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

Abstract Background Subnasal lip lifts address perioral aging, but long-term quantitative data on postoperative changes and permanence remain limited. Objectives To provide the first three-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 40 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= 0.013 vs –5.95 ± 1.77 mm, p<0.001) and increased upper vermilion surface area (1.40 ± 0.86 cm2, p=0.022 vs 1.42 ± 1.23 cm2, p=0.022). Fat grafting produced greater early volumetric augmentation (1.18 ± 0.86 cc vs 0.53 ± 0.25 cc), though 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=0.003), 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 re-lengthening occurs over time. Additionally, early gains in vermilion display and lip volume decrease substantially by two years. Fat grafting enhances early augmentation but shows limited long-term retention.