Planning Principles

• Conservative skin excision (“less is more”)
• Symmetrical marking is essential
• Avoid over-resection → unnatural results

Surgical Techniques

1. Subnasal “Bullhorn” Lip Lift (Gold Standard)

• Most commonly performed technique (~75% cases)
• Skin excision beneath nasal base in bullhorn shape
• Advantages:
  • Reliable lift
  • Good scar camouflage in nasal crease
• Disadvantage:
  • Permanent scar (though often well hidden)

2. Gullwing (Direct Lip Lift)

• Incision along vermilion border
• More visible scar
• Used selectively (e.g., precise vermilion enhancement)

3. Italian Lip Lift

• Two small incisions under nostrils
• Subtle lift
• Less aggressiv

4. Endonasal / Modified Techniques

• Aim to hide scars internally
• Technically demanding but effective in selected cases

Step-by-Step (Bullhorn Lip Lift – Conceptual)

1. Precise marking under nasal base
2. Excision of predetermined skin segment
3. Optional muscle modification
4. Superior advancement of lip
5. Layered closure to minimise tension

👉 Outcome:

• Shorter philtrum
• Increased vermilion show
• Improved dental display

Post-Operative Care

Immediate (0–7 days)

• Mild swelling and bruising expected
• Head elevation
• Cold compress
• Antibiotic ointment to incision
• Avoid excessive lip movement

Early Phase (1–3 weeks)

• Sutures removal (5–7 days typically)
• Scar begins to settle
• Gradual return to normal activity

Late Phase (3–12 weeks)

• Scar maturation phase
• Final results become visible

Scar Management (Critical Discussion)

This is a non-negotiable part of consent and outcome.

Key Points

• The procedure always leaves a permanent scar
• Usually hidden at nasal base shadow
• Visibility depends on:
  • Skin type
  • Surgical precision
  • Post-op care

Scar Optimisation Strategies

• Silicone gel/sheets
• Sun protection (SPF mandatory)
• Steroid injections (if hypertrophic)
• Laser therapy if required

Scar Camouflage (Important Patient Education)

• Makeup techniques
• Medical tattooing (paramedical micropigmentation)
• Must be discussed pre-operatively

Complications and Limitations

Early Complications

• Swelling, bruising
• Hematoma
• Infection

Late Complications

• Visible scar / hypertrophic scar
• Asymmetry
• Overcorrection (“gummy” appearance)
• Nasal distortion (if poorly planned)
• Reduced lip mobility

Complications such as asymmetry, hematoma, and scarring are documented, particularly with excessive tissue removal.

Longevity of Results

• Considered long-lasting structural change
• Some minor relaxation over years may occur
• Significant improvement maintained long-term

Lip Lift vs Fillers – A Critical Distinction

👉 Often, the best outcomes come from correct diagnosis—not default filler use.

Upper Lip Lift – At a Glance

Indications

• Long philtrum
• Thin upper lip
• Poor tooth show

Procedure

• Local anaesthesia
• Skin removal under nose
• Lip elevated

Results

• Fuller, youthful lip
• Better smile

Recovery

• 5–7 days sutures
• 2–3 weeks settling

Key Consideration
⚠️ Permanent scar → must be accepted and managed

MACS Clinic Philosophy

• Precision over aggression
• Anatomy-driven planning
• Ethical patient selection
• “No surgery is always an option”
• Transparent discussion of scar trade-offs

Final Thought

The upper lip lift is one of the most powerful yet misunderstood procedures in facial aesthetics.

When performed on the right patient, with the right indication, and with surgical restraint, it produces natural, elegant, and long-lasting rejuvenation.

When performed indiscriminately, it can lead to visible scars and unnatural results.