and with identical digital camera settings. All images were taken using a consistent backdrop and camera-mounted illumination, and normal head position (about the horizontal plane of Frankfort) was succeeded by having the patient stare directly forward to a place on the wall at eye level. Markings were made on the subnasale, labiale superius, and stomion to assess the vertical asymmetry of the upper lip. Moreover, to assess the horizontal asymmetry of the upper lip in the resting posture, both the cheilion of the mouth and the alare of the nose were demonstrated. Using these defined locations, the length of the philtrum (the gap between the subnasal and superius labiale) and the visible upper vermilion height (space between the superius labiale and stomion) were determined. Surgical procedures : Surgical marks were drawn using a marker with a fine- tipped. To reduce postsurgical webbing, a contoured ellipse was drawn beneath the nose after the nose-lip juncture well beyond the nasal sill and one millimeter from the alar crease. Using callipers, a gap of 5 to 6 mm was measured, which was subsequently reduced laterally. This measurement determined the placement of the incision's inferior limb. A skin incision was performed with a No. 15 blade, and the symmetric, undulating ellipse was removed using precise dissection. The dissection plane reached the orbicularis oris fascia but did not enter it. The orbicularis oris's deep fascial planes and layers were not disturbed; just the skin and subcutaneous tissue were lifted. The resulting defect was subsequently repaired using a 5 − 0 Monocryl suture in a concealed, interrupted fashion. In the same manner, the residual subcutaneous tissue was reapproximated using a 6 − 0 Polysorb suture. The skin was closed tension-free using 6 − 0 mild chromic gut suture in a locking running, manner. Postoperative follow-up : On surgical day 7, all sutures were released, and the length of the philtrum and the visible upper vermilion mean height were redetermined. At the follow-up, the incisional scar looked to be growing poorly. At the follow-up evaluation, patients were asked to rate their satisfaction with the aesthetic and physiognomic outcomes on a 5-point scale (5 = extremely satisfied, 4 = satisfied, 3 = neutral, 2 = unsatisfied, and 1 = very dissatisfied). Infection, sad-look deformities, gummy grin, hypertrophic scarring, and keloid development were recorded as complications. The primary outcome was the mean visible upper vermilion height. The secondary outcomes were philtrum length, patients’ satisfaction, and complication. Sample size calculation : The sample size calculation was done by G*Power 3.1.9.2 (Universitat Kiel, Germany). According to a previous study [ 10 ] , the mean ± SD of the visible upper vermilion mean height was 3.93 ± 2.27 mm presurgical and 6.16 ± 1.74 mm postsurgical. The sample size was determined by 1.084 effect size, 95% confidence limit, 99% power of the study, and 7 cases were added to overcome dropout. Therefore, recruited 25 patients. Statistical analysis Statistical analysis was done by SPSS v28 (IBM Inc., Chicago, IL, USA). Shapiro-Wilks test and histograms were used to evaluate the normality of the data distribution. Quantitative parametric data were presented as mean and standard deviation (SD) and were compared by paired T-test. Qualitative variables were presented as frequency and percentage (%). A two-tailed P value < 0.05 was considered statistically significant. Results The mean value (± SD) of age was 36.6 (± 13.09) years. Sex was male in 4 (16%) patients and female in 21 (84%) patients. The purpose of the operation was aesthetic improvement in 12 (48%) patients, physiognomic improvement in 3 (12%) patients, and both aesthetic and physiognomic improvement in 10 (40%) patients (Table 1 ). Table 1 Demographic data of the studied patients (n = 25) Age (years) 36.6 ± 13.09 Sex Male 4 (16%) Female 21 (84%) Purpose of the operation Aesthetic improvement 12 (48%) Physiognomic improvement 3 (12%) Both aesthetic and physiognomic improvement 10 (40%) Data are presented as mean ± SD or frequency (%). The mean value (± SD) of philtrum length was 23.5 ± 5.52 preoperatively vs 19.3 ± 5.59 postoperatively. The mean value (± SD) of visible upper vermilion height was 3.8 ± 0.93 preoperatively vs 5.7 ± 1.18 postoperatively. The length of the philtrum was significantly lower postoperative than preoperative (P value < 0.001). The height of the visible upper vermilion was significantly higher postoperative than preoperative (P value < 0.001) (Table 2 ). Table 2 Length of the philtrum and the visible upper vermilion height of the studied patients Preoperative Postoperative P value Length of the