Upper Lip Thread Lift (Nose-to-Lip Distance)

What Is an Upper Lip Thread Lift (Nose-to-Lip Distance)?

An upper lip or nose-to-lip distance thread lift is a treatment that aims to make the skin-covered area between the base of the nose and the red part of the upper lip (the philtrum area) look shorter by lifting it with threads. ‘Thread lift’ is the general name for lifting treatments carried out with threads; the French Thread Lift is one of the techniques within this group. The clinic uses dissolvable threads (PLLA/PDO).

The first thing to know is that published evidence on this treatment is extremely limited. A systematic review of upper lip lift methods (a review that searches for the studies on a topic using set rules and assesses them together) screened 495 records; only nine studies that measured the amount of lift in numbers could be included. Eight of these concerned surgical methods and only one a non-surgical method. The overall conclusion was that the effect of surgical methods lasts longer but inevitably leaves a scar, while non-surgical methods are less invasive but their effects are temporary.

In general, lifting threads have small barbs on their surface that grip the tissue. The thread is placed under the skin along a set direction, with the aim of holding the tissue in that direction. Even reviews on the face state that the long-term effectiveness of treatments with dissolvable threads is not clear; for the upper lip, this question has not yet been answered.

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Why Does the Area Between the Nose and Lip Look Long?

The distance between the nose and the upper lip can genuinely increase with age, but length is not the only reason it looks long. A review of ageing around the mouth lists lengthening and flattening of the upper lip, and less of the red part of the lip and the upper teeth showing, among the main signs of ageing in this area.

In a study of MRI scans from 200 people of Caucasian origin, the upper lip in the 65–80 age group measured 19.24% longer in women and 18.24% longer in men than in the 20–30 age group; in the same older group, lip thickness and volume had also decreased markedly. According to the researchers, lengthening, thinning and volume loss together affect the ageing area around the mouth.

In a study of Lebanese women with measurements taken directly on the skin, philtrum height averaged 14.3 mm in the younger group and 19.8 mm in the older group. These figures are averages from a single group in a single population; they do not show what length is right for any one person.

Perception also plays a part. In a study in which 1,100 people compared two versions of the same portrait, with and without philtrum lines, 81% of participants saw the upper lip of the young face as longer when its philtrum lines had been erased. Flattening of the philtrum is also counted among age-related changes, along with thinning of the lip border (vermilion border) and volume loss. In other words, when an upper lip looks long, what has really changed is sometimes its shape rather than the distance; this distinction is made at the consultation.

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Anatomy of the Philtrum and Upper Lip

In the skin-covered part of the upper lip, beneath the skin and the subcutaneous layer (the layer under the skin), lies the orbicularis oris, a muscle that circles the mouth like a ring, together with the facial expression muscles (the muscles you use to make facial expressions) that blend into it. The philtrum is made up of two raised columns running from the base of the nose down to the lip border, and the groove between them. To understand what a thread would meet in this area, you need to know these layers, how the muscles cross one another and where the blood vessels run.

In a study that built a three-dimensional model of the upper lip muscles from cadaver sections, the philtral columns were found to be shaped where fibres of the orbicularis oris cross fibres of the muscles that raise the upper lip, and some of the deep orbicularis fibres were seen to extend to the base of the nose. The main functions of the upper lip are to cover the teeth and to take part in facial expressions; the philtrum, the Cupid’s bow and the lip border are structures in this area that need particular care.

The muscle also changes with age. In a high-resolution ultrasound study of 30 volunteers, the angle of the orbicularis oris muscle decreased significantly with age; this change was most marked in the upper lip and in women, and was linked to the lip taking on a more inward-turned shape.

The area has a rich blood supply. In a meta-analysis combining 23 studies (an analysis that pools the data from many studies), the upper lip artery (superior labial artery) was absent in 3.55% of cases; where present, it most often ran in the submucosal layer (just beneath the lining of the inner surface of the lip). According to the researchers, no layer of the lip can be considered completely free of blood vessels. Another meta-analysis, combined with a cadaver study, also reported that the upper lip artery mostly runs under the mucosa or within the muscle, and only rarely under the skin.

Studies give the superficial fat layer or the superficial musculoaponeurotic system (a layer of connective tissue linked to the facial expression muscles) as the target layer for thread treatments. In a measurement of 30 cadavers using a 3D scanner, facial skin was found to get thicker from the temple towards the area around the mouth. None of these findings sets out a defined route for placing threads in the upper lip; they only explain why the area needs care.

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What Does the Research Say About This Treatment?

The short answer: the literature search carried out on this topic found no controlled study (a study that compares results with a comparison group) on shortening the nose-to-lip distance with threads. The available evidence comes mostly from face and neck thread lifts and cannot be applied directly to the upper lip.

The evidence on facial thread lifts is also limited. According to a review that re-examined ten years of publications, although the method looks promising, no new evidence has been added to support its use; anyone who wants this procedure should be given detailed information about side effects, how long the effect lasts and the limited data on effectiveness. A recent systematic review of dissolvable threads reports that in the mid-face and lower face the effect is seen straight after treatment, but that long-term effectiveness data are lacking and the longest follow-up was two years.

The publications that could be found on using threads in the upper lip have a different aim: too much gum showing when smiling. A preliminary report describes treatment in 22 female patients, in which smooth (non-barbed), dissolvable polydioxanone threads were placed along the direction of the muscles that raise the lip; the report has no comparison (control) group, and the authors present the method as a new proposal. This study looks at how much gum shows when smiling, not at philtrum length.

