How to time tip plasty with lip lift - should they be performed at the same time?

Thank you for your detailed and thoughtful question. When it comes to combining or staging facial procedures like a tip plasty and lip lift, especially in the setting of prior surgery and concerns about structural integrity, careful planning is critical.

Columella & Lip Lift Interactions
A hanging columella, worsened after your previous lip lift, often indicates:

Overexposure of the columella from upward pull of the lip.

Possible weakness or displacement of the medial crura or septal cartilage.

Tension at the base of the nose that the underlying anatomy may not be supporting well.

In your case, you’re correct in being concerned about the stability of the columella/septum—it plays a critical role in anchoring the lip lift and maintaining results.

Should You Do Both Together?
If you already know your columella is weak or structurally compromised, it makes anatomical and functional sense to correct this at the same time as the lip lift, especially if:

The tip is drooping or asymmetric.

The lip lift would place tension on an unstable nasal base.

You're hoping for a lasting, symmetrical result.

Performing a tip plasty and revision lip lift together ensures:

Better control of the tension dynamics between the lip and nasal base.

Opportunity to reinforce the columella or septum if needed (e.g., grafting).

More precise reshaping if the two structures are influencing one another.

Staging Strategy Advice
Since your deep plane facelift and brow lift are planned for October, here are two reasonable pathways:

Option 1 – Earlier Combined Surgery (Tip Plasty + Lip Lift 3 Months Prior)
✅ Pros:

Corrects structural concerns before facelift.

Allows swelling to subside before the October procedures.

Avoids layered recovery and lets each area heal more cleanly.

❗Cons:

Requires coordination between two surgeons.

Risk of scar tissue or healing variability that could influence facelift contours.

Option 2 – Lip Lift with October Surgery, Tip Plasty Later
✅ Pros:

Keeps surgical load lower per procedure.

May allow your facial surgeon to better contour around new lip shape.

❗Cons:

Still leaves the issue of columella weakness unresolved during the second lip lift.

Could lead to recurrent failure or poor result if nasal base isn’t supported.

Recommendation
Given your history and goals, it would be wise to perform the tip plasty and revision lip lift together (Option 1), under a surgeon comfortable addressing both soft tissue and nasal support structures. This provides a better foundation for your October facelift and helps ensure the lip lift holds properly this time.

And yes — a dropping columella can be a sign of weakened or unsupported cartilage, especially post-surgery. This is something a tip-plasty specialist should assess directly, and possibly reinforce with grafts if needed.

Final Note
It’s important the surgeons involved are aware of each other's plans to avoid conflicting changes to your anatomy or healing timelines. A strong columella supports both nasal aesthetics and lip structure, so this stage deserves focused attention.

Unfortunately, you have not provided photographs. A revision lip lift can involve several things. Without more information I cannot give you an accurate answer.

Best Wishes,

Gary Horndeski, M.D.