Male Surgical Lip Lifts and Advancements Case Study

Introduction

For changing the size of the lips there are two surgical options, lifts and advancements. They are called surgical because tissue is either removed or changed position to create a permanent lip enhancement. Their effects are quite different both in execution and in the result they create. They are often confused as one (lifts) is done more commonly than the other (advancements).

A lip lift shortens the distance between the base of the nose and the upper lip (the philtrum), increasing visible red lip, improving tooth show, and creating a more projected, youthful lip. Most of this effect is more central and often has has little to no effect on the sides of the upper lip.

Types of Surgical Lip Lifts

A. Subnasal (“Bullhorn”) Lip Lift

The most common technique.
How it works: Skin is removed from beneath the nose in a “bullhorn” pattern, lifting the central and lateral lip.
Benefits:

• Strongest increase in upper lip show
• More dental show in repose
• Minimal visible scarring when well executed
  Ideal for: Thin lips, long philtrum, aging lip descent.

B. Italian Lip Lift

Two small incisions beneath the nostrils instead of one continuous incision.
Pros: Reduced central tension; some consider scarring even more concealed.
Cons: More subtle lift than bullhorn,will result in loss of nasal sill.

C. Corner Lip Lift (CLL)

Targets downturned lip corners.
How it works: Small triangular excisions at the oral commissures.
Benefits:

• Reduces “resting sad mouth”
• Can be combined with a bullhorn lift
  Notes: Shape must be carefully planned to avoid visible lateral scar.

Surgical Lip Advancements

1. Vermilion Advancement

• Creates its effect by removing skin along the vermilion edge
• Can be used in both the upper and lower lips
• Greatest increase in red lip surface
• Excellent for congenital thin lips or asymmetry
  Drawbacks:
• Scar lies directly along the vermilion border (usually heals well but may be more visible than subnasal).

B. Central Lip Lift (Cupid’s Bow Lift)

A smaller, focused advancement in the central upper lip.
Used when only the Cupid’s bow area needs enhancement.

Surgical Lip Enhancement Combinations

In some patients a combination of surgical lip enhancemcent procedures may be needed which can include:

Bullhorn + Corner Lift

For patients needing both philtral shortening and upturned corners.

Upper + Lower Vermilion Advancement

Creates proportional augmentation in patients with globally thin lips.

Lip Lift +  Lateral Vermilion Advancements

The most common combination in which the lateral vermilion advancement prevents an A frame deformity in those patients with thin lips from side to side.

Lip Lift + Fat Grafting

For added volume and longer-term stability—especially helpful when patients want structure without fillers.

Surgical Lip EnhancementTechnique Comparison Chart

Technique	Incision Location	Best For	Advantages	Disadvantages / Risks	Scar Visibility	Degree of Lip Increase
Subnasal “Bullhorn” Lip Lift	Hidden under columella + nasal sill	Long philtrum, thin central & lateral lip, minimal tooth show	Strong lift; enhances lip + tooth show; scar well concealed	May not address corners; over-shortening risk	Low (well hidden)	Moderate–High
Italian Lip Lift	Two small incisions under nostrils	Patients wanting subtle lift with minimal central tension	Discreet scarring; less tension than bullhorn	Smaller lift; not ideal for major philtral shortening	Very low	Subtle–Moderate
Corner Lip Lift (CLL)	Triangular excisions at oral commissures	Downturned corners, “sad mouth” appearance	Lifts corners; can combine with bullhorn lift	Visible lateral scars if overresected; limited central lip change	Moderate	Low (localized)
Vermilion Advancement (Upper)	Along upper vermilion border	Very thin lips, asymmetry, desire for dramatic red lip increase	Most powerful at increasing visible red lip; precise shaping	Scar at lip border; risk of border stiffening	Moderate (at border)	High
Lower Vermilion Advancement	Along lower vermilion border	Thin lower lip; proportion balancing	Dramatic lower lip show increase; good symmetry correction	Same scar considerations as upper	Moderate	High
Direct/ Central Lip Lift	Small excision above Cupid’s bow	Localized central lift; refining Cupid’s bow	Focused enhancement; minimal downtime	Subtle lift only; small visible scar	Moderate	Low–Moderate (central only)
Deep-Plane Lip Lift	Same as subnasal but deeper dissection	Patients wanting longest-lasting structural support	Less skin tension ? finer scar; more stable elevation	Technically more demanding; more swelling	Low	Moderate–High
Combined Lip Lift (e.g., Bullhorn + CLL)	Both subnasal & corner incisions	Patients needing both philtral and corner elevation	Comprehensive correction; customizable	Multiple incision sites; more postop care	Moderate	High (targeted)