philtrum (mm) 23.5 ± 5.52 19.3 ± 5.59 < 0.001 Height of the visible upper vermilion (mm) 3.8 ± 0.93 5.7 ± 1.18 < 0.001 Data are presented as mean ± SD. The patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients. Complications (infection, sad appearance deformity, gummy smile, keloid formation, hypertrophic scarring) did not occur in any patient (Table 3 ). Table 3 Physiognomic results and complications of the studied patients (n = 25) Patient satisfaction Very satisfied 9 (36%) Satisfied 13 (52%) Neutral 1 (4%) Unsatisfied 2 (8%) Very unsatisfied 0 (0%) Complications Infection 0 (0%) Gummy smile 0 (0%) Sad appearance deformity 0 (0%) Keloid formation 0 (0%) Hypertrophic scarring 0 (0%) Data are presented as frequency (%). Three cases before and after lip lifting are presented in Figs. 1–3 Discussion The look of the upper lip may play a key role in the aged face syndrome [ 11 ] . The aging of the upper lip is characterized by three major issues: wrinkles, thinning, and lengthening. The typical facelift does not treat these signs of aging. Numerous techniques, including resurfacing through dermabrasion, laser, and chemical peels, have been documented. Additionally, fillers were employed to enhance the upper lip's fine lines and thinning. Nevertheless, facelift and supplementary operations cannot resolve the upper lip lengthening issue. Several surgical procedures have been recorded to address an extended upper lip, including V-Y advancement, direct vermillion advancement, and subnasal lip lift [ 12 ] . However, numerous issues remain about the advantages and disadvantages of each approach [ 9 , 10 ] . Our results revealed that the mean value (± SD) of age was 36.6 (± 13.09) years. Female gender was predominant in 21 (84%) patients. The "upper lip unit" was evaluated for variations between younger and older subjects using precise measurements. The findings indicated significant age-related variations in the upper lip's structure. Among them was a substantial extension of the upper lip in elderly persons relative to younger individuals. In the elder group, the thickness of soft tissue of the upper lip was reduced by around 41% in women and 33% in males. Volume loss of soft tissue likewise promotes the deepening of nasolabial wrinkles, a distinguishing characteristic of the aging face [ 13 ] . Male and female upper lip appearance variations are the rationale for lip lifts. Males have a broader upper lip on average than females. Consequently, females have a higher ideal upper incisor revealed in rest than men (around 4 vs 2 mm, respectively). Males also have a larger ratio of upper lip dermal skin height to upper vermilion height [ 7 ] . Nevertheless, there is no difference in upper vermilion height between men and females. Along similar lines, it has been shown that increasing upper vermilion height is more appealing to both sexes [ 14 ] . The previous reasons associated with females always searching for an attractive appearance may explain the predominance of the female gender according to our results. Researchers have discovered that women's desires to enhance their appearance have biological and societal sexual concerns [ 15 ] . Supporting our finding, Júnior et al. [ 16 ] conducted a recent systematic review including 4 studies, and revealed that 92.4% of subnasal lip lift procedures were done on women between the ages of 21 and 65. Our results revealed that the length of the philtrum was significantly lower postoperative than preoperative. The height of the visible upper vermilion was significantly higher postoperative than preoperative. The patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients. According to our results, complications (gummy smile, infection, sad appearance abnormality, keloid formation, hypertrophic scarring) did not occur in any patient. Austin and Weston [ 17 ] documented that lifting the center of the upper lip may make the patient seem unhappy by causing the lip margin to tilt downward. This effect is known as the "deformed sad look." To avoid this, the lateral side of the lips was raised by extending the incision line to the lateral aspect of the alar. To prevent this, the side profile of the lips was elevated by extending the incision line to the alar cartilage lateral aspect. The incisor margins of the top teeth may become visible when the lip protrudes. Our findings agreed with, Seo et al. [ 18 ] who observed that after surgery, The average ratio of lip height to breadth climbed to 0.39, the ratio of upper to lower vermilion increased to 0.84, and the ratio of upper vermilion thickness to upper lip height increased to 0.393. The postoperative ratio of patients offered the most favored handsome and healthy