Plastic surgeons have been publishing their experiences with lip lift surgery since the early 1980s, but only within the past five years has the procedure firmly embedded itself in the beauty zeitgeist. Doctors credit social media with boosting the lip lift’s profile, just as it has those of other once obscure surgical tweaks, like buccal fat removal.
During a lip lift, surgeons remove a bullhorn-shaped strip of skin from just below the nose, to shorten the space between the base of the nose and the upper lip—“that is the number one primary goal and the only thing we can really control during surgery,” says Dr. Gary Linkov, a board-certified facial plastic surgeon in New York City. Reducing the length of the philtrum—the groove atop your Cupid’s bow, which elongates with age—balances the proportions of the midface, for a more youthful look.
While the lip lift is often promoted as a lip-filler alternative—a means of rolling up the vermillion border, to evert and enhance the top lip without injections—this subtle plump is really more “a side effect of shortening the philtrum,” points out Dr. Linkov. The same is true for the improved tooth show touted by lip lift proponents. Ideally, “you want to see around two to three millimeters of upper tooth show with the lips in repose,” notes Dr. Catherine S. Chang, a board-certified facial plastic surgeon in Beverly Hills, California. But both of our experts stress that they generally cannot guarantee that sexy sliver of incisors post-op. While “odds are, there will be some improvement in tooth show,” Dr. Linkov explains, if the patient has short teeth and/or a generous amount of red lip, “sometimes the inner mucosa of the lip will still cover the teeth after surgery.”
And when individual anatomy sways the particulars of a procedure to such an extent, outcomes can vary. So then, what exactly are the markers of a successful lip lift? Here, our surgeons share key aspects to look for in lip lift before-and-afters.
1. A proportional philtrum
If you’ve never before pondered the precise number of millimeters separating your nose from your mouth, you’re probably not alone. But there are plenty of folks “who feel like their proportions are off—whether it’s an aging thing or they’re born that way, they just feel like their midface is too long and attracts too much attention,” says Dr. Linkov. What is “too long”? A female philtrum is said to fall in the range of 11–13 millimeters—but textbook averages rarely account for ethnic variations or the significant shifts that occur with age.
During surgery, “you typically don’t want to go shorter than 11 millimeters,” says Dr. Chang. Moreover, trying to bring an exceptionally long philtrum into textbook range is usually not a great idea. “I’ve worked on philtrums as long as 28 or 29 millimeters,” says Dr. Linkov, “and for those people, if I take 10-plus millimeters, it distorts them too much—it’s such a major change, even at the longer philtral lengths, and I prefer not to do anything that drastic.” While the amount of tissue he removes depends on the patient’s starting measurement, he typically carves out between four and six millimeters for the most harmonious effect, with eight millimeters being his upper limit.
2. A thin, well-hidden scar
According to Dr. Chang, by about three months post-op, “you should not be able to see lip lift scarring—the pinkness or the contour—at a conversational distance.” As an interesting aside, she adds, part of what makes someone a good candidate for a lip lift is having the type of nose that provides some natural camouflage for the inevitable scar—a nose that “casts a favorable shadow on the upper lip” and isn’t overly rotated or upturned at the tip.
While everyone heals differently—and this lends an aspect of unpredictability to all surgical outcomes—your surgeon’s lip lift technique will largely influence the long-term look of your scar. “I like to hide the central part of the incision at the junction between the end of the nose and the start of the upper cutaneous lip [not the red of the lip, but the flesh-toned part]—right where the columella naturally folds when I push on the tip of the nose,” says Dr. Linkov. He then carries the incision under the nasal sills (lower ridges of nostrils), stopping right outside of the alae (where the nostrils bump out on the sides of the nose).
To keep the scar from widening, our surgeons like to dissect down to the muscle and place internal sutures in the SMAS—the sturdy connective tissue overlying the muscle—“to have the deeper layers bear tension and not the skin edges,” says Dr. Linkov. Some doctors suture the dermis instead of the SMAS, notes Dr. Chang, but in her experience, “the scar doesn’t look as good when you do that.”
3. A natural-looking nasal base
Following the proper bullhorn approach should also help prevent the normal contours of the nose from getting distorted. “The sills can get pulled down with surgery—in probably a quarter of patients, there’s some degree of nasal sill drop,” Dr. Linkov tells us. “Some surgeons, [when making their incision,] will go into the nose, and that flattens the sills—actually deleting the sills in certain cases, which looks even worse.”
So when you’re looking at a surgeon’s after photos, you want to make sure that you’re not seeing “the sills pulled way down or the nasal base looking obviously unnatural” consistently across all lip lift patients, he adds.
Of course, as a lay person, detecting a dropped nasal sill can be tricky. “When those contours are disrupted, the viewer doesn’t necessarily recognize that is what’s happening, but rather the lack of normal shadow and contour tells the brain that something looks off,” says Dr. Chang. Again, “this is often due to poorly placed incisions.”
4. Balance and symmetry
A well-executed incision should beget a balanced excision—meaning, “it’s not just the center of the lip that’s been lifted,” says Dr. Linkov. “You can see some degree of change across the upper lip”—save for the very corners, which require a separate procedure, aptly dubbed a corner lip lip, which leaves scars along the vermillion border.
A balanced outcome also considers the proportions of the lips themselves. “You have to balance the upper lip, not only in relation to the lower lip but also in relation to the entire face,” Dr. Chang says. This is especially crucial for patients who have naturally full lips and desire a shorter philtrum without the added oomph that may accompany it. “This is when I go more conservative, removing no more than five millimeters,” says Dr. Linkov, so as not to tug up the top lip too much.
Beyond taking only a modest amount of tissue in these cases, Dr. Chang urges restraint when suturing, explaining that “the more you tighten the SMAS, the more eversion of the lip you will create.” Whether a patient is aiming for that pillowy effect or not, she’s always cautious when suturing the deep tissue, insisting that “an overly everted lip is a telltale sign of surgery.”
When reviewing after photos, you’ll also want to pay close attention to the height of the Cupid’s bow—and more specifically, the relative symmetry of those two halves. It’s common for patients to present with some natural asymmetry, especially around the nostrils, but surgeons should account for this when mapping out their incisions.
“It’s very hard, in the initial markings, to be exactly right all the time,” admits Dr. Linkov. Which is why he builds in a routine symmetry check to every lip lift operation. “I have this moment, before I place the surface stitches, where I clean the area and I just look—I look with my assistant, from multiple angles, and I’m looking at the Cupid’s bow and vermillion border, and I’m asking, ‘Is it symmetrical?’ If it’s not, we address the low side by removing more skin.”
5. Improved tooth show (in some cases)
While surgeons can’t promise ample tooth show with every lip lift, at least some of their after shots should show a noticeable improvement—which is why it’s important for doctors to post various post-op perspectives, angles, and poses. In this scenario, “you need to see both mouth-open and mouth-closed views,” says Dr. Linkov. “If the patients’ mouths are closed in every picture, then you’re left to wonder what happened with the teeth.”
