Lip lift risks

A lip lift — most commonly performed as a bullhorn (subnasal) lip lift — involves the surgical removal of a strip of skin from beneath the nose. While it is a relatively focused procedure compared with larger facial operations, it is still invasive surgery performed on a highly visible part of the face. It carries a range of risks, from expected and temporary changes that are part of normal healing, through to uncommon complications that may require further treatment or revision surgery.

Understanding these risks before consenting to surgery is essential. The risks below vary in likelihood and severity between individuals, and are influenced by factors including your anatomy, skin type and quality, whether you smoke, your general health, and how closely post-operative care instructions are followed.

Dr Roth (MED0001185485), Specialist Otolaryngologist & Head and Neck Surgeon (specialist registration — Otorhinolaryngology, Head & Neck Surgery), will discuss these risks with you in the context of your individual circumstances before any surgery proceeds.

1. General Anaesthesia

A lip lift in Australia is most commonly performed under general anaesthesia, though it can be performed under local anaesthesia with sedation in some circumstances. General anaesthesia carries its own set of risks, separate from those of the surgical procedure itself.

A pre-anaesthetic assessment will be conducted before your surgery, and you will be reviewed by the anaesthetist prior to the procedure. Most people tolerate general anaesthesia without difficulty. Known risks include:

• Nausea and vomiting: Common in the immediate post-operative period. Anti-nausea medications are routinely used to reduce this.
• Sore throat: Caused by the breathing tube placed during anaesthesia. Usually resolves within one to two days.
• Temporary confusion or disorientation: More common in older patients. Resolves as the anaesthetic clears.
• Adverse drug reactions: Reactions to anaesthetic agents can range from mild to, rarely, severe. Your anaesthetist will discuss your personal risk at the pre-operative assessment.
• Respiratory complications: Including chest infection or breathing difficulties. Risk is higher in patients with pre-existing lung conditions or those who smoke.
• Deep vein thrombosis (DVT) and pulmonary embolism: Blood clots that form in the deep veins of the legs can, in rare cases, travel to the lungs. Risk is low for short procedures in healthy patients but increases with certain risk factors. Preventative measures are taken routinely.
• Serious cardiac or respiratory events: Extremely rare in healthy patients undergoing elective procedures in accredited facilities, but possible. These will be discussed with your anaesthetist based on your medical history.

You must inform Dr Roth and the anaesthetist of all medications, supplements, allergies, previous anaesthetic reactions, and relevant medical history prior to surgery.

2. Bleeding and Haematoma

Some bleeding during and immediately after surgery is normal and expected. A haematoma is a collection of blood that accumulates in the surgical site after the wound has been closed. In lip lift surgery, the risk of significant haematoma is low, as the procedure involves only superficial tissue layers. However, it can occur.

A small haematoma may resolve on its own with conservative management. A larger haematoma may cause increased swelling, tension on the wound, discolouration, and pain, and may need to be drained — either in the clinic or in a return to theatre. If a haematoma is not managed appropriately, it can impair wound healing and increase the risk of scarring and asymmetry.

To reduce bleeding risk, you will be advised to stop blood-thinning medications and supplements — including aspirin, ibuprofen, fish oil, vitamin E, and certain herbal supplements — for at least two weeks before surgery. Alcohol should also be avoided in the days before and after the procedure. All medications and supplements must be disclosed at your consultation.

Post-operatively, strenuous activity, heavy lifting, and bending should be avoided for at least one week, as these raise blood pressure and increase the risk of delayed bleeding.

3. Infection

Infection following a lip lift is uncommon. The face generally has a good blood supply, which supports healing and reduces infection risk compared with some other areas of the body. However, the proximity of the incision to the nostrils — a naturally colonised area — means that bacterial contamination is a consideration, and careful wound hygiene is important during recovery.

Signs of infection include increasing rather than decreasing redness, warmth, and swelling at the incision site, discharge or pus, fever, and chills. If any of these occur, prompt review by Dr Roth is necessary. Most infections respond well to antibiotic treatment when identified early. Delayed or inadequately treated infection increases the risk of poor healing and scarring.

An antibiotic ointment is routinely prescribed after surgery and applied to the incision as directed. Keeping the incision clean and dry, avoiding touching the wound unnecessarily, and rinsing the mouth with antiseptic mouthwash or saltwater after eating all reduce infection risk during the healing period.

Patients with diabetes, immunosuppression, or other conditions affecting healing are at higher risk of infection and must disclose these conditions prior to surgery.

