Lip Lift Bullhorn

Aesthetic surgery • informed choice of treatment

A lip lift and lip filler are not two versions of the same procedure.

A surgical lip lift shortens the skin portion of the upper lip and changes its position. Hyaluronic acid adds volume and may shape the contour. The appropriate choice therefore depends not on the popularity of the method, but on the patient’s anatomy and goals.

Medical author: Piotr Rak, MD, PhD, specialist in general and oncological surgery, aesthetic medicine

Date of publication: 20 July 2026

Last updated: 20 July 2026

First an aesthetic diagnosis, then the name of the procedure

Patients often say: “my upper lip is too small”. This description may refer to completely different situations:

• limited volume of the lip vermilion;
• a long skin segment between the base of the nose and the upper lip;
• limited exposure of the upper incisors at rest or while smiling;
• inward rolling of the lip vermilion;
• asymmetry of the lips, nose, jaw or bite;
• changes in proportions associated with ageing;
• previous fillers altering the appearance and mobility of the tissues.

The same concern may therefore lead to different recommendations. In some cases, a lip lift may be appropriate; in others, a small amount of filler may be suitable, while sometimes the best decision is not to perform either procedure.

What is the philtrum and is there an ideal length?

The philtrum is the vertical midline groove of the upper lip, although in aesthetic practice the broader skin segment between the base of the nose and the border of the lip vermilion is assessed. Its appearance depends on sex, age, the structure of the nose, jaw and teeth, lip thickness and the proportions of the entire face.

There is no single measurement that is ideal for every face. Measurement may assist with planning, but it should not determine the decision to operate on its own. Excessively aggressive shortening may result in unnatural tooth exposure, a difficult-to-correct change in proportions or problems closing the lips.

How does a bullhorn lip lift work?

In the bullhorn technique, the surgeon removes a carefully planned section of skin directly beneath the base of the nose. The shape of the incision resembles stylised horns, which is where the method gets its name. After the wound is closed, the skin portion of the upper lip is shorter and the vermilion may become more visible.

This is a surgical procedure, not “lip augmentation without filler”. It does not add a product or directly increase tissue volume. It changes the geometry and position of the lip. The result is long-lasting, but the face continues to age and the appearance may change over time.

How does hyaluronic acid work in the lips?

Cross-linked hyaluronic acid is injected into selected tissue layers. Depending on the product and technique, it may increase volume, improve the contour, correct minor asymmetry or change lip projection. The effect is temporary because the product is gradually broken down.

A filler does not remove skin and does not anatomically shorten the distance between the nose and the lips. Attempting to “conceal” a long upper lip by adding increasing amounts of volume may cause the lip to project excessively and may worsen the proportions of the profile.

Lip lift versus hyaluronic acid – comparison

When might a surgeon consider a lip lift?

Surgical elevation of the lip may be one of the options when:

• the skin portion of the upper lip is long in relation to the rest of the face;
• the vermilion of the upper lip is poorly visible because of its position, rather than solely because of limited volume;
• exposure of the upper teeth is limited and changing it would improve the smile;
• the patient understands that the procedure will leave a scar and is difficult to reverse;
• the expected result is subtle and consistent with the patient’s anatomy.

The indication is not based solely on age or a single measurement. The deciding factors include proportions seen from the front and in profile, smile dynamics, the relationship between the lip and the teeth, and skin quality.

When might a filler better address the problem?

Hyaluronic acid may be considered when the main objective is:

• a moderate increase in the volume of the lip vermilion;
• improvement of the contour or proportions between the upper and lower lips;
• correction of selected asymmetry that can be treated by injection;
• a temporary change without surgical removal of skin.

Filler treatment also requires medical assessment. Previous injections, product migration, active herpes, medical conditions and medicines may affect the treatment plan and safety.

Can a lip lift and hyaluronic acid be combined?

Sometimes, because the methods address different problems. This does not mean, however, that they should be performed at the same time or that every person who undergoes a lip lift will later require filler. The tissues should first heal and the surgical result should stabilise. Only then can the physician assess whether additional contouring is justified.

If a previous product is present in the lips, the surgeon should be informed about the name of the product, the date and the site of injection. Observation, imaging or planned dissolution of the product may sometimes be necessary, depending on the clinical findings.