appearance among Koreans. Supporting our results, Seo et al. [ 18 ] reported insignificant complications that required revisional treatment. Also, the findings from the research involved in the systematic review by Júnior et al. [ 16 ] showed that based on anthropometric measurements and patient satisfaction, all investigations indicated that the subnasal lip lift improved the aesthetics of the lips. Moreover, Yamin et al. [ 2 ] conducted a comprehensive literature review including 17 studies with a total number of patients 2265. Their results indicated high satisfaction rates and comparatively small complication rates imply a more important part of surgical cheiloplasty in face rejuvenation. Additionally, Lee et al. [ 10 ] reported that following treatment the vertical asymmetry of the lower face was improved, Moreover, there was a considerable reduction in philtrum length and a prominent rise in upper vermilion. The present research is restricted by a small sample size. The investigation was conducted at a single centre. Hence larger scale, multicentre studies and comparison with different techniques are required to generalize our findings. Conclusions Inspiring anthropometric measurements, satisfaction rates, and absence of complications reveal the vital role of surgical lip lifting in facial aesthetics. Declarations Financial support and sponsorship: Nil Conflict of Interest: Nil References Talei B, Pearlman SJ. CUPID lip lift: Advanced lip design using the deep plane upper lip lift and simplified corner lift. Aesthet Surg J. 2022;42:1357-73. Yamin F, McAuliffe PB, Vasilakis V. Aesthetic surgical enhancement of the upper lip: A comprehensive literature review. Aesthetic Plast Surg. 2021;45:173-80. Spiegel JH, Spiegel OL. Lip lifting: Not just fullness-everything you need to know about lifting and creating youthful, beautiful lips. Facial Plast Surg. 2019;35:129-33. Vedamurthy M. Beware what you inject: Complications of injectables-dermal fillers. J Cutan Aesthet Surg. 2018;11:60-6. Fallahi HR, Keyhan SO, Bohluli B, Cheshmi B, Jafari P. Lip lift techniques in smile design. Dent Clin North Am. 2022;66:443-57. Stanley K, Caligiuri M, Schlichting LH, Bazos PK, Magne M. Lip lifting: Unveiling dental beauty. Int J Esthet Dent. 2017;12:108-14. Santanchè P, Bonarrigo C. Lifting of the upper lip: Personal technique. Plastic and Reconstructive Surgery. 2004;113:55-67. Gordon AR, Schreiber JE, Tortora SC, Ferreira S, Dorfman RG, Sadaat S, et al. Turning back the clock with lip lift: Quantifying perceived age reduction using artificial intelligence. Facial Plast Surg Aesthet Med. 2021. Salibian AA, Bluebond-Langner R. Lip lift. Facial Plast Surg Clin North Am. 2019;27:261-6. Lee DE, Hur SW, Lee JH, Kim YH, Seul JH. Central lip lift as aesthetic and physiognomic plastic surgery: The effect on lower facial profile. Aesthet Surg J. 2015;35:698-707. Podmelle F, Rutkowski R, Reinert S. Aesthetic surgery. In: Eufinger H, Kübler A, Schliephake H, editors. Oral and maxillofacial surgery : Surgical textbook and atlas. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023. p. 803-38. Mahmoud N, Massoud KS. Upper lip rejuvenation by myocutaneous subnasal lift technique. Egypt J Plast Reconstr Surg. 2019;43:237-41. Ramaut L, Tonnard P, Verpaele A, Verstraete K, Blondeel P. Aging of the upper lip: Part i: A retrospective analysis of metric changes in soft tissue on magnetic resonance imaging. Plast Reconstr Surg. 2019;143. Penna V, Fricke A, Iblher N, Eisenhardt SU, Stark GB. The attractive lip: A photomorphometric analysis. J Plast Reconstr Aesthet Surg. 2015;68:920-9. Teresa A. Direct and indirect roles of men in determining women decision to use laser procedures for skin care. Clin Cosmet Investig Dermatol. 2023;16:617-33. Júnior LCA, da Silva Cruz NT, de Vasconcelos Gurgel BC, de Aquino Martins ARL, Lins R. Impact of subnasal lip lift on lip aesthetic: a systematic review. Oral Maxillofac Surg. 2023;27:9-15. Austin HW, Weston GW. Rejuvenation of the aging mouth. Clin Plast Surg. 1992;19:511-24. Seo M-G, Sakong Y, Lee DE, Lee J-H. Achieving attractive and healthy-looking lips through a central lip lift. Arch Aesthetic Plast Surg. 2023;29:109-14. Additional Declarations The authors declare no competing interests. 