4. Poor Wound Healing

Most patients heal well following a lip lift, but wound healing is influenced by a range of individual factors that can affect the quality and speed of recovery.

Factors that increase the risk of poor wound healing include:

• Smoking: Nicotine causes vasoconstriction — narrowing of the blood vessels — which reduces the blood supply to the healing tissue. This significantly impairs wound healing, increases the risk of wound breakdown (dehiscence), infection, and scarring, and can compromise the final result. Patients who smoke are strongly advised to cease well in advance of surgery and to remain non-smoking throughout the recovery period.
• Diabetes: Poorly controlled blood glucose impairs the immune response and cellular repair processes, slowing healing and increasing infection risk.
• Immunosuppression: Patients on immunosuppressive medications (including long-term corticosteroids) may heal more slowly and are at greater risk of infection.
• Nutritional deficiencies: Adequate nutrition — including protein, vitamin C, and zinc — supports wound healing. Deficiencies can impair recovery.
• Excessive movement of the incision site: The lip and perioral area is inherently mobile. Wide mouth opening, laughing, and exaggerated facial movements in the early post-operative period place mechanical stress on the incision and can disrupt healing. Limiting these movements during the first week is important.

Wound dehiscence — partial or complete separation of the wound edges — is uncommon but can occur, particularly if the wound is subjected to excessive tension or trauma during healing. If dehiscence occurs, the management depends on the extent: minor separation may be managed with careful wound care; more significant dehiscence may require re-closure.

5. Scarring

All surgery that involves skin incisions results in a scar. In a lip lift, the incision is placed just beneath the nose, designed to follow the natural contours of the nostrils and sit within the natural shadow of the base of the nose — the position where it is least visible. Over time, in most patients the scar fades to a fine, pale line that is not conspicuous in everyday social interaction.

However, scar quality varies significantly between individuals and is influenced by genetics, skin tone, sun exposure during healing, and whether any complications occur. It is not possible to predict with certainty how a scar will heal in any individual patient.

Possible scar-related outcomes include:

• Hypertrophic (raised) scarring: The scar becomes raised, thickened, and red rather than fading to a flat, pale line. This is more common in patients with a personal or family history of hypertrophic scarring, in darker skin types, and when healing is complicated by infection or wound tension. Treatment options include topical silicone gel or sheets, corticosteroid injections, and in some cases laser treatment or scar revision.
• Widened scar: If the wound heals under tension, or if there is disruption during healing, the scar may widen beyond the original incision line.
• Contraction bands: As scar tissue matures it can contract, occasionally creating a tight band across the base of the nose or along the upper lip border. This can affect the natural movement and drape of the lip and may require treatment.
• Persistent redness: Incision lines commonly remain pink or red for several months before fading. In some patients, redness persists longer than expected. Sun protection is particularly important during this period — UV exposure to a healing scar can cause permanent darkening (post-inflammatory hyperpigmentation).
• Hyperpigmentation: Darkening of the scar line is more common in patients with medium to darker skin tones (Fitzpatrick types III–VI). Strict sun protection — SPF50+ sunscreen and physical coverage — during the healing period is essential to minimise this risk.

Dr Roth may recommend scar management treatments once healing is sufficiently advanced. Patients should protect the incision from direct sun exposure for a minimum of three months following surgery.

6. Asymmetry

Achieving perfect symmetry of the upper lip is one of the central technical challenges of a lip lift, and it is important for patients to understand that no face — and no lip — is perfectly symmetrical before surgery. Pre-existing asymmetry is common and is carefully assessed and documented at consultation.

Despite meticulous surgical planning and precise markings, some degree of asymmetry in the post-operative result is possible. Contributing factors include:

• Pre-existing asymmetry in lip shape, philtrum length, or nostril position that influences the final result
• Differential healing and scar contraction between the two sides of the incision
• Uneven swelling during the healing phase — this is very common in the early weeks and usually resolves as swelling subsides
• Minor variation in the amount of tissue removed from each side during surgery

Mild asymmetry that persists after full healing may be amenable to minor revision under local anaesthesia. More significant asymmetry may require a formal revision procedure. Patients should be aware that revision surgery carries its own risks and that further improvement, while often achievable, cannot be guaranteed.

7. Numbness, Altered Sensation, and Pins and Needles

Temporary altered sensation in the upper lip, the skin between the nose and lip (the philtrum), and the area around the incision is common following a lip lift. This may present as numbness, reduced sensation, hypersensitivity, tingling, or a pins-and-needles sensation. These symptoms occur because small sensory nerve fibres in the skin are disrupted by the incision and the surgical dissection.

