The Landscape of Lip Enhancement in 2024: A Journey Through Options
Over the past decade, there has been an undeniable surge in lip procedures, and the momentum shows no sign of fading. Let me walk you through the spectrum of possibilities—from the simplest non-surgical touches to the more permanent surgical transformations—to help you understand what is truly effective and what might be less so.
The Non-Surgical Path: From Makeup to Machines
We can start with the most accessible option: makeup. Some have even coined the term "lip lift" for a technique involving merely overlining the lips with cosmetic products. This can be wonderfully confusing when you are trying to decide between a surgical lip lift and a makeup trick. Makeup can certainly transform how your lips appear, and for many, it is a safe, reversible, and perfectly adequate choice.
Next, there is Botox, often called a "lip flip." This involves injecting about four to five units along the vermilion border of the upper lip. What it does is slightly evert the upper lip, but the impact is minimal—you might get, at best, half a millimeter of lift. In my experience, most patients do not return for repeated treatments because they find the effect never really did anything meaningful in the first place.
Then we have filler, which is far more familiar to most people. The most common choice is hyaluronic acid, or HA. The key here is to choose a filler that is low in G prime—meaning it is not too dense or thick. My preference is to inject HA filler into the body of the red lip, whether it is the upper or lower lip. However, I do not recommend it for the vermilion border. When you inject the border, you tend to see migration over time, as the filler spills out into the cutaneous portion of the lip. Similarly, injecting the philtral columns often leads to an unnatural look as time passes. For these reasons, I advise patients to avoid filler in those specific locations.
Another non-surgical option is thread lifting. Some have tried various thread approaches to lift the upper lip, but these results are short-lived; they do not last, and they rarely look good. I have never seen a thread lift for the upper lip that looked impressive, even immediately after the procedure. It is an option that exists, but it is usually not one I recommend.
Finally, there is the plasma pen. This is essentially a cautery device used along the upper cutaneous lip to tighten the skin. Unfortunately, it tends not to do a whole lot, and most people are dissatisfied with its impact. You may see people on TikTok using it for the upper eyelid or the upper lip, but in both places, the effect is minimal, and it can even create some degree of scar tissue.
The Surgical Realm: Enhancing the Red Lip
Let us now turn to surgical options, which I have broken down by the specific area they manipulate: the red lip itself, the vermilion border, and the nasal base.
For enhancing the red lip, one option is a fat transfer. This involves taking fat from another part of the body, like the abdomen or flank, processing it, and injecting it into the red lips. It is an alternative to HA filler, and it tends to be more long-lasting—though not permanent. About 50% of the injected fat is resorbed by the body. Also, since that fat retains a "memory" of where it came from, if you gain weight later in life, your lips will get fuller, because it is still your abdominal fat. This makes it harder to control what happens over time, and there is also a risk of developing little lumps that may require surgical removal, as there is no safe dissolving agent for fat in the lips.
Another surgical option for the red lip is an implant. These silicone-based implants were more popular about a decade ago. They are solid pieces of silicone, similar to a cheek or chin implant, shaped to fit into the lip. While the procedure is relatively small, many patients do not like how it feels. I have seen it look good and be non-bothersome for some, but many patients eventually have these implants explanted due to dissatisfaction with either appearance or sensation.
A third approach is the V-to-Y advancement. This can be done for the upper or lower lip, using an incision made on the inside. The tissue is advanced forward to add fullness. I am not a fan of this procedure because it tends to create redundancy of the mucosal tissue. Some patients feel like they are biting on the tissue when eating, and the floppy, excessive tissue often leads them to seek a lip reduction later. Additionally, it does nothing to shorten the filtrum itself, which is a significant limitation.
Surgical Options at the Vermilion Border
At the vermilion border, there are several surgical choices. The first is a gullwing, sometimes called a seagull or direct lip lift. This involves tracing the entire vermilion border of the upper lip and advancing the tissue upward, inverting the red lip. A similar procedure can be done on the lower lip. While it can be a nice option for some, my biggest concern with the upper lip direct lift is that cutting right on the Cupid's bow makes it nearly impossible to fully recreate those distinct lines when you stitch it up. There is always a blurring of the Cupid's bow, which gives the lip an artificial look, especially once healed.
More laterally, we have the corner lift, or grin lift. These incisions are also at the vermilion border but placed lateral to the Cupid's bow. When I perform a corner lip lift, the medial segment goes right up to where the Cupid's bow starts, extending all the way laterally to the commissure. This tends to heal better and blur the borders less, especially in the critical central zone. Some surgeons do an extended corner lift where the incision comes off the vermilion border to address a downturned oral commissure, but the scar from that approach can be quite visible, so I usually avoid it. Vermilion border incisions are not all bad, but when you work into the central region, you start to see the least natural results. More lateral incisions heal better, and that is how I employ them.
