Lip lift guide: surgical philtrum shortening vs. non-surgical lip augmentation

The lip lift is a surgical procedure that permanently shortens the philtrum — the skin between the nose and the upper lip — by excising a strip of skin beneath the nostrils. This elevates the upper lip, increases visible pink vermilion, and creates a more youthful lip-to-nose ratio. It addresses a different anatomical problem than filler or Botox and produces permanent results. Here is a complete guide.

The anatomy: why the philtrum matters

Lip aging and philtrum elongation

A key but often underappreciated feature of lip aging is philtrum elongation:

In youth, the average philtrum length (base of columella to top of cupid's bow) is 11–13 mm in women and 13–15 mm in men. As skin loses elasticity and soft tissue descends, the philtrum elongates — often reaching 15–20+ mm with age. This produces:
Progressive "tucking" of the vermilion (the pink lip tissue) inward — the lip appears thinner even if lip volume is preserved
Loss of visible tooth show at rest ("dental show")
A longer, more aged mid-face appearance

The key insight: A longer philtrum hides the lip — it doesn't thin it. A patient complaining of "thin lips with age" may primarily have philtrum elongation rather than volume loss. Filler adds volume but does not shorten the philtrum; only surgery addresses philtrum length.

Philtrum-to-lip ratio

The ideal aesthetic upper lip ratio positions the philtrum at approximately 1/3 of the lower face height with the vermilion show appropriate for the individual's aesthetic. The "golden ratio" for lip aesthetics includes:
Philtrum length ≤ 13 mm (women) / ≤ 15 mm (men) for optimal proportion
Upper lip vermilion height 6–8 mm (the visible pink portion from cupid's bow to wet-dry border)
Lower lip height approximately 1.6× the upper lip height

When philtrum length exceeds these values and is the primary aging change, surgical lip lift is the appropriate correction.

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The bullhorn lip lift

The procedure

Incision design: The bullhorn (subnasal) lip lift places an incision at the base of the nose — following the natural contour of the nostrils in a "bullhorn" or "mustache" shape. This hides the scar in the nasal-lip junction crease, the most inconspicuous location for this incision.

Tissue removal: A precisely measured strip of skin is excised — the width of the excised strip equals the desired philtrum shortening (typically 4–8 mm). The upper lip is advanced upward and sutured to the nose base.

Effect: Shortening the philtrum by 4–8 mm:
Increases visible vermilion show by the same amount
Elevates the cupid's bow closer to the nose
Creates more visible tooth show at rest
Produces a subtle "lip roll" — slight eversion of the upper lip vermilion as the lip is advanced

Anesthesia: Performed under local anesthesia (lidocaine with epinephrine) with or without oral sedation; or general anesthesia in a surgical facility. Not a hospital-level procedure — performed in office surgical suites or accredited ambulatory surgical centers.

Duration: 45–90 minutes.

Recovery

Days 1–3: Significant upper lip swelling and mild ecchymosis; sutures in place. Eating soft foods; no stretching the lip.

Days 5–7: Suture removal. The lip appears "overdone" during the swelling phase — patients should not evaluate the result until swelling resolves.

Weeks 2–4: Swelling resolves progressively. Final result is assessable at 4–6 weeks.

Scarring: The bullhorn incision scar matures over 3–6 months. In most patients, the scar is inconspicuous or invisible at the nasal crease by 6 months. Risk of hypertrophic scar exists, particularly in Fitzpatrick types III–V — appropriate patient selection and post-operative scar management (silicone, SPF) are important.

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Variations: corner lip lift and Italian lip lift

Corner lip lift (commissuroplasty)

A small ellipse of skin excised at each corner of the mouth — elevates a downturned mouth corner without affecting the central lip. Appropriate for patients whose primary concern is the "sad" or "frowning" mouth appearance from descended corners, not philtrum length.

Recovery: Less swelling than central bullhorn; similar scar maturation timeline.

Italian lip lift (double-incision)

Two separate incisions placed directly beneath each nostril (not connected in the midline). Preserves more philtrum anatomy; reduces the risk of an overly retracted central philtrum. Some surgeons prefer this for smaller shortenings (3–5 mm).

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Lip lift vs. lip filler vs. lip flip

| | Lip Lift (Surgical) | Lip Filler (HA) | Lip Flip (Botox) |
|---|---|---|---|
| What it does | Shortens philtrum; permanently elevates lip | Adds volume; increases projection | Relaxes orbicularis → lip everts slightly |
| Duration | Permanent | 6–12 months | 6–8 weeks |
| Addresses philtrum length | Yes | No | No |
| Increases visible vermilion | Yes | Partially (projects lip out) | Slightly (everts lip) |
| Recovery | 1–2 weeks | 24–48 hours bruising | None |
| Cost | $2,000–$5,000 (one-time) | $500–$1,000 per session | $100–$200 per session |
| Reversible | No | Yes (hyaluronidase) | Yes (wears off) |
| Best for | Philtrum elongation; permanent change | Volume loss; lip definition | Very subtle eversion; Botox maintenance |

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Who benefits from a lip lift vs. non-surgical options

Lip lift is the better choice when:
Philtrum length > 15 mm (women) or > 17 mm (men) — philtrum elongation is the primary issue
Patient wants permanent, maintenance-free results
Patient has had repeated filler and is dissatisfied — often because filler is addressing volume when the anatomical problem is philtrum length
Minimal volume loss — the patient has adequate lip volume but the lip is hidden by philtrum elongation

Non-surgical (filler) is the better choice when:
Philtrum length is within normal range — volume is the primary concern
Patient wants reversible, adjustable results
Younger patient whose anatomy may continue to change
Patient unwilling to accept surgical recovery or scar risk

Combined approach
Many patients benefit from both: lip lift to correct philtrum elongation + conservative filler for volume once surgical swelling resolves. The lift provides the structural correction; filler fine-tunes volume and definition.

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Contraindications and surgical risks

Contraindications:
Active smoking — impairs wound healing; nicotine cessation 4+ weeks before surgery is mandatory
Bleeding disorders or anticoagulation
History of keloid formation (significant hypertrophic scar risk)
Unrealistic expectations — patients expecting to eliminate all lip aging signs

Risks:
Hypertrophic or widened scar (most common; managed with silicone, steroid injection)
Asymmetry
Excessive shortening — philtrum too short, unnatural appearance; requires conservative planning
Lip retraction — if too much tissue is excised, the lip cannot return to a relaxed position

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