Lip lift

What it is

The upper lip lengthens with age: the skin between the nose and the red lip grows taller while the visible red lip shrinks and the lip muscle thins (PMID 22660001, PMID 30688885). Less red lip and less of the upper teeth show, which reads as an older mouth (PMID 41731334). In women, the lip skin measured about 5.5 mm taller in an older group than in a younger one, a figure surgeons can use to plan how much skin to remove (PMID 38643687).

A lip lift shortens that skin. The scar sits under the nose, in its shadow (PMID 12848113). It does not treat the fine vertical lines of the upper lip, which need dermabrasion or a chemical peel (PMID 7296156). Rejuvenating the lip also takes volume, which surgeons add with fat grafting (PMID 30789473).

Where it came from

In 1981 Rozner described the lip lift as a simple addition to facial rejuvenation (PMID 7296156). In 1986 Austin called the long upper lip a seldom-considered sign of aging and corrected it by removing a wavy ellipse of skin and hiding the scar under the nose (PMID 3714896). In 1992 he placed the lip in the middle of three rings of the aging face, a ring the usual facelift does not treat (PMID 1576793).

In 2003 Ramirez published the bull's horn pattern: skin removed directly under the nose in the shape of a pair of horns, usually under local anesthetic (PMID 12848113). It became the most used pattern (PMID 32676900). In 2007 only a limited number of surgeons knew the operation (PMID 18005892).

Skin-only lifts can scar poorly when the skin closure carries the pull (PMID 42711479). In 2019 Talei described a deep-plane lip lift that releases the lip's SMAS layer and the pyriform ligament and suspends them, so the deep layer carries the lift (PMID 31280853). Later work built on the same idea with SMAS plication or excision (PMID 42711479) and triple suspension stitches (PMID 39920523). Demand has grown with changing ideals and social media (PMID 41230113), and in Asia younger people ask for a shorter lip (PMID 41377925).

Who it suits

• A long upper lip from aging. Good candidates have a tall lip, little or no tooth show and no upper jaw problem (PMID 24604786).
• A long lip after jaw surgery. In Asian practice, younger patients often seek a lip lift because the lip looks long after jaw surgery or orthodontics (PMID 26038373).
• An upper jaw that protrudes or is too long. These are diagnosed and corrected first, because a lip lift over an untreated jaw problem can show too much tooth (PMID 41377925).
• A long lip that has also lost volume. Shortening alone is not enough; a lip lift combined with fat grafting treats both (PMID 30789473).
• People who will not accept a visible scar. A suspension stitch placed through the nostril shortens the lip with the scar inside the nose (PMID 21359992).
• People planning nose surgery. A lip lift can be done with rhinoplasty and nostril reduction at the same operation (PMID 38742031, PMID 39659329).

How it is done

Skin removed under the nose

The surgeon marks a bull's horn shape directly under the nose, removes that skin and draws the lip up to the base of the nose, so the scar lies in the nose's shadow (PMID 12848113). The amount and width of skin removed is set for each patient (PMID 12848113). In cadavers, the lip shortened by more than the width of skin removed, and tooth show and red lip rose with it (PMID 35354201).

Deep-plane lip lift

The surgeon frees the layer under the skin and suspends it, so the lift is held deep and the skin closes without tension (PMID 35750522). The lip's SMAS layer and the pyriform ligament are released (PMID 31280853). SMAS plication or SMAS excision is chosen by lip volume, which controls how far the red lip turns out (PMID 42711479). The CUPID design adds a guide to lip balance and to when a corner lift is needed (PMID 35583637).

The lip muscle itself is handled three ways. Some surgeons leave it intact (PMID 35750522). Some tighten it with stitches, which trades red lip for tooth show millimeter for millimeter (PMID 41203329). Some remove a T-shaped piece of it and hang the muscle from the base of the nose (PMID 27771260).

Scar inside the nose

Flaps from inside the nostril improve the scar and keep tension off visible skin, and the same incisions give access for surgery on the lower nose (PMID 24604786). A flap at the nostril sill hides the scar at the base of the nose (PMID 37402393). A stitch passed through the nostril and anchored to the bony spine under the nose lifts the lip with no outside scar (PMID 21359992).

Corner lift

A corner lift raises the outer part of the lip and can be added to a central lip lift (PMID 19371836, PMID 35583637).

Results and how long they last

A lip lift shortens the lip and shows more red lip and more teeth. In recent studies, upper tooth show rose to about 3.5 to 5 mm (PMID 41731334). In one series of middle-aged women, lip length fell by about a fifth (PMID 33421416). Patients rated the improvement highly (PMID 41731334), and an artificial intelligence analysis measured a lower perceived age after the operation (PMID 34287019).

A surgical lip lift lasts longer than nonsurgical lifting (PMID 36856780). Results held for one to about five years in reviewed studies (PMID 35253108), and the gain in lip show declined only slowly over time (PMID 34613848). Some of the lift does return: in 3D follow-up of facial feminization patients, less than half of the early shortening remained at 2 years, and gains in red lip volume faded (PMID 42445689).