In most patients, sensation gradually returns over the following weeks to months as the nerve fibres regenerate. The timeline for recovery varies between individuals. During the period of reduced sensation, patients should take care with heat near the area — including hot food and drinks — as burns can occur without the normal warning sensation of pain.

In a small number of patients, altered sensation may persist longer term. Permanent significant numbness following a lip lift is uncommon but is a recognised risk. This will be discussed in the context of your individual anatomy at consultation.

8. Stiffness and Restricted Movement

Some stiffness and tightness of the upper lip and perioral area is normal and expected in the weeks following a lip lift, and is more pronounced than might be anticipated given the relatively small size of the excision. This occurs because the tissues are healing under some degree of tension, and because scar tissue — which is initially less elastic than normal skin — forms across the incision line.

Stiffness is typically most noticeable when opening the mouth wide, laughing, or making exaggerated facial expressions. It generally improves progressively over several weeks to months as the scar matures and softens. Gentle massage of the scar, once the wound is fully closed and Dr Roth has confirmed it is appropriate to begin, can assist with softening the tissue over time.

In some patients, a degree of stiffness or reduced mobility of the upper lip persists longer term. This is more likely if the excision was larger, if healing was complicated, or if significant scar contraction occurs. In these cases, the management options include massage, physiotherapy-directed facial exercises, or in some cases further surgical intervention.

9. Distortion of Lip Shape

Changes to the shape of the upper lip or the surrounding structures are among the more significant potential complications of a lip lift, and are largely related to the amount of tissue removed, the precision of the excision design, and how the tissues heal.

Possible shape-related complications include:

• Over-correction (excess shortening): If too much tissue is removed, the upper lip can appear excessively short, with too much upper tooth show, a turned-up appearance of the lip border, or an unnatural relationship between the lip and the nose. This is difficult to reverse and may require complex revision surgery — including the addition of tissue — to correct. Conservative surgical planning is essential to minimise this risk.
• Under-correction: If insufficient tissue is removed, the desired change in lip proportions may not be achieved. This is generally preferable to over-correction and may be amenable to minor revision.
• Distortion of the nostril base or alar shape: The bullhorn lip lift excision is designed close to the base of the nostrils. If the excision or the subsequent scar contraction pulls on the alar base, it can alter the appearance of the nostrils — widening them, creating asymmetry, or distorting the natural contour of the alar-facial groove. Careful incision design aims to minimise this risk, but it can occur, particularly with larger excisions.
• Distortion of the philtral columns: The philtrum — the two vertical ridges running from the nose to the upper lip — defines much of the characteristic shape of the upper lip. Incision placement and scar contraction can, in some cases, affect the appearance of the philtral columns, making them appear flattened, shifted, or asymmetric.
• Upper lip eversion or inversion: The border of the upper lip (the vermillion border) may be affected by tension or scar contraction in a way that causes it to roll outward or inward, altering the natural appearance of the lip at rest.

The risk of lip shape distortion is closely related to the precision of surgical planning, the amount of tissue removed, and the quality of healing. Dr Roth uses careful anatomical markings and a conservative approach to excision volume to minimise this risk. Where any distortion persists after full healing, the options for correction will depend on the nature of the issue and will be discussed at a follow-up consultation.

10. Need for Revision Surgery

Despite careful planning and execution, a proportion of patients may not achieve their desired outcome from a primary lip lift, or may develop complications that require further surgical intervention. Reasons for revision may include persistent asymmetry, unsatisfactory scar appearance, over- or under-correction of lip length, or distortion of lip shape.

Revision surgery in this area carries its own risks — often greater than the primary procedure — because the tissues have already been operated on and the normal anatomy has been altered. The ability to achieve improvement through revision surgery depends on the nature of the problem, the degree of scarring present, and the amount of tissue available for repositioning.

Patients considering a lip lift should approach the decision with realistic expectations and an understanding that a revision procedure may occasionally be necessary and that outcomes from revision surgery are less predictable than from primary surgery.

Making an Informed Decision

The risks outlined on this page are not exhaustive — they represent the most significant and most commonly discussed complications, but other unexpected outcomes can occur. The decision to proceed with a lip lift should be made after careful reflection, and only after you have had the opportunity to discuss your specific circumstances, anatomy, goals, and concerns with Dr Roth in detail.

You are encouraged to take as much time as you need before deciding whether to proceed, to prepare questions for your consultation, and to seek a second opinion if you wish. No reputable surgeon will pressure you to commit to surgery before you are ready.

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