Will I look like a rabbit if I do Bullhorn liplift? (photos)

Question

In 2006, I had permanent filler injected into my lips. But now I want a liplift. Only I am afraid that my lips will look like a rabbit or very puffed up. I also have a scar on the inside of my lip and I am afraid that it will be visible. Is my thought realistic? Or would it be very subtle? In the pictures I show with my hand what I am afraid of happening.

Anna Chacon, MD, FAAD · Answer

I understand why you're concerned. Based on your photos and your history of permanent lip filler, your question is very reasonable. A bullhorn lip lift can create beautiful, natural-looking results in the right patient, but it does require extra caution when permanent filler is already present.

The "rabbit lip" appearance you're describing usually occurs when too much skin is removed, causing the upper lip to rotate excessively upward. This can expose too much of the pink portion of the lip or even the upper teeth at rest, giving an unnatural appearance. Fortunately, this is not an inevitable outcome. An experienced surgeon can avoid this by performing a conservative lift and tailoring the amount of skin removed to your facial proportions.

The permanent filler is the more important consideration. Unlike temporary hyaluronic acid fillers, permanent fillers can alter the lip's shape, firmness, and movement. If there is excess filler, scar tissue, or uneven distribution, lifting the lip may make those irregularities more noticeable. In some cases, surgeons recommend addressing the permanent filler first if it is causing distortion, although this depends on the type of filler and how it has behaved over the years.

Regarding the scar on the inside of your lip, an internal scar is not usually made more visible by a bullhorn lip lift because the incision is placed at the base of the nose rather than inside the mouth. However, if the internal scar is affecting the lip's mobility or contour, it could influence the final appearance, so it should be evaluated as part of the surgical planning.

From your photos, the amount of lift you're demonstrating with your hand appears greater than what would typically be recommended. Most successful lip lifts are subtle. The goal is to shorten the distance between the nose and upper lip enough to improve balance while preserving a natural appearance. Small changes often have the biggest impact and are less likely to look overdone.

If your lips already have significant fullness from the permanent filler, a conservative approach is especially important. The objective should be to enhance your facial harmony—not simply make the lips appear larger.

Overall, I don't think your concern is unrealistic, but I also don't think a well-planned bullhorn lip lift automatically leads to the exaggerated appearance you're worried about. The final result depends far more on careful patient selection, conservative surgical planning, and the presence of permanent filler than on the procedure itself. With thoughtful planning, many patients achieve a refreshed, balanced look rather than an overly lifted or "puffy" one.

Gary M. Horndeski, MD · Answer

A lip lift can be done in a variety of different ways.  In your case, I would excise more skin laterally and very little, if any, centrally.  This will pull up the corners.

Best Wishes,

Gary Horndeski, M.D.

Will I look like a rabbit if I do Bullhorn liplift? (photos)

Answers (2)

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