Tag: lip lift expert

The “Neonatal Deformity” is the Upper Lip Lift’s Unwanted Offspring

Posted on by Randal Haworth

To think that when Dr. Randal Haworth started his practice over 30 years ago, he was one of only a handful of leading plastic surgeons who specialized in lip reshaping surgery. Now, as one of the world’s most renowned lip lift experts, he has witnessed how upper lip lifts have exploded in popularity thanks to the influence of social media on the young and old alike. However, as with any trend, unintended consequences may arise such as the “neonatal deformity,” which originates from the congenital Apostrophe Lip. I first described this latter labial morphology in a chapter I authored for “Aesthetic Surgery of the Facial Skeleton”, a textbook edited by Dr. Steven Baker in 2019.

What Is an Apostrophe Lip?

You might not recognize the name, but you’ve likely seen the effect: the pink vermilion (the visible part of the lip) is full and prominent only in the center, while the outer thirds taper off or even disappear. This narrowing gives the mouth a stylized, doll-like appearance reminiscent of Kabuki makeup, where the lips are intentionally painted small and central.

While deliberate in performance art, this effect is aesthetically unflattering when unintentional—and unfortunately, upper lip lifts performed without addressing corner anatomy often exaggerate this deformity.

Kabuki performance artist's lips
Kabuki-style makeup mimicking an Apostrophe lip — note the abrupt loss of vermilion toward the corners, creating a slit-like mouth.

Kabuki lips
Another example of a stylized Kabuki “rosebud” mouth, often unintentionally replicated by improper upper lip lifts.

Overfilled lips due to both patient and practitioner perception drift
Before and after correction of an apostrophe lip using a medialized corner lip lift. This patient had chronic filler injections that exacerbated the deformity, narrowing the vermilion into a slit-like central zone.

How an Upper Lip Lift Can Create A Neonatal Lip

Lips of a Neonate
The neonatal deformity gets its name from the naturally recessed corners and centralized vermilion seen in newborns—charming in infants, but unflattering in adults.

Regardless of type, if an upper lip lift is performed without taking into account the oral commissures and lateral upper vermilion, a preexisting apostrophe lip can be exacerbated. The slope from the Cupid’s bow to the oral commissure (mouth corners) becomes unnaturally steep. The outer pink vermilion rolls inward or disappears entirely, leading to a pinched, slit-like appearance akin to that of a newborn. In essence, a neonatal deformity. Patients from around the world have come to me distressed by this outcome, often feeling disfigured and despondent.

Classic Neonatal deformity
Classic Neonatal lip deformity after an upper lip lift without regards to the oral commissures
A moderate neonatal lip deformity
A moderate neonatal lip deformity after an upper lip lift and an inadequate traditional corner lip lift

The Medialized Corner Lip Lift: A Powerful Solution

Enter the medialized corner lip lift—a precise, elegant surgical solution I’ve refined over the years to correct these issues. It not only repositions the corners of the mouth upward but also:

  • Restores lost vermilion by rolling it outward, eliminating that paradoxically tightlipped “rosebud” look.
  • Corrects asymmetry, which is present in the majority of mouths.
  • Improves the marionette folds (those stubborn lines running from the corners of the mouth downward) that facelifts often miss.
  • Softens the harsh slope from Cupid’s bow to oral commissure, restoring a balanced, natural curvature.

This is a high-precision procedure involving design and execution tolerances as fine as a quarter millimeter. But when done correctly, the results are not only restorative—they are transformative.

Neonatal lip deformity stemming from past upper lip lift.
This patient required a direct revision of her previous upper lip lift to correct pleating at the nasal base and a medialized corner lip lift to correct the neonatal deformity. A lower V–Y plasty was also performed.
Asymmetrical, neonatal, deformity after upper lip lift and simultaneous rhinoplasty
Another case of asymmetrical neonatal lip deformity after having undergone a previous upper lip lift simultaneous with a rhinoplasty. Dr. Randal Haworth corrected this with a medialized corner lip lift along with medical dermabrasion of her upper lip lift and nasal base/past rhinoplasty scars.. The vermilion was central and collapsed at the corners.

