How it differs from lip fillers
Both are requested with the words "I want more lip", which is why they get confused.
Hyaluronic acid filler increases the volume of the lip, is done in the consulting room, has an immediate effect and is reabsorbed over time. It does not change the distance between the nose and the lip. When that distance is long and more filler keeps being added, the lip tends to weigh down and the proportion gets worse.
A lip lift shortens that distance surgically, and the skin removed does not come back. It does not add volume, although the effect can look similar because more red lip is on show. At the consultation the actual distance is measured before deciding: some cases call for filler, some for surgery and some for both in stages.
Who is a candidate
The indication is assessed by measuring the lower third of the face and observing the lip at rest and when smiling. These signs point towards a lip lift:
- A long distance between the base of the nose and the edge of the upper lip, either by build or because of the descent that comes with age.
- Little or no upper tooth show with the lip at rest.
- A thin, long upper lip that does not improve with filler, or that looks out of proportion with filler.
- Loss of definition of the Cupid's bow and the philtrum.
It is not suitable for everyone. If the distance is short to begin with, shortening it further gives a forced look and a smile that shows too much gum, which is hard to correct. That is why the measurement beforehand shapes the whole decision.
The technique
The most common is the subnasal lip lift, known as the bullhorn because of the shape of the incision. A strip of skin is removed just below the base of the nose, following the outline of the nostrils and the columella, and the wound is closed in layers.
The amount of skin removed is calculated from each patient's measurements, because removing too much cannot be undone. The muscle layer is also worked on so that the closure does not depend only on skin tension, which is what determines how the scar evolves. It is done under local anaesthesia, with or without sedation depending on the case and the anaesthetist's assessment, as an outpatient procedure.
Where the scar sits
In the crease at the base of the nose, following its outline, where the change in texture and the natural shadow help to disguise it. There is always a scar, and how it evolves depends on each person's skin, on aftercare and on sun protection in the first months.
Recovery
Swelling of the upper lip is noticeable in the first days and goes down gradually. Stitches are removed when the surgeon indicates, usually during the first week.
In the first days a soft diet is advisable and movements that stretch the lip should be avoided. The scar goes through a red, firm phase before it fades, a process that takes months. Strict sun protection of the area is part of the treatment. The final shape of the lip can be seen once the swelling has gone and the scar has matured.
Risks and limitations
They are explained at the consultation before any decision: a visible or hypertrophic scar, asymmetry between the two sides, too much gum showing when smiling, temporarily altered sensation and under-correction. Over-correction is very difficult to reverse, which is why the approach in this surgery is to stay on the conservative side.
How it fits with the rest of the lower face
The lip is not assessed in isolation. The position of the chin and the projection of the nose change how the upper lip reads in profile, and in some cases a lip lift is planned as part of a study of the whole facial profile.
If there is also sagging of the midface and neck, a lip lift does not address it: that calls for a deep plane facelift, with a different recovery. Both can be done in the same operation if the assessment advises it.
Frequently asked questions
Is a lip lift the same as a facelift?
No. A lip lift works only on the distance between the nose and the upper lip. A facelift repositions the deep tissues of the face and neck. They share the word lift; the technique, the incision, the operating time and the recovery are different.
How much more lip will show?
It shows the lip you already have. What is shortened is the skin above it, and the amount is calculated from each patient's measurements. Giving a figure before measuring makes no medical sense.
Does the change last?
The skin removed does not come back, so in that sense it does. The tissues keep ageing, and over the years the lip slowly descends again, at a pace that varies from person to person.
Will the scar show?
It sits in the crease at the base of the nose, where the natural shadow and the change in texture help to disguise it. There is always a scar, and its final appearance depends on the skin and on care in the first months. Anyone who does not want to accept a scar there should probably consider other options.
Can it be done if I have had lip fillers?
Yes, but it should be assessed at the consultation. Recent filler makes it harder to measure the real proportion of the lip, and in some cases it is better to wait until it is reabsorbed to plan on the original anatomy.
Can it be combined with rhinoplasty?
It is assessed case by case. The lip lift incision is at the base of the nose, an area also handled in rhinoplasty, so combining them requires careful planning of tissue tension and the order of the steps.