The upper lip may get longer as one ages in some people. For others, they have a naturally long upper lip when gets more so with age. A long upper lip associated with a thin vermilion can be cosmetically treated through skin removal.
One option for shortening a long upper lip is a lip lift. With this technique, the skin is taken high up under the nose and the upper lip skin is shortened as the remaining skin is pulled upwards. This will leave a residual fine line scar along the base of the nose and only the central lip will have more fullness or pout. It is always slightly over-corrected as there will be some relaxation (mild re-lengthening) of the upper lip afterwords.
While this is a fairly simple procedure, complications have been reported from it. One complication appears to come from sewing the underlying orbicularis oris muscle up as well as the skin, presumably for better long-term stability. However, such a maneuver creates an unnatural stiffness and deformity of the upper lip as the orbicular muscle is somewhat restricted from acting like its natural sphincter. It is far better to run the inconsequential risk of doing a secondary tuck-up of the procedure if there has been some relapse.
Abnormal scarring has also been reported. This appears to come from an effort to hide the scars inside the nostrils. This sounds theoretically beneficial but that causes distortion of the nostril sill and enlargement of the nostril opening. Secondary correction of the nostril is difficult. This is not a good trade-off given that subnasal scars generally heal quite well.
Changes in the shape of the nostril can be caused by being pulled downward from removing too much skin (a few extra millimeters is all that it takes) underneath the nostril. This is why the cutout is wavy or bullhorn-shaped with the greatest amount taken centrally between the philtrums. Since skin can not be replaced, secondary correction can be attempted by a modification of the inner alar wedge technique.
Upper lip lifts can be a very satisfying procedure but it is important to not try and take too much skin or do modifications of the procedure that interfere with the natural nostril sill. In my Indianapolis plastic surgery practice, I take a central 4 -5 mms of skin removal whose pattern tapers out to the lateral alar rim. This approach produces consistent results with negligible risks of any of the aforementioned complications.