Final Thoughts

If you’ve undergone an upper lip lift and are unhappy with the corner distortion or feel like your lip looks smaller or more “pursed” than before—know that you’re not alone. These issues are more common than many realize, but they are entirely correctable.

Performed under local anesthesia, the medialized corner lip lift offers a sophisticated solution to restore harmony and confidence to your face.

Dr Randal Haworth

Beverly Hills 2025

Hot Lips, Cold Sores

Posted on by Randal Haworth

 Stress, weather, chemicals and injury to the lip can all awaken the virus in your body. But needle punctures can be particularly triggering for cold sores.   As one of the Beverly Hills top lip injector of fillers, Plastic Surgeon Dr Randal Haworth does see the occasional cold sore erupt 1-2 days after a treatment. It is for that reason, Dr Haworth recommends antiviral prophylaxis is select cases.

Cold sore herpes Simplex Type I of the lips
Cold sore herpes Simplex Type I which can occur after any lip procedure.

Of course, you can be prone to cold sores, get a lip filler and have no sign of an outbreak. But it’s good practice to be precautious and minimize the risk.

Dr Haworth notes that any cosmetic procedure which causes stress to your skin has the potential to stimulate cold sore recurrence. Cold sores are a prevalent affliction and are generally due to herpes virus (HSV) type one particular (generally oral herpes), with the minority (10%) being due to HSV type 2 (usually genital).

Many main infections of HSV-1 are asymptomatic, while recurrent infections can present as fever blisters at the vermillion border. Although cold sores may well not cause any long-term skin damage, they do possess the potential to cause scarring at the contaminated area.

Roughly two-thirds of a global population under 55 are infected with HSV-1. Primary illness develops in childhood through non-sexual contact usually, for example by sharing utensils or towels, but it is regularly assumed to be solely caused by kissing. If symptoms do present with primary infection, they take place two to 20 days after direct exposure.

Aesthetic procedures such as for example lasers, injectables, microneedling and chemical peeling often require limited or deliberate, manipulated trauma to skin, which includes the potential to trigger cold sore recurrence. Dr Haworth, the world’s foremost lip reshaping expert (including upper lip and corner lip lifts) will even warn his patients that his signature lip enhancements can trigger a herpes simplex outbreak. When a fever blister shows up after an aesthetic treatment, it could be devastating for the individual due to distress, pain and potential skin damage of a cosmetically very sensitive area. You will find a particular likelihood of scarring after ablative types of procedures (lasers, peels).

Cold sore prophylaxis can be recommended in the subsequent circumstances:

-More than three spontaneous occurrences every yea
-Previous eruption at any time, as a result of a procedure
-Lip augmentation and HSV eruption regardless of date or time
-Facial resurfacing procedures; anything that breaches skin carrier, and especially medium or deep peels, facial skin lasabrasion, microneedling and microdermabrasion

Immunocompromised patients

Prophylaxis Dr Haworth recommends includes predosing with Valtrex 500mg daily for 2 days to continue for 3 after the procedure. He’ll substitute 1000 mg daily in particularly susceptible individuals.

