Why the Philtrum Looked Longer Before and After Revision Philtrum Reduction Surgery

Hello.

I’m Lee Won, the chief surgeon at 21 Plastic Surgery.

Recently, consultations for revision philtrum reduction surgery have been gradually increasing.

These are cases where patients come in saying,

“Even after reducing it once, it still looks long,”

or “I had it reduced at another clinic, but it doesn’t look natural.”

The philtrum is not simply a matter of reducing a few millimeters.

It is an area where the overall proportions of the midface, the movement of the upper lip,

and the connection structure of the columella must all be considered together!!

This case involves a patient who previously underwent philtrum reduction at another clinic,

but the length improvement was not sufficient.

When analyzing the preoperative photos,

the absolute philtrum length

was not excessively long.

However, compared with the midface, the philtrum proportion was relatively long,

and the upper lip was relatively thin,

which created the impression that the philtrum was even longer.

Some tissue had been removed in the previous surgery,

but the angle of connection between the columella and the upper lip

had not changed much.

For revision surgery, it was necessary to recalculate the proportions rather than simply reduce more.

So the surgical plan was established as follows.

Surgical plan

Revision philtrum reduction surgery (4.5 mm)

1 week after surgery,

tension at the incision site and swelling are still present.

At this stage,

the upper lip may feel somewhat firm,

but the change in philtrum length is already visible.

In revision surgery,

because tissue adhesions are present,

careful management of early tension is especially important.

1 month after surgery,

swelling and tension have largely subsided,

and the connection between the philtrum and the upper lip settles more naturally.

The length is not simply shorter;

rather, as the proportions of the midface and lower face are balanced,

the overall impression around the mouth becomes clearer.

The key point of this revision surgery was to maintain natural upper-lip exposure

without making the columella excessively lifted.

Revision philtrum reduction surgery is about ‘proportion,’ not ‘mm’

Revision philtrum surgery

is not simply a procedure that cuts a lot.

Excessive resection

can lead to columellar distortion, upper-lip elevation,

and an unnatural appearance.

Therefore, the amount of resection must be calculated precisely,

and an approach that considers the overall proportions of the midface

is necessary to achieve stable results.

At 21 Plastic Surgery,

we do not judge based only on philtrum length;

we analyze the proportions and structure of the entire face

when planning surgery.

Whether the philtrum looks long because of a simple issue of absolute length,

or because of its proportion relative to the midface,

must be distinguished through accurate structural analysis.

An approach tailored to each person’s facial proportions

can lead to a natural result.

Thank you.

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