Case Study

This older male had very thin lips but a tremendously long philtral distance (28mms).He had a prior bullhorn lip lift of unknown amount of vertical tissue removed. He was undergoing multiple other facial procedures and wanted a shorter upper lip and more visible vermilion show.

In the prep area before going back to surgery his lips were marked for a secondary 6mm bullhorn lip lift, a 6mm upper lip vermilion advancement and a 3mm lower lip vermilion advancement.

As the last of his facial procedures performed they were done one side at a time due to the presence of the midline endotracheal tube used for his general anesthesia. The lower lip vermilion was initially done stopping the excision short of the mouth corners.

The upper lip vermilion advancement was then done.

Lastly the secondary bullhorn lip lift was done to complete the ‘trifecta’ of surgical lip enhancements.

Surgical lip enhancements in men are different from women in several ways. First, the lip skin removed will almost always be containing hair bubs due to the beard skin of the surrounding lips. While most men have a strip of non-hair bearing skin between the beard skin of the lips and the edge of the lip vermilion in this male patient he did not. Regardless surgical lip enhancements will place the scar lines into or right next to beard skin. Which makes for one difference between men and women a significant and positive one. Scar lines that are in beard skin heal most ideally due to the contributions of the hair follicles to healing. And some men may continue to sport various forms of moustaches, goatees and beards…all of which lessens the concern about adverse scarring. Also men typically need more conservative lip enhancement changes so the tension on the closure lines will be less.

Discussion

Good Candidates for surgical lip enhancement procedures are:

• A long philtrum (typically >15–18 mm)
• Minimal upper tooth show
• Thin upper lip unresponsive to fillers
• Filler fatigue and filler distortions
• Downturned corners
• Pencil thin lips
• Flat Cupid’s bow
• Upper and lower lip disproportion

Contraindications include smokers (relative)and those who are very scar phobic.

Common misconceptions about surgical lip procedures are:

• “A lip lift replaces fillers.”
  Not always—volume and lift are different. A lift creates more visible vermilion while making the existing vermilion bigger is about volume.
• “Scars are always noticeable.”
  With proper technique and skin type considerations, scars usually heal extremely discreetly. They actually do better under men than women due to the beard skin.
• “It leads to a ‘duck lip’ look.”
  Surgical lifts can never create this undesired look as ‘duck lips’ mean too much volume for the amount of vermilion show.

Key Points for Clinical Decision-Making

? When you want maximum vermilion show

? Vermilion advancement (upper/lower) or combined advancements

? When you want maximal philtral shortening with minimal scarring

? Bullhorn lift

? When you need to fix downturned corners

? Corner Lip Lof extended lateral vermilion advancements

? When skin tension / scarring is a concern

? Italian Lift and the concomitant use of either synthetic filler or fat injections

Key Points

1) With congenially or aging thin lips vermilion advancments are an effective technique as they create controlled increased vermilion show.

2) In the vertically long philtrum a subnasal or bullhorn lip lift needed…and it can be repeated twice for sequential upper lip shortening.

3) It is possible to combined bullhorn lip lifts with total (side to side) vermilion advancements for maximal lip enhancement.

Barry Eppley, MD, DMD

World-Renowned Plastic Surgeon