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Plast Reconstr Surg. 2013 Sep;132(3):543-51. doi: 10.1097/PRS.0b013e31829accb6.

Analysis and classification of the upper lip aesthetic unit.

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American Institute for Plastic Surgery and University of Texas Southwestern Medical Center, Dallas, TX, USA.

Erratum in

  • Plast Reconstr Surg. 2013 Oct;132(4):1040.



Disharmonies of the upper lip aesthetic unit generally stem from tall ergotrids and/or thin lips. Comprehension and correction of such defects has been stifled by a lack of metrics and organized systems of diagnosis and treatment.


The philtral-labial score was devised to better analyze the upper lip region. Measurements were made with Adobe Photoshop CS6, and computations were performed on a standard calculator. A retrospective medical records review identified 908 patients of the senior authors' (P.R. and S.W.H.) practices who underwent perioral rejuvenation between January 1, 2001, and July 31, 2012. Two hundred patients were randomly selected and assessed for disharmonies in three surveys that sequentially built on data points provided.


When preoperative anteroposterior and lateral photographs, dental show measurements, and philtral-labial scores were available, diagnostic concordance between the authors approached 100 percent. Pattern analysis resulted in a classification system (labral classification system), designating patients as either type 0 (no defects), type 1 (thin upper lip), type 2 (long philtrum), or type 3 (both) defects. Characteristic dental show values, philtral-labial scores, and suggested treatments were paired with each type.


The labral classification system and its associated analytical tools serve as useful references in consultation, simplify discussion of patients with upper lip defects, furnish a practical alternative to complex algorithms, enable documentation of changes, and facilitate analysis of large sample sizes. When implemented judiciously, the tools described in this article will help surgeons confidently address upper lip problems by streamlining accurate diagnosis and guiding proper treatment.

[Indexed for MEDLINE]

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