Randal Haworth MD, FACS

Nostril narrowing through Weir excisions does not have to look fake

Posted on by omnispear
Wier excisions are very powerful tools to augment a rhinoplasty. This is a procedure that I usually perform at the conclusion of a nose job in order to refine and narrow the nostrils while controlling the flare when smiling. Most people and surgeons alike equate this procedure to simply narrowing the “floor” of the nostril by cutting out some skin but it is actually more nuanced than that. The design of the excision can be customized by changing the angulation, the position and the width of the cuts which, in turn, can change not only the dimensions but also the curvature of the actual nostril itself. A deep permanent suture is often used as well to prevent re-widening of the nostrils and reduce tension across the scar. Reducing tension across the scar as well as accurate angulation is important to achieve a nearly invisible scar. So many times I have seen obvious notching that is visible from 5 feet away and is a definite giveaway of having had a rhinoplasty. Weir excisions can be also be performed in conjunction with an upper lip lift adding to the complexity of the procedure. As a rhinoplasty and lip lift expert, I have performed hundreds of these combination techniques with excellent results. All facial plastic surgery, whether it’s primary or revisional, is challenging but taking the time to address all the details and plan them accordingly can maximize the aesthetic outcome that is not only beautiful but natural as well. The devil is in the details so to speak.
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Poor rhinoplasty result with crooked , distorted tip and obvious nostril scarring after a Weir excision
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Again, note obvious nostril scarring from Weirs and tell-tale signs of a past rhinoplasty
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Before and after revision rhinoplasty and Weir excision as performed by Dr. RANDAL HAWORTH
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty and Weir excision to narrow the nostrils in Asian patient. Note added tip projection and lack of notching
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth
Primary rhinoplasty, Weir excision and concomitant upper lip lift as performed by Dr. Haworth

Lip Lift status for 2014 and beyond

Posted on by omnispear

Lip lifts for 2014

Patients often asked me what are the differences between a skin-only lip lift and my muscle hemming technique. To put it simply, longevity, scarring and nasal distortion.

Skin Only Lip Lift

Until the late 90’s, the only lip lift I knew how to do was the skin only type. I would perform this by excising a certain amount of skin below the nasal base and sewing the lower edge of the excision to the upper edge which happens to be the skin of the nose.  The only thing now supporting this entire weight of the upper lip (which happens to move millions of times a day, eating, kissing, expressing and speaking) is the freshly closed incision at the skin level.  One can imagine that this provides little support for all the action occurring around the upper mouth area.  Consequently, the longevity of the lip lift itself is lessened, the nostrils are more likely to be pulled downwards while the resulting scar is more likely to stretch and thicken.

The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.
The results of a skin-only lip lift. Notice the widened scars, significant nostril distortion and recurrent long upper lip.

Muscle Hemming Lip Lift

After many years of observing the long-term results of skin-only lip lifts, I developed the muscle hemming technique.  By employing moderate principles of plastic surgery in which nip and tucks (such as a facelift) are improved by lifting and tightening the layers below the skin including muscle I have noted a significant benefit to my lip lifts in terms of scarring, longevity and less nasal distortion.  However, the recovery period was notably increased.  The muscle hemming technique involves placing slowly dissolvable sutures into the muscle layer below the skin and intern suturing that to the periosteum (lining) of the bone deep to the nose itself.  The lip lift is thus a solid one without relying on skin closure to achieve its  superior long-term results while lessening the chance of undesirable scarring and pulling around the nostrils.

Skin Flap Lip Lift

Which brings me to today.  For the last 3 years I have been employing a skin-flap technique which provides all the benefits of the muscle hemming technique but with half the recovery.  Suturing of the muscle is minimized in this technique but none of the longevity and superior scarring is sacrificed. The period of significant distortion and swelling has been halved from 2 weeks to less than 1.  Additionally, the results are “softer” in appearance with minimal to no distortion of the nostril area.

Patient with subliminal long upper lip with minimal upper toothshow
Patient with subliminal long upper lip with minimal upper tooth show
After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant improvement tooth show, natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed surgery during to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only at muscle-hemming techniques.
After skin -flap lip lift by Dr. Haworth of Beverly Hills. Notice significant increase in tooth show and natural shortening of the upper lip with minimal nasal distortion. Being a lip lift expert, he developed this surgery to further his evolutionary journey into perfecting the ideal upper lip lift. This new technique also produces softer results those from the skin-only and muscle-hemming techniques.

Performing the modern lip lift with minimal-to-no-scarring and achieving a permanent beautiful result is challenging .  It requires attention to minute detail and appreciation of how the oral region plays a central role in facial harmony.  The vast majority of patients are thrilled with the subtle yet powerful results of this operation, but it has taken over 2 decades of  unwavering dedication and imagination to get this far.