Difference Between Types of Lip Lift Surgery?

Question

What's the difference between an Italian lip lift and a Bullhorn lip lift? What are the pros and cons of each type of lip lift procedure?
Thank You!!

Otto Joseph Placik, MD · Answer

Italian Lip Lift: Two separate incisions beneath each nostril. Skin is removed and the right and then the left lip are each separately lifted by closing the wound and reducing the distance bewteen the lip and nose.

	Bull-Horn (subnasal) Lip lift: A single bull horn shaped excision of skin immediately beneath both nostrils shaped like a mini moustache. Closing the wound lifts the right, central, and left portions of the upper lip

	Gull-wing (direct) lip lift: A single gull wing shaped removal of skin directly above the red portion of the lip where a woman typically applies lipstick liner.

	None of the above 3 lift the corners of the mouth and can actually make them appear to turn downwards even more. Therefore, the above are frequently combined with a corner lift.

	Corner lip lift: a triangular or heart shaped excision of skin directly above and to the outside of the "corners" of the mouth to lift and prevent a downturning or frowning appearance.

Jed H. Horowitz, MD, FACS · Answer

Hi! For your guidance, lip lift, or sometimes called as bullhorn procedure, is a minor surgical procedure that shorten the distance between the nose and upper lip which allows more of your central upper teeth to show both at rest and when you smile. The incision is done at the base of the nose, just within the nostrils. It was called bullhorn because of its shape as the muscle is tucked which shortens the skin providing a youthful upper lip in less than an hour under local anaesthetic.On the other hand, italian lip lift is a modified bullhorn lip lift in which it has a short incision (compared to bullhorn) that creates a similar effect. This procedure has two shorter incisions centered under the nostrils rather than continuing completely across the nose. Do not hesitate to ask your surgeon about detailed information on your options. #RealSelf100

Gary Linkov, MD · Answer

I've attached a link to a photo that I think you will find useful and that illustrates the various types of lip lifts. Basically, you could have two separate incisions under the nose (italian), one incision under the nose (bull horn), one incision at the red/white upper lip junction (gull wing) or two separate incision at the corners, or a combination.

James M. Pearson, MD, FACS · Answer

With the Bullhorn or Subnasal lip lift, incision placement
is concealed within natural skin creases underneath the nose. With the Italian
lip lift, incision placement is concealed within the nostrils. The relative
benefit of the Italian lip lift is potentially 'invisible' scars given their
placement in a location that is not visible to the average onlooker. The relative
disadvantage of the Italian lip lift is that it does not affect the lip
distance between the nostrils due to its more limited incision. A hybrid lip
lift may be undertaken, sometimes called an 'endonasal lip lift', which
conceals a portion of the scar within the nostrils while incorporating a
subnasal component to the incision between the nostrils.

Gary M. Horndeski, MD · Answer

Great question. My colleagues have explained in great detail the differences in techniques; pros and cons. What I prefer to do in my practice is take variations of these to suit a patient's individual needs. No one person is alike so procedures should be customized to fit the specific needs of the patient. Kind regards,Gary Horndeski M.D.

Farhad Rafizadeh, MD · Answer

There are many variations of lip lift techniques. The direct lift above the vermilion is an option that is out of favor today because it interferes with an important anatomical feature that is the white line separating the vermillion from the skin and forming the cupids bow. The sub nasal techniques are a much better option. The shape and the size of the incision will depend on the individual patient's requirements and the goals that are established after examining the patient. One can plan on lifting the center of the lip more than the sides. In this case the skin excision should be wider in the center and taper off to the base of the nostrils. In other situations, a wider excision is done laterally. A great degree of artistic evaluation is needed to achieve a best results. This is one the most artistic and rewarding surgeries that I do. You have included a picture and I assume you want to know what needs to be done in this particular case. It this case an incision is made going from the base of the ala, and then it goes into the nostril, then it continues in the angle between the columella and the lip into the other nostril and then under the other alar base. An even amount of skin is taken from the center and the sides to try to maintain the pleasing shape of this lip. This person obviously needs to be evaluated carefully to decide exactly what works for them and how much lifting is required, but the person in this picture is a great candidate.

Raffy Karamanoukian, MD, FACS · Answer

A lip lift and/or lip reduction surgery has many variants. The type of lip lift performed depends on the amount of scar risk and the amount of central lip pull required. Raffy Karamanoukian MD FACS

Evan Ransom, MD, FACS · Answer

Thank you for the great question. The Italian lip lift is not a commonly performed procedure, but the general idea is that this technique avoids cutting under the columella (the part of the nose that divides the nostrils). The bullhorn technique is similar but includes the central portion. In my opinion, it is easier to get a natural-appearing curvature of the upper lip with this option.

Ricardo L. Rodriguez, MD · Answer

I had not done an italian lip lift, so I looked up the article.

	 

	It looks like a long run for a short slide, as they say in baseball. To avoid cutting under the columella (the small vertical column between the nostrils), the incisions are extended along the side of the columella, then the columella is elevated. This is what allows the central part of the lip to be excised.

	 

	Aside from wether the scar is noticeable or not, the real problem is it makes the whole angle between the lip and the columella look kind of funny, especially when viewed from the side.

	 

	I like trying new things, but that one is one I'll pass on.

Karan Chopra, MD · Answer

Hi @TobyRyan Thanks for your other question and sharing the picture again. The Italian Lip Lift attempts to disguise the scar inside the nose with two separate incisions. This is unlike the Bull-Horn Lip Lift which is what i prefer which uses a single incision hidden under the nose. Or the Gull Wing Lip Lift which is a single incision along the white roll of the upper lip.
You would do better with a Bullhorn pattern which is more anatomically natural and give a better result. It is also hidden right below the nose. The gullwing pattern is along the actual lip and is a more obvious scar and less poutier lift. 
An upper lip lift is an excellent procedure to give naturally beautiful, youthful and poutier lips. It's one of my favorite procedures because it is quick (90 minutes), does not require general anesthesia, and it makes a big difference that is long-lasting.
Patients of all ages can benefit from an upper lip lift, the idea candidates have an upper lip length greater than 1.5 cm. This is measured as the distance from the base of the nostrils to the red part of your lip. An easy way to tell if you can benefit from an upper lip lift is to relax your mouth so your mouth is slightly open... if you cannot see your upper teeth during natural lip separation - you may benefit from an upper lip lift. 
The surgery is designed so the incision is concealed along the groove under your nose and heals with an inconspicuous scar. Patients with a long upper lip who elect to get lip filler instead of a lip lift are at increased risk for developing "Duck Lips" because the filler has no more vertical room to push the lips, and so they end up going out like a duck bill. So fillers are a great option for lip augmentation but cannot deliver a lip lift like an actual lip lift procedure. 
Regarding the scars in your question above - the scar typically heals extremely well and can be further effaced with laser if it's a concern.To optimize your chances of an excellent scar we recommend no smoking 4 weeks prior to the surgery and limit sun exposure after the surgery.
Dr. Karan Chopra
★★★★★
Minneapolis Plastic Surgeon
Face ⨀ Breast ⨀ Body Expert
Johns Hopkins Trained
Cosmetic Fellowship Trained

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