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Increased patient interest in lip rejuvenation has stemmed from the recent growth in the popularity of less invasive face cosmetic approaches. With aging, gravity forces the upper lip to droop downward, leading to an increase in the lip's vertical height and philtrum, reversed Cupid's bow, vermilion reduction, as well as the tooth concealing \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn the previous research, several ways for upper lip lifting have been documented, including injectable fillers and lip lifting surgical procedures, including removal of subnasal skin, sub-nostril cutaneous excision, or vermilion expansion \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, filler treatments have the potential to cause problems such as it is permanent non-resorbable products and modified host immunity. Therefore, it is essential to focus on surgical techniques to avoid or minimize complications \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe lip lift is one of the most acceptable and frequent surgical approaches used to improve the shape and curves of the upper lip. A lip lift may confidently be used for the reduction of the philtrum height, expansion of the upper vermilion, enhancement of the dental show, restoration of face aesthetic proportions, and development of an attractive smile with a comprehensive management plan and skilled surgery \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eConventional subnasal bullhorn lifts are effective for face feminization in people who are suitably chosen. Various excisions and other techniques with fewer scars have now attracted attention. Nevertheless, it is uncertain if they have the same effects, and accurate measurement data is lacking \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe lip lift reduces the distance from the nasal base to the vermilion border by removing skin and advancing tissue. Even though the operation results in a slight alteration, it may significantly lead to lower-face feminization. There are several procedures for achieving an upper lip lift, but the advantages and disadvantages of each treatment remain unclear \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Therefore, this study aimed to evaluate the facial aesthetics of lip lift surgery.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis prospective cohort study was carried out on 25 cases aged \u0026gt; 18 years old, both sexes, undergoing senile upper lip repair by sub-nasal lip lift (SNLL). All patients provided written consent based on their knowledge. The research was conducted with the agreement of the Assiut University Hospitals Ethical Committee (approval code: 04-2023-300300) from …… to …….\u003c/p\u003e\u003cp\u003eExclusion criteria were inherited facial malformation, oral and maxillofacial illness, an abnormally small upper lip (less than one-ninth of the face's vertical length), hypertrophic or keloid scarring history, significantly downturned lips' corners, underwent another cosmetic method including the nasal or perioral areas, underwent previous lip lift procedures.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePreoperative procedures\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eBefore therapy, patient data, including age, the etiology of the lengthy philtrum, and the aim of treatment, were documented. The frontal and lateral pictures of each subject were taken at the same distance (1.5 m) and with identical digital camera settings. All images were taken using a consistent backdrop and camera-mounted illumination, and normal head position (about the horizontal plane of Frankfort) was succeeded by having the patient stare directly forward to a place on the wall at eye level.\u003c/p\u003e\u003cp\u003eMarkings were made on the subnasale, labiale superius, and stomion to assess the vertical asymmetry of the upper lip. Moreover, to assess the horizontal asymmetry of the upper lip in the resting posture, both the cheilion of the mouth and the alare of the nose were demonstrated.\u003c/p\u003e\u003cp\u003eUsing these defined locations, the length of the philtrum (the gap between the subnasal and superius labiale) and the visible upper vermilion height (space between the superius labiale and stomion) were determined.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSurgical procedures\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eSurgical marks were drawn using a marker with a fine- tipped. To reduce postsurgical webbing, a contoured ellipse was drawn beneath the nose after the nose-lip juncture well beyond the nasal sill and one millimeter from the alar crease. Using callipers, a gap of 5 to 6 mm was measured, which was subsequently reduced laterally. This measurement determined the placement of the incision's inferior limb.\u003c/p\u003e\u003cp\u003eA skin incision was performed with a No. 15 blade, and the symmetric, undulating ellipse was removed using precise dissection. The dissection plane reached the orbicularis oris fascia but did not enter it. The orbicularis oris's deep fascial planes and layers were not disturbed; just the skin and subcutaneous tissue were lifted.