In the systematic review of upper lip lift methods, too, only one study could be included in the non-surgical group, and the studies did not measure the amount of lift in a consistent way. For this reason, no figure can be given for how much a thread lift shortens the nose-to-lip distance, how long the effect lasts or how many people it works for; there are no published data that provide such a figure.

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Surgical Lip Lift: The Most Researched Method

For a lengthened upper lip, the most researched method is a surgical lip lift: a bullhorn-shaped strip of skin is removed from just below the base of the nose, and the skin-covered part of the upper lip is shortened. A thread lift is not a non-surgical equivalent of this operation; one removes skin and the other does not.

According to a recent systematic review, in seven studies covering 1,754 patients, this technique and its variations reduced philtrum length from 14.0–14.5 mm to 10.8–12.0 mm, and more of the red part of the lip and the upper front teeth became visible. Complications were mostly mild and temporary, and revision (corrective procedure) rates ranged from 0.6% to 6.7%. The overall quality of the studies was rated as moderate, and the review noted a need for new prospective studies using standard measurements.

There are also data from surgery on how long the effect lasts. A retrospective review of 52 patients who had a lip lift from under the nose reported that the shortening achieved was maintained over time, with a slow decline. Another series of 500 consecutive surgical cases argues that lengthening and volume loss should be addressed together when rejuvenating the upper lip.

Surgery also has a cost. According to the review of upper lip lift methods, surgical methods inevitably leave a scar. In a study of 25 accounts shared online by patients who were unhappy after a lip lift, the most common complaint concerned the scar; a distorted shape of the nostril wings and lip asymmetry were also mentioned. Assessment for a surgical lip lift belongs to the relevant surgical specialty; it is included here only so that you can compare.

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What Options Other Than Threads Are Discussed?

A concern about the upper lip is not always about distance; sometimes it is that little of the red part of the lip shows, or that the lip turns inwards. For these concerns, studies look at two non-surgical options besides threads: a treatment known as a ‘Lip Flip’, which uses botulinum toxin (often called Botox®), and hyaluronic acid (HA) filler.

In a Lip Flip, the orbicularis oris muscle is partly relaxed with botulinum toxin, with the aim of turning the upper lip slightly outwards; this treatment does not add volume. In a systematic review on the subject, only seven of 48 records could be included. Patient satisfaction was high, and side effects were mild and temporary; the reported side effects include difficulty whistling and difficulty drinking through a straw. Even so, it is important to bear in mind that only a small number of studies were reviewed.

A review of lip options in young adults describes three approaches separately: botulinum toxin turns the lip slightly outwards; hyaluronic acid filler adds volume and contour; and a surgical lip lift shortens the skin-covered part of the upper lip, turns the red part outwards and makes the upper teeth more visible. Of these three, only the last one shortens the distance directly.

Researchers who studied how philtrum lines affect perception note that current lip treatments include shaping the soft tissue around the lips, especially the philtrum. Filler does not shorten the distance; however, in the same study, an upper lip with its philtrum lines erased was perceived as longer. Whether one option, several together or none of them makes sense for you is discussed at the consultation.

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Limits of this treatment

A thread lift does not remove skin from the upper lip, so it is not expected to shorten a true lengthening caused by excess skin in the way a surgical lip lift does. Published data do not show how much shortening this use achieves or how long the effect lasts.

The appearance of the upper lip does not depend on soft tissue alone. According to a review of upper lip ageing, this ageing is strongly influenced by the upper jaw (maxilla) and the teeth; ageing of the skin-covered part can be made worse by sunlight and smoking. Threads do not change an appearance caused by the position of the teeth or the upper jaw.

The effect of non-surgical methods is temporary; according to the systematic review of upper lip lift methods, the effect of surgical methods lasts longer. Even for facial thread lifts with dissolvable threads, long-term effectiveness data are lacking; for the upper lip, there are no such data at all.

These limits do not mean the treatment cannot be done; they show what your expectations should be based on. If your main goal is to genuinely shorten the philtrum, the method defined for that goal is surgery, and this option should also be discussed openly at your consultation. Your doctor assesses you; the decision is yours.

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Known risks

There are no complication data specific to upper lip thread lifts; what is known comes from face and neck thread lifts. The most commonly reported problems are swelling and bruising; threads that can be seen or felt, and skin dimpling, can appear later.

A meta-analysis pooling 26 studies and 2,827 patients reported swelling in 34%, bruising in 26%, threads that could be seen or felt in 10% and skin dimpling in 7%; however, the variation between studies was high. The researchers separate early findings in the first four weeks from late findings such as visible threads, dimpling and thread migration (the thread moving out of place), and state that late findings may be more important clinically.

In a systematic review of face and neck thread lifts, the most commonly reported findings were asymmetry, oedema (swelling) and bruising. Serious side effects were rare; they included altered sensation, hair loss, and injuries to blood vessels and glands. Most side effects went away on their own; however, contour irregularities (uneven contours), injuries to blood vessels and glands, infection and inflammatory reactions were exceptions to this.

Facial expression is one of the main functions of the upper lip; the area moves constantly when you talk, eat and laugh. There are no data showing whether the rates reported for the face and neck also apply to this area. High revision and complication rates have been reported with early treatments using non-dissolvable threads; these events have been reported less often with dissolvable threads.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (medicines that stop platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor. For this reason, giving a complete list of the medicines and supplements you take at your consultation is part of planning.

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