Three-Dimensional Morphometric Trajectories Following Lip Lift With or Without Fat Grafting in Facial Feminization Patients.

BACKGROUND

Subnasal lip lifts address perioral aging, but long-term quantitative data on postoperative changes and permanence remain limited.

OBJECTIVES

The aim of this study was to provide the first 3-dimensional (3D) evaluation of morphometric changes after subnasal lip lift ± autologous fat grafting over time.

METHODS

A retrospective cohort (2022-2025) of facial feminization patients undergoing subnasal lip lift ± fat grafting was analyzed. Standardized VECTRA 3D imaging measured philtral height, vermilion height and width, nasal base width, columella-labial angle, surface area, and lip volume preoperatively and at serial postoperative intervals. Early changes (3 months) were compared using t tests and longitudinal trajectories with linear mixed-effects models.

RESULTS

Forty patients were included (lip lift alone, n = 10; lip lift + fat grafting, n = 30). Both cohorts showed significant early philtral shortening (-2.92 ± 1.53 mm, P = .013 vs -5.95 ± 1.77 mm, P < .001) and increased upper vermilion surface area (1.40 ± 0.86 cm2, P = .022 vs 1.42 ± 1.23 cm2, P = .022). Fat grafting produced greater early volumetric augmentation (1.18 ± 0.86 vs 0.53 ± 0.25 cc), although between-group differences did not reach statistical significance. Mixed-effects modeling showed significant divergence in permanence. Philtral shortening showed 43% retention by 24 months (P = .003), whereas volumetric and surface area gains approached zero by 22 and 24 months, respectively.

CONCLUSIONS

There is measurable philtral shortening after subnasal lip lift. However, partial relengthening occurs over time. Additionally, early gains in vermilion display and lip volume decrease substantially by 2 years. Fat grafting enhances early augmentation but shows limited long-term retention.