\u003c/p\u003e\u003cp\u003eThe resulting defect was subsequently repaired using a 5 − 0 Monocryl suture in a concealed, interrupted fashion. In the same manner, the residual subcutaneous tissue was reapproximated using a 6 − 0 Polysorb suture. The skin was closed tension-free using 6 − 0 mild chromic gut suture in a locking running, manner.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePostoperative follow-up\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eOn surgical day 7, all sutures were released, and the length of the philtrum and the visible upper vermilion mean height were redetermined. At the follow-up, the incisional scar looked to be growing poorly.\u003c/p\u003e\u003cp\u003eAt the follow-up evaluation, patients were asked to rate their satisfaction with the aesthetic and physiognomic outcomes on a 5-point scale (5 = extremely satisfied, 4 = satisfied, 3 = neutral, 2 = unsatisfied, and 1 = very dissatisfied).\u003c/p\u003e\u003cp\u003eInfection, sad-look deformities, gummy grin, hypertrophic scarring, and keloid development were recorded as complications.\u003c/p\u003e\u003cp\u003eThe primary outcome was the mean visible upper vermilion height. The secondary outcomes were philtrum length, patients’ satisfaction, and complication.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSample size calculation\u003c/b\u003e:\u003c/p\u003e\u003cp\u003eThe sample size calculation was done by G*Power 3.1.9.2 (Universitat Kiel, Germany). According to a previous study \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e, the mean ± SD of the visible upper vermilion mean height was 3.93 ± 2.27 mm presurgical and 6.16 ± 1.74 mm postsurgical. The sample size was determined by 1.084 effect size, 95% confidence limit, 99% power of the study, and 7 cases were added to overcome dropout. Therefore, recruited 25 patients.\u003c/p\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was done by SPSS v28 (IBM Inc., Chicago, IL, USA). Shapiro-Wilks test and histograms were used to evaluate the normality of the data distribution. Quantitative parametric data were presented as mean and standard deviation (SD) and were compared by paired T-test. Qualitative variables were presented as frequency and percentage (%). A two-tailed P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean value (\u0026plusmn;\u0026thinsp;SD) of age was 36.6 (\u0026plusmn;\u0026thinsp;13.09) years. Sex was male in 4 (16%) patients and female in 21 (84%) patients. The purpose of the operation was aesthetic improvement in 12 (48%) patients, physiognomic improvement in 3 (12%) patients, and both aesthetic and physiognomic improvement in 10 (40%) patients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic data of the studied patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.6\u0026thinsp;\u0026plusmn;\u0026thinsp;13.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4 (16%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21 (84%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePurpose of the operation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eAesthetic improvement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12 (48%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePhysiognomic improvement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 (12%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003eBoth aesthetic and physiognomic improvement\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10 (40%)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or frequency (%).\u003c/p\u003e\u003cp\u003eThe mean value (\u0026plusmn;\u0026thinsp;SD) of philtrum length was 23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52 preoperatively vs 19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59 postoperatively. The mean value (\u0026plusmn;\u0026thinsp;SD) of visible upper vermilion height was 3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93 preoperatively vs 5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18 postoperatively. The length of the philtrum was significantly lower postoperative than preoperative (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The height of the visible upper vermilion was significantly higher postoperative than preoperative (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLength of the philtrum and the visible upper vermilion height of the studied patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePostoperative\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLength of the philtrum (mm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e23.5\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e19.