Risks and how surgeons lower them

• A visible or poor scar. The most common problem, about 7 in 100 in a pooled review (PMID 32676900), and the most common complaint in dissatisfied patients' online reviews (PMID 41230113). Holding the lift in the deep layer lowers skin tension: in a SMAS-based series, the few raised scars were treated with fractional CO2 laser and none needed surgery (PMID 42711479), and a triple-suspension deep-plane lift scarred less than the bullhorn (PMID 39920523).
• A change in the nose. A lip lift alone narrowed the angle between nose and lip and can make the nose tip look more projected (PMID 33421416). Nostril distortion and a wider nostril sill are mostly avoidable risks of the inside-the-nostril method (PMID 24604786), and nose or nostril distortion was the second most common complaint in dissatisfied reviews (PMID 41230113).
• Uneven lip or wrong tooth show. Lip asymmetry appears in dissatisfied reviews (PMID 41230113); careful marking before surgery keeps the lift symmetric (PMID 12848113). An untreated jaw problem can leave too much tooth showing (PMID 41377925), and undercorrection is a known risk (PMID 24604786).
• Revision. Revision rates ranged from under 1 to about 7 in 100 in recent studies (PMID 41731334). In nearly three decades of direct lip and corner lifts, few minor scar irregularities needed revision (PMID 19371836).
• Distress after a poor result. Patients who posted dissatisfied reviews showed high emotional distress (PMID 41230113).
• Stitch problems. With the suspension-stitch method, a few patients had a stitch abscess or a stitch that came loose (PMID 21359992).

Recovery

• The bull's horn lift is usually done under local anesthetic (PMID 12848113).
• Mild scarring and temporary numbness were the most common problems after lip lift with rhinoplasty, and both resolved within a few months (PMID 39659329).
• A raised scar can be treated with fractional CO2 laser (PMID 42711479).
• The scar is judged at 12 months (PMID 37402393).
• The lip partly lengthens again over the first 2 years (PMID 42445689).

With a facelift

• A facelift alone does not shorten the upper lip: philtrum length was unchanged after facelift without a peel (PMID 41433344). Adding a phenol-croton oil peel around the mouth shortened it by about 9% (PMID 41433344).
• Austin treated the face as three rings: facelift, eyelid lift and brow lift for the outer ring; lip lift, corner lifts, chin implant and dermabrasion for the middle ring (PMID 1576793).
• In one MACS-lift practice, about 1 in 4 facelift patients also had a lip lift (PMID 40906287).
• Rejuvenating the upper lip takes both shortening and volume: a precisely designed lip lift with microfat grafting (PMID 30789473).
• Weston and colleagues added direct lip and corner lifts to facial rejuvenation from 1980, accepting a scar barely visible from inches away (PMID 19371836).
• Fanous used a lip lift along the red lip border for thin lips, with facial lifts or on its own (PMID 6739598).

Questions to ask a surgeon

• How much skin will you remove, and how much of my teeth will show afterward? (PMID 35354201)
• Is my jaw or bite part of why my lip looks long? (PMID 41377925)
• Will you lift the deep layer so my skin closes without tension? (PMID 35750522)
• Where will my scar be, and can I see your patients' scars at a year? (PMID 37402393)
• How will the lift change the look of my nose? (PMID 33421416)
• Do I also need fat grafting for volume or a peel for lip lines? (PMID 30789473)
• How much of the lift should I expect to keep after 2 years? (PMID 42445689)
• How often do your lip lifts need a revision? (PMID 41731334)

Open questions

• Skin-only or deep suspension: recent deep and SMAS series report few scar problems (PMID 42711479, PMID 39920523), and a 2026 review could not pool the data because the studies differed too much (PMID 41731334).
• How much of the shortening lasts: one 3D series found partial relengthening by 2 years (PMID 42445689), another a slow decline over more than 5 years (PMID 34613848).
• Outcome measures differ between studies (PMID 36856780).
• Effects on the nose: a smaller nose-lip angle and an apparently more projected tip (PMID 33421416).
• How patients see mouths afterward: women with a prior lip lift looked longer at the mouth and rated less youthful smiles lower (PMID 42598817); dissatisfied patients report severe distress (PMID 41230113).
• Whether to keep, tighten or remove the lip muscle (PMID 35750522, PMID 41203329, PMID 27771260).
• Checking the jaw before a lip lift in younger patients (PMID 41377925).

Terms

• Philtrum: the skin of the upper lip between the nose and the red lip; its height is what a lip lift shortens (PMID 38643687).
• Vermilion: the red part of the lip (PMID 35354201).
• Subnasal lip lift: skin removal just below the nostril base (PMID 18005892).
• Bullhorn (bull's horn): the excision pattern under the nose shaped like a pair of horns (PMID 12848113).
• Deep plane (modified) lip lift: a lift that releases and suspends the layer under the skin, including the pyriform ligament (PMID 31280853).
• Orbicularis oris: the ring muscle around the mouth (PMID 41203329).
• Incisor show: how much of the upper front teeth is visible (PMID 35354201).
• Nasolabial angle: the angle between the base of the nose and the upper lip (PMID 33421416).
• Corner lift: excision at the mouth corner, sometimes added to a subnasal lift (PMID 35583637).
• GAIS: Global Aesthetic Improvement Scale, a 5-point rating of improvement (PMID 41731334).

Papers