Scarring after a bullhorn lip lift – the key compromise

The incision is made at the base of the nose so that the scar follows a natural crease. This does not mean that it will become completely invisible. Its appearance depends, among other factors, on the suturing technique, wound tension, healing biology, sun exposure, smoking, infection and the individual tendency to develop abnormal scars.

Initially, the scar may be red, firm or uneven. Scar maturation takes months. Before making a decision, the patient should accept the possibility of a visible scar and the potential need for treatment or revision.

Possible adverse effects and complications of a lip lift

Every surgical procedure involves risk. Possible complications of a lip lift include:

• swelling, bruising, pain, tenderness and a feeling of tightness;
• bleeding, haematoma, infection or wound separation;
• a visible, widened, discoloured or hypertrophic scar;
• asymmetry of the nostrils, lip or vermilion exposure;
• altered sensation, stiffness and prolonged discomfort;
• an unsatisfactory result, excessive or insufficient elevation;
• a change in the smile or difficulty closing the lips freely;
• the need for scar treatment or further surgery.

Published studies generally suggest high satisfaction among selected patients, but their methodologies and methods of measuring outcomes are inconsistent. The result for an individual patient cannot be predicted on the basis of an average reported in publications.

When should you urgently contact a physician after surgery?

• bleeding does not stop despite following the instructions provided;
• pain, redness or swelling rapidly increase instead of improving;
• fever, pus or an unpleasant smell from the wound develops;
• the wound edges separate or the sutures become damaged;
• the skin becomes very pale, bluish or dark;
• shortness of breath, fainting or symptoms of an allergic reaction occur.

How is the result assessed?

The result should not be assessed during the first few days. Swelling may be asymmetrical, the lip may feel stiff and the smile may temporarily look different. Early healing usually takes several weeks, while the scar and tissues continue to change over the following months.

The outcome is assessed not only by measuring the length of the lip. Important factors include the proportions of the vermilion, the position of the corners of the mouth, tooth exposure at rest and while smiling, nostril symmetry, profile and lip function.

Common misconceptions

“A lip lift creates full lips without any scar”.
No. It may increase the visible amount of vermilion, but it does not add volume, and a scar is an inherent part of the operation.

“Filler is a trial version of a lip lift”.
Not entirely. A filler demonstrates the effect of increased volume, not the result of shortening the skin portion of the upper lip.

“Because the result is permanent, it will never change”.
The anatomical change is long-lasting, but the tissues continue to age, and the appearance of the scar and lip may evolve.

“The shorter the philtrum, the better”.
Excessive shortening may impair proportions and function. The objective is a harmonious change, not achieving the lowest possible measurement.

When considering a surgical procedure

This article is intended to compare treatment methods. Organisational information, the current cost, the scope of the consultation, booking arrangements and details of the procedure performed at Wyspa Medycyny Przyjaznej are available on a separate service page.

Piotr Rak, MD, PhD is a specialist in general and oncological surgery who performs aesthetic surgery procedures. During the medical assessment, he evaluates proportions, tissue condition, previous procedures, expectations and the risk of scarring.

What should you ask the surgeon before making a decision?

• Does my concern relate to the length of the skin portion of the upper lip, volume, bite or several factors at the same time?
• How will the proposed change affect tooth exposure and my smile?
• Where exactly will the scar be located and what might it look like after healing?
• How do previous fillers affect the treatment plan?
• Which complications are most important in relation to my anatomy and health?
• What can be done if the scar or asymmetry is unacceptable to me?
• What are the alternatives, including choosing not to have the procedure?

Frequently asked questions – FAQ

Sources and medical basis

• The Bullhorn and Beyond: Evidence-Based Review and Clinical Recommendations for Lip Lift Techniques, 2026: PubMed (accessed: 20 July 2026).
• Different Techniques and Quantitative Measurements in Upper Lip Lift: A Systematic Review, 2023: PubMed (accessed: 20 July 2026).
• Impact of Subnasal Lip Lift on Lip Aesthetic: A Systematic Review, 2022: PubMed (accessed: 20 July 2026).

Medical information: this article is educational and does not replace a consultation or medical assessment for surgery. Results and the course of healing vary between individuals.