Before deciding on Philtrum shortening. Numbers to measure during your consultation

The first measurement is the distance from below the nose to the lower edge of the upper lip. Textbooks indicate that 19–22 mm is the normal range, and how much longer than this becomes the starting point for determining the amount to be excised[1]. Another factor examined is how much of the upper front teeth are visible when the mouth is gently closed—these two measurements together determine whether surgery is suitable[2].

How far should the upper lip length be measured?

From the center below the nose to the lower edge of the upper lip. This length is shown in textbooks as 19–22 mm in the normal range, and the deviation from this serves as the basis for determining the amount to be excised.[1]. As a simpler guideline, it is also noted that this measurement is approximately the same as the distance from the tip of the nose to the base of the nasal septum[3]. However, the cause of the appearance of length is not limited to skin alone, so a conclusion cannot be drawn from the numerical measurement alone[1].

How does the appearance of the front teeth change things?

Whether to augment with filler or shorten with surgery is determined. A classification system has been reported that combines three factors: the height of the philtrum, the height of the red lip, and the amount of upper front teeth visible at rest to guide treatment selection.[2]. Patients with a long philtrum and adequate red lip height but no visible front teeth at rest are good candidates for surgery.[2]. For patients with a long philtrum and thin red lips, the approach is surgery combined with filler augmentation.[2].

Can skeletal factors be the reason it looks longer?

Yes. Textbooks note that excessive vertical development of the upper jaw or the direction of the nasal tip can be causes.[1]. When skeletal factors are involved, planning based solely on the amount of skin to be excised can result in an unfavorable relationship between the nose and lips; approaches combining jaw surgery when necessary have been reported[4]. The field of orthodontics also recommends that anterior open bite and occlusal depth be measured before and after surgery[5].

How much can the scar position be discussed?

The appearance changes depending on whether it is placed just below the nostrils or closer to the base of the nasal septum. Modified techniques involving suturing into deeper layers have been reported as an approach to address the concern that scars below the nose become more noticeable.[2]. Textbooks state that precise incision planning, including fine curves and taper, determines success, and that an inappropriate arch below the nose compromises the final result[6]. Where the incision line is planned can be explained while looking in a mirror.

Where does postoperative dissatisfaction come from?

From a mismatch between expectations and results. Research analyzing reviews on rating sites identified dissatisfaction with aesthetic outcomes and emotional impact as primary themes, noting these tend to be overlooked despite high satisfaction ratings[7]. Review articles also cite a limitation: measurement methods vary by technique, and standardized measurements are still lacking[8]. Sharing specific numbers—how many millimeters will be excised and how much upper front tooth is expected to show postoperatively—can reduce discrepancies.[7].

What are key questions to ask during your consultation?

A good starting point is to ask for the measured numbers and the reasoning behind them. If this surgery is performed on patients without sufficient vertical excess, the front teeth can appear too prominent or the mouth may be difficult to close; textbooks list this as outside the scope of indication.[6]. Have the measured values shown to you to clarify which side of this boundary you fall on.

If you are also considering nasal surgery, discussing it together will make planning easier. A review article has compiled simultaneous Philtrum shortening and rhinoplasty procedures,[9], and assessing the angle below the nose and gum display when smiling are fundamental to nasal evaluation[10]. Results become more predictable when the upper lip is not evaluated in isolation.