In our youth, we all seem to have adequate upper and lower lips, but as we age, the upper lip seems to become thinner.

It was assumed by most that the upper lip had thinned, and thus using fillers such as Restylane or Juvederm would correct the problem by “refilling” lost volume.

This might help, but it is far from the whole story.

As we age, the skin between the nose and the red part of the upper lip, the vermillion, lengthens. This results in the upper lip actually getting longer and thinner, turning downward and thus inward.

Also, as the lip lengthens and becomes thinner, fine “whistle” or “pucker” lines begin to appear. This first occurs when pursing your lips, but eventually the wrinkles become permanent even at rest.

Unfortunately, this happens to everyone; however, those born with a shorter distance between the nose and the upper lip will have less of an issue, as there is less drooping.

Men are lucky in that they can hide this with a moustache.

The ideal distance between the nose and vermillion is 14 to 15 mm (millimeters). By the time many turn 50 and older, they will have a length of as much as 20 mm or more, and this measurement increases the older one gets.

Notice in a young person with the lips parted, their upper teeth can be seen, a sign of youth, but when the lip lengthens, the upper lip hides the teeth.

Besides fillers, what else can be done? The answer is actually very simple.

Under local anesthesia, an incision can be made just below the nose and the correct amount of skin can be removed to achieve the ideal distance of 14 to 15 mm.

The physician must be careful with the measurement because too much skin removal will not be attractive either.

The incision is about 1/2 inch long and made just under the nose in the crease.

It is then sutured, and the scar, which is basically hidden by the nose itself, will be mostly unnoticeable after the redness is gone.

The procedure takes less than an hour with minimal downtime, if any.

To demonstrate this, look in the mirror and place one finger below your nose on each side and slightly lift the skin above the upper lip.

The upper lip should rise slightly, returning your lip to its original position. Voila, a more youthful looking upper lip.

Filler injections can be performed at a later date if the patient still wants more fullness. Fillers might also be necessary for minimizing any “pucker” wrinkles.

Patients must be individualized, and any or all of the above procedures might be suggested for optimum results.

E. Ronald Finger, MD, FACS is a board certified plastic surgeon with offices in Savannah and Bluffton. www.fingerand