Lip lift (1.5 years post) changed my whole face - what can I do to look less pulled across my cheeks? (Photos)

Question

I had a bullhorn lip lift a year and a half ago. The surgeon had performed a facelift on my friend and she looked great, so I went with him. The incision went all the way around the outside of my nose. I look like a freak. It pulled my cheeks in a weird way and now they look filled (which they are not and never have been) and I am at a loss of what to do. I want to have skin grafting but I know that's extreme. What did he do? Can anyone tell me what they see and what I can do to look less pulled across my cheeks. I am devastated.

Carl Truesdale, MD · Answer

If you had a facelift before the bullhorn lip lift and now feel pulled across the cheeks, the source of the tension is almost certainly the facelift, not the lip lift itself.
A subnasal bullhorn lip lift only affects tissue between the columella and the upper lip vermillion. The dissection is shallow and short. It physically cannot create the kind of cheek tension you're describing 1.5 years out.
A few things I'd actually look at.
The deep plane facelift you had previously. Even a well-executed facelift can settle in a way that emphasizes mid-cheek tension over time, especially if the vector was pulled more horizontally than vertically. The lip lift may have made you more aware of the pre-existing tension by drawing attention to the lower face.
Soft tissue volume loss in the cheek itself. As cheek fat declines, the underlying SMAS tension becomes more visible. Conservative volume restoration with fat grafting or filler in the malar area can soften the pulled appearance significantly.
Animation patterns. Sometimes the issue is more visible when smiling because the muscles aren't moving freely against the surgical tissue planes. Targeted Botox to the appropriate facial mimic muscles can sometimes help.
For specific advice you'd need an exam in person. But before considering a facelift revision, try the conservative route. Fat grafting or HA filler in the lateral cheek hollow often resolves what looks like pulling because it restores the convex curve that tension flattens.
Worth a consult with the original surgeon and one second opinion before any revision is on the table.

Anna Chacon, MD, FAAD · Answer

First, I want to say that I’m very sorry you’re feeling this way about your result. When a cosmetic procedure changes the way someone recognizes their own face, it can be incredibly emotionally distressing. Patients often expect a subtle enhancement and instead become focused on a change that feels “off” or unfamiliar, especially around the central face where even small shifts can affect overall harmony.

From what you’re describing, it sounds like the lip lift may have created excessive upward tension through the upper lip and perinasal tissues. In some cases, particularly when the incision extends broadly around the nostrils or too much skin is removed, the lift can alter the balance of the midface. That can create:

a tighter or “pulled” appearance around the cheeks
exaggerated nasolabial contours
a fuller-looking midface even without filler
or a change in facial expression at rest

What many patients perceive as “cheek fullness” after this type of procedure is sometimes actually tissue tension and altered vector pull rather than true added volume.

The encouraging part is that at 1.5 years post-op, what you are seeing now is likely the stable result — not lingering swelling. That means any future decisions can be approached thoughtfully rather than waiting for more healing.

I would be very cautious about jumping directly to skin grafting. While grafting can occasionally be used in severe revision situations, it is considered a much more aggressive reconstructive step and can introduce additional texture and color mismatch issues. In many cases, surgeons first explore less extreme revision strategies.

Depending on the anatomy and degree of tension present, possible approaches that specialists sometimes consider include:

scar release or revision
lowering/repositioning the lip slightly
structural fat grafting to rebalance contours
conservative filler placement in surrounding areas
laser or microneedling treatments for scar softening
or simply improving facial harmony rather than fully “undoing” the procedure

One important thing I want to mention is that after cosmetic surgery, patients can become intensely focused on features that others may perceive much more subtly. That does not mean your concerns are invalid — only that our own facial changes are often magnified emotionally because we know exactly what we looked like before.

What matters most now is finding someone with true expertise in facial revision work who can evaluate:

tissue tension
scar placement
lip-to-nose proportions
and overall facial balance

rather than someone who immediately proposes another aggressive procedure.

Revision facial surgery is often about restoring softness and harmony, not perfection. Subtle adjustments can sometimes make a surprisingly meaningful difference in helping the face feel more natural again.

Jeffrey H. Spiegel, MD · Answer

Can you give us more information? I do a lot of lip lifts. You do not look like you have a significant problem in any of these pictures. The immediately postoperative photo sows expected swelling but everything seems to have been done correctly. In the others your lips look fuller, but not abnormal at all. You do have very full cheeks. Is there a lot of filler there?

Lip lift (1.5 years post) changed my whole face - what can I do to look less pulled across my cheeks? (Photos)

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