Surgical Options at the Nasal Base
Moving to the nasal base, the first option is an Italian-type lip lift. Here, the incisions are made at the nasal sills on both sides, with two separate incisions instead of one continuous one. Some patients prefer this because the center does not lift much. However, the reason I do not like it is that when tension is concentrated at two points, those incisions tend to heal worse than a single, extended incision where the tension is shared. Also, patients often believe the Italian lift will lift the corners, but since it is still at the base of the nose, the corners do not lift much. The scarring can be worse, so it is not my preference.
Another nasal base approach is endonasal, where the incision is hidden more internally, around the nasal sill. While it sounds great to have a hidden incision, the problem is that you are essentially pulling lip tissue into the nose, blurring the boundary between the lip and nose. Even though the scar is hidden, the result often looks artificial, and in many cases, the nasal sill itself is removed, which does not look right.
Then we have the bullhorn and subnasal approaches. There are versions where only skin is removed. However, the skin of the upper lip is quite thick, and removing just the epidermis and dermis creates a lot of tension, leading to worse scars. I prefer a deep plane dissection, which I call the L-lift. This involves going down to the orbicularis muscle through all the layers. I leave the muscle intact to preserve function, and I find the results last just as long as those where the muscle is sutured. Some surgeons use an extended bullhorn, where the lateral incision swings around the ala and along the nasolabial fold. Their goal is to make the nasolabial folds less obvious and evert the lateral lip. However, healing takes longer, webbed scars are more likely, and the corners do not lift as much as claimed. The nasolabial folds also tend to return to their preoperative state within a year, so I do not recommend this extended approach.
Essential Wisdom for Your Journey
Let me caution you about the images you see online. Many are adjusted with Photoshop, editing tools, or AI-generated models that are not real people. Do not chase results that exist only in the digital realm. When evaluating before-and-after photos, look for consistent lighting and angulation, and note whether the "after" image includes makeup. This will give you a realistic idea of what is actually achievable.
When it comes to how much to remove in a bullhorn or L-lift, the average for a primary lip lift is 4 to 6 millimeters. But a 4-millimeter lift is very different from a 6-millimeter one. Each half-millimeter changes the look, so the amount must be tailored to your anatomy and goals. Occasionally, we go below 4 mm or above 6 mm. The industry standard for the minimum philtral length to leave is about 7 mm when unstretched, or 10 mm when stretched. This is well documented in our literature.
As for combining a lip lift with filler, I strongly advise against it. Numbing the lips causes swelling, which distorts the appearance, making it impossible to know how much filler to add. My recommendation is to wait about three months after a lip lift before introducing any filler or fat transfer. This allows the lip to settle so you can see exactly what the lift has achieved.
Post-operative care is critical. I recommend starting scar gel about 10 to 12 days after surgery, once the wound is no longer bubbling if tested with hydrogen peroxide. A scar gel with a matte finish and quick-drying properties is ideal, and sunscreen should be applied over it to protect the area. For those traveling from out of town, suture removal typically happens 5 to 7 days after surgery. Plan ahead—schedule an appointment with a qualified surgeon at home or return to New York. Do not leave it to the last minute or try an urgent care, as they may not know what to do.
Be aware of post-operative infections. After a lip lift, they do not usually appear as a large abscess but rather as cellulitis or honeycombing, sometimes with whitish or yellowish vesicles indicating a viral infection. Ensure the doctor removing your sutures is familiar with these complications. For hypertrophic scarring, I often use Kenalog, a steroid, to flatten the scar. If you have thick skin, I may inject it during surgery to reduce the risk. Full healing takes up to a year, so patience is essential.
On Revisions and Final Thoughts
Occasionally, patients want a revision. Most know within the first month if they want more removed. In my practice, about 5% of patients come back for this. I recommend waiting at least three months before a revision. Keep in mind that each lip lift creates more arching of the upper lip, so you must be comfortable with that change. Revision procedures tend to have a slightly slower recovery and more sensitivity, but most patients do well.
For corner lip lifts, I usually perform a classic bullhorn deep plane lift first, then wait three months to see how things settle before considering a corner lift. However, if the corners are already rolled in at the initial evaluation, I may do both at the same time for the right patient.
Surgical results tend to be more natural and long-lasting than non-surgical options, but not everyone is a good candidate. Your anatomy, risk tolerance, and overall health must be considered. If you opt for surgery, understand the risks and benefits thoroughly. Do not sign forms you do not understand. Have a conversation with your doctor about alternatives and what else is possible. Remember, these are permanent changes that may be difficult to reverse. Think it through carefully.
Finally, trust the surgeon you have chosen. Let them guide you through recovery and toward your optimal outcome. With careful planning and realistic expectations, your journey to lip enhancement can be a rewarding one.