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHeight of the visible upper vermilion (mm)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e\u003cp\u003e3.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e5.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\u003cp\u003eThe patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients. Complications (infection, sad appearance deformity, gummy smile, keloid formation, hypertrophic scarring) did not occur in any patient (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003ePhysiognomic results and complications of the studied patients\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003ePatient satisfaction\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery satisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSatisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnsatisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVery unsatisfied\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eComplications\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eInfection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGummy smile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSad appearance deformity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eKeloid formation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHypertrophic scarring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003eData are presented as frequency (%).\u003cp\u003eThree cases before and after lip lifting are presented in Figs. 1\u0026ndash;3\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe look of the upper lip may play a key role in the aged face syndrome \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. The aging of the upper lip is characterized by three major issues: wrinkles, thinning, and lengthening. The typical facelift does not treat these signs of aging. Numerous techniques, including resurfacing through dermabrasion, laser, and chemical peels, have been documented. Additionally, fillers were employed to enhance the upper lip's fine lines and thinning. Nevertheless, facelift and supplementary operations cannot resolve the upper lip lengthening issue. Several surgical procedures have been recorded to address an extended upper lip, including V-Y advancement, direct vermillion advancement, and subnasal lip lift \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. However, numerous issues remain about the advantages and disadvantages of each approach \u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOur results revealed that the mean value (\u0026plusmn;\u0026thinsp;SD) of age was 36.6 (\u0026plusmn;\u0026thinsp;13.09) years. Female gender was predominant in 21 (84%) patients.\u003c/p\u003e\u003cp\u003eThe \"upper lip unit\" was evaluated for variations between younger and older subjects using precise measurements. The findings indicated significant age-related variations in the upper lip's structure. Among them was a substantial extension of the upper lip in elderly persons relative to younger individuals. In the elder group, the thickness of soft tissue of the upper lip was reduced by around 41% in women and 33% in males. Volume loss of soft tissue likewise promotes the deepening of nasolabial wrinkles, a distinguishing characteristic of the aging face \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eMale and female upper lip appearance variations are the rationale for lip lifts. Males have a broader upper lip on average than females. Consequently, females have a higher ideal upper incisor revealed in rest than men (around 4 vs 2 mm, respectively). Males also have a larger ratio of upper lip dermal skin height to upper vermilion height \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Nevertheless, there is no difference in upper vermilion height between men and females. Along similar lines, it has been shown that increasing upper vermilion height is more appealing to both sexes \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. The previous reasons associated with females always searching for an attractive appearance may explain the predominance of the female gender according to our results. Researchers have discovered that women's desires to enhance their appearance have biological and societal sexual concerns \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eSupporting our finding, J\u0026uacute;nior et al.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e conducted a recent systematic review including 4 studies, and revealed that 92.4% of subnasal lip lift procedures were done on women between the ages of 21 and 65.