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JPRAS Open
JPRAS Open
JPRAS Open
2352-5878
Elsevier

S2352-5878(24)00122-0
10.1016/j.jpra.2024.07.022
Short Communication
Quantifying upper lip height difference between two young male and female populations by direct surface measurement: Implications for gender-affirming upper lip shortening surgery
Sleilati F.H. fadi.sleilati@hdf.usj.edu.lb
⁎
Daou B.
Nassar A.
From the Plastic Surgery Department, Hotel Dieu de France University Hospital, Saint Joseph University, Lebanon
⁎ Corresponding author. fadi.sleilati@hdf.usj.edu.lb
03 8 2024
9 2024
03 8 2024
41 406410
31 7 2024
31 7 2024
© 2024 The Author(s)
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
The female upper lip is shorter than its male counterpart. We have recently described a precise direct surface measurement technique of the philtral height. In this study we aim to quantify the difference in philtral height using this same measuring technique between two groups of young male and female Lebanese subjects. The mean philtral height obtained in the young male group was 15.7 ± 1.7 mm. By comparing this result to the previously described mean philtral height of 14.3 ± 1.9 mm in the young female group, we obtained a mean difference of 1.3 ± 1.8 mm between the two groups. This result confirms and quantifies by direct surface measurement the gender difference in upper lip height and should be considered when planning a gender-affirming upper lip shortening surgery.

Keywords

Upper lip
Lip lifting
Philtral height
Philtrum
Gender-affirming
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pmcIntroduction

The gender related difference in the upper lip height is well documented and a shorter upper lip is considered more feminine and youthful. In a recent publication,1 we have used a precise surface measurement technique to measure the philtral height in a group of young female subjects. The aim of our study is to use this same technique to measure the philtral height in a group of young male subjects and to compare it to the female group. We hypothesize that the result will help us quantify the gender related difference in the upper lip height and consider this difference when planning a gender affirming upper lip shortening (GAULS).

Material and methods

The study follows the STROBE guidelines.

The subjects were Lebanese men aged between 18 and 30 years picked randomly from the first author's patients’ list. The oral approval of the subjects was obtained for inclusion in the study. Exclusion criteria were the presence of permanent filler or a recent injection of resorbable filler (<6months), previous surgeries to the lip, previous orthognathic surgery, and patients with heavy moustache. The age was recorded and the philtral height was measured from the subnasale to the labialis superioris points (Figure 1, Figure 2) with a flexible ruler with the lips resting in a slightly parting position. The data for the young women group was sourced from a previous study conducted by the first author.1Figure 1 Measurement of the philtral height from subnasale (SN) to labialis superioris (LS) points.

Figure 1

Figure 2 Measurement of the philtral height following the curvature of the philtrum.

Figure 2

Statistical analysis was performed using SAS version 9.4. Continuous variables were studied by sex using mean ± standard deviation (SD). Sex comparisons were performed to evaluate the differences in philtral height and age between men and women. We hypothesized that women have philtral height shorter than men. A parametric Studentʼs t-test was used to assess the statistical significance of sex differences.

Results

Fifty subjects were included in the male group. Their mean age was 25 ± 2.9 years, and the mean philtral height was 15.7 ± 1.7 mm.

As previously described, the female group included fifty subjects, with a mean age was 23.7 ± 3.5 years, and a mean philtral height of 14.3 ± 1.9 mm.

The mean difference in philtral height between the two groups was 1.3 ± 1.8 mm. The upper lip was significantly longer in male patients than in women (p < 0.001).

Discussion

The female face has a shorter upper lip as it has been demonstrated by many studies, but the difference doesn't exceed 3 mm.2 Published studies relied on MRI imaging or photographic analysis that were challenging to transpose to practical surgical measurements.

The advantages of our surface measurement technique have been described previously1 and our results concord with the literature, confirming a statistically significant shorter female upper lip of only 1.3 ± 1.7 mm, and proving once again that a short upper lip is a feminine characteristic.

Only a few articles focus on the lips in gender affirming surgeries. According to Altman et al.,3 the amount of skin excision should not exceed 25 % of the overall height of the lip. Telang4 excised 5–7 mm of philtral height. Salibian5 recommends 5–10 mm of philtral height excision. However, these studies do not report the age of their patients, and the illustrative cases presented are elderly patients with age related elongation of their upper lip. Furthermore, the amount of shortening recommended is arbitrary and exceeds by far the upper lip length gender related difference in young individuals.

Obviously, when it comes to planning a GAULS, aiming for 1.3 ± 1.7 mm shortening is not enough. This is particularly true for younger patients. But as the upper lip lengthens with age, lip shortening becomes more indicated in older individuals. In fact, when we perform the GAULS, our goal is to obtain mainly a more feminine upper lip, but also a more youthful and aesthetic one.

According to our previous study the mean philtral length of a young female lip was 14.3 ± 1.9 mm. This value may be considered as a target when planning a GAULS. Depending on the patient's initial upper lip length, the amount of lip shortening required is calculated. This target may be modified cautiously according to the patient's desire and the surgeon's expertise to avoid an over-shortened upper lip, especially in disproportionate faces.

The results of our study are limited by the particularities of the studied population mixed white ethnicities and cannot be transposed to other Asian or African populations without further investigation.

Conclusion

This study confirms and quantifies by direct surface measurements the gender related difference in upper lip height in a young Lebanese population. The mean difference is 1.3 ± 1.8 mm. We suggest using the mean philtral height of the young female lip of 14.3 ± 1.9 mm as a guide when planning a GAULS, as the aim of the surgery is not only a more feminine lip but also a younger and a more aesthetic one.

Declaration of competing interest

None.

Funding source

None.

Acknowledgments

The authors would like to thank Doctor Carine Nassar for her kind assistance in the statistical analysis.

Ethical approval

Ethical approval was granted by the ethics committee at Saint Joseph University, Beirut, Lebanon.

This work has never been presented at a meeting or published elsewhere.
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References

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2 Winiarska N. Stachura A. Roszkowski B. Pietruski P. Włodarski P. Paskal W. Anthropometry and current aesthetic concept of the lower third of the face and lips in caucasian adult population: a systematic review and meta-analysis Aesthetic Plast Surg 48 13 2024 2353 2364 38467850
3 Altman K. Facial feminization surgery: current state of the art Int J Oral Maxillofac Surg 41 8 2012 885 894 22682235
4 Telang P.S. Facial feminization surgery: a review of 220 consecutive patients Indian J Plast Surg 53 2 2020 244 253 32884190
5 Salibian A.A. Bluebond-Langner R. Lip lift Facial Plast Surg Clin N Am 27 2 2019 261 266