\u003c/p\u003e\u003cp\u003eOur results revealed that the length of the philtrum was significantly lower postoperative than preoperative. The height of the visible upper vermilion was significantly higher postoperative than preoperative. The patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients.\u003c/p\u003e\u003cp\u003eAccording to our results, complications (gummy smile, infection, sad appearance abnormality, keloid formation, hypertrophic scarring) did not occur in any patient.\u003c/p\u003e\u003cp\u003eAustin and Weston \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e documented that lifting the center of the upper lip may make the patient seem unhappy by causing the lip margin to tilt downward. This effect is known as the \"deformed sad look.\" To avoid this, the lateral side of the lips was raised by extending the incision line to the lateral aspect of the alar. To prevent this, the side profile of the lips was elevated by extending the incision line to the alar cartilage lateral aspect. The incisor margins of the top teeth may become visible when the lip protrudes.\u003c/p\u003e\u003cp\u003eOur findings agreed with, Seo et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e who observed that after surgery, The average ratio of lip height to breadth climbed to 0.39, the ratio of upper to lower vermilion increased to 0.84, and the ratio of upper vermilion thickness to upper lip height increased to 0.393. The postoperative ratio of patients offered the most favored handsome and healthy appearance among Koreans. Supporting our results, Seo et al. \u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e reported insignificant complications that required revisional treatment.\u003c/p\u003e\u003cp\u003eAlso, the findings from the research involved in the systematic review by J\u0026uacute;nior et al.\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e showed that based on anthropometric measurements and patient satisfaction, all investigations indicated that the subnasal lip lift improved the aesthetics of the lips.\u003c/p\u003e\u003cp\u003eMoreover, Yamin et al. \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e conducted a comprehensive literature review including 17 studies with a total number of patients 2265. Their results indicated high satisfaction rates and comparatively small complication rates imply a more important part of surgical cheiloplasty in face rejuvenation.\u003c/p\u003e\u003cp\u003eAdditionally, Lee et al. \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e reported that following treatment the vertical asymmetry of the lower face was improved, Moreover, there was a considerable reduction in philtrum length and a prominent rise in upper vermilion.\u003c/p\u003e\u003cp\u003eThe present research is restricted by a small sample size. The investigation was conducted at a single centre. Hence larger scale, multicentre studies and comparison with different techniques are required to generalize our findings.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eInspiring anthropometric measurements, satisfaction rates, and absence of complications reveal the vital role of surgical lip lifting in facial aesthetics.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFinancial support and sponsorship:\u003c/strong\u003e Nil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u003c/strong\u003e Nil\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTalei B, Pearlman SJ. CUPID lip lift: Advanced lip design using the deep plane upper lip lift and simplified corner lift. Aesthet Surg J. 2022;42:1357-73.\u003c/li\u003e\n\u003cli\u003eYamin F, McAuliffe PB, Vasilakis V. Aesthetic surgical enhancement of the upper lip: A comprehensive literature review. Aesthetic Plast Surg. 2021;45:173-80.\u003c/li\u003e\n\u003cli\u003eSpiegel JH, Spiegel OL. Lip lifting: Not just fullness-everything you need to know about lifting and creating youthful, beautiful lips. Facial Plast Surg. 2019;35:129-33.\u003c/li\u003e\n\u003cli\u003eVedamurthy M. Beware what you inject: Complications of injectables-dermal fillers. J Cutan Aesthet Surg. 2018;11:60-6.\u003c/li\u003e\n\u003cli\u003eFallahi HR, Keyhan SO, Bohluli B, Cheshmi B, Jafari P. Lip lift techniques in smile design. Dent Clin North Am. 2022;66:443-57.\u003c/li\u003e\n\u003cli\u003eStanley K, Caligiuri M, Schlichting LH, Bazos PK, Magne M. Lip lifting: Unveiling dental beauty. Int J Esthet Dent. 2017;12:108-14.\u003c/li\u003e\n\u003cli\u003eSantanch\u0026egrave; P, Bonarrigo C. Lifting of the upper lip: Personal technique. Plastic and Reconstructive Surgery. 2004;113:55-67.\u003c/li\u003e\n\u003cli\u003eGordon AR, Schreiber JE, Tortora SC, Ferreira S, Dorfman RG, Sadaat S, et al. Turning back the clock with lip lift: Quantifying perceived age reduction using artificial intelligence. Facial Plast Surg Aesthet Med. 2021.\u003c/li\u003e\n\u003cli\u003eSalibian AA, Bluebond-Langner R. Lip lift. Facial Plast Surg Clin North Am. 2019;27:261-6.\u003c/li\u003e\n\u003cli\u003eLee DE, Hur SW, Lee JH, Kim YH, Seul JH. Central lip lift as aesthetic and physiognomic plastic surgery: The effect on lower facial profile. Aesthet Surg J. 2015;35:698-707.\u003c/li\u003e\n\u003cli\u003ePodmelle F, Rutkowski R, Reinert S. Aesthetic surgery. In: Eufinger H, K\u0026uuml;bler A, Schliephake H, editors. Oral and maxillofacial surgery : Surgical textbook and atlas. Berlin, Heidelberg: Springer Berlin Heidelberg; 2023. p. 803-38.\u003c/li\u003e\n\u003cli\u003eMahmoud N, Massoud KS. Upper lip rejuvenation by myocutaneous subnasal lift technique. Egypt J Plast Reconstr Surg. 2019;43:237-41.\u003c/li\u003e\n\u003cli\u003eRamaut L, Tonnard P, Verpaele A, Verstraete K, Blondeel P. Aging of the upper lip: Part i: A retrospective analysis of metric changes in soft tissue on magnetic resonance imaging. Plast Reconstr Surg. 2019;143.\u003c/li\u003e\n\u003cli\u003ePenna V, Fricke A, Iblher N, Eisenhardt SU, Stark GB. The attractive lip: A photomorphometric analysis. J Plast Reconstr Aesthet Surg. 2015;68:920-9.\u003c/li\u003e\n\u003cli\u003eTeresa A. Direct and indirect roles of men in determining women decision to use laser procedures for skin care. Clin Cosmet Investig Dermatol. 2023;16:617-33.\u003c/li\u003e\n\u003cli\u003eJ\u0026uacute;nior LCA, da Silva Cruz NT, de Vasconcelos Gurgel BC, de Aquino Martins ARL, Lins R. Impact of subnasal lip lift on lip aesthetic: a systematic review. Oral Maxillofac Surg. 2023;27:9-15.\u003c/li\u003e\n\u003cli\u003eAustin HW, Weston GW. Rejuvenation of the aging mouth. Clin Plast Surg. 1992;19:511-24.\u003c/li\u003e\n\u003cli\u003eSeo M-G, Sakong Y, Lee DE, Lee J-H. Achieving attractive and healthy-looking lips through a central lip lift. Arch Aesthetic Plast Surg. 2023;29:109-14.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Assiut University Hospitals","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Lip Lift, Aesthetics, Facial rejuvenation","lastPublishedDoi":"10.21203/rs.3.rs-7076739/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7076739/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eWith aging, gravity forces the upper lip to fall downward, leading to facial aesthetic dissatisfaction. Unfortunately, fillers might result in problems, such as persistent, non-resorbable products and an alteration to host defences. Hence, it is important to focus on surgical techniques to avoid or minimize complications. Therefore, this study aimed to evaluate the facial aesthetics of lip lift surgery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis prospective cohort study was carried out on 25 cases aged\u0026thinsp;\u0026gt;\u0026thinsp;18 years old, both sexes, undergoing senile upper lip repair by sub-nasal lip lift (SNLL). The frontal and lateral photos of each subject were captured from the same location (1.5 m). The average height of the upper visible vermilion, philtrum length, patients\u0026rsquo; satisfaction, and complications were documented.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe length of the philtrum was significantly lower postoperative than preoperative (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The height of the visible upper vermilion was significantly higher postoperative than preoperative (P value\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The patient satisfaction was very satisfied in 9 (36%) patients, satisfied in 13 (52%) patients, neutral in 1 (4%) patient, and unsatisfied in 2 (8%) patients. Complications (infection, sad appearance abnormality, gummy smile, keloid formation, hypertrophic scarring) did not occur in any patient.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eInspiring anthropometric measurements, satisfaction rates, and absence of complications reveal the vital role of surgical lip lifting in facial aesthetics.\u003c/p\u003e","manuscriptTitle":"Lip Lift Surgery as An Essential Procedure to Achieve Good Facial Aesthetics","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-10 10:57:18","doi":"10.21203/rs.3.rs-7076739/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"91012cdf-e7b7-4984-8083-efaf0d1cbcdd","owner":[],"postedDate":"July 10th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":51231928,"name":"Plastic \u0026 Reconstructive Surgery"}],"tags":[],"updatedAt":"2025-07-10T10:57:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-10 10:57:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7076739","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7076739","identity":"rs-7076739","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}