In short
- 🔑 First of all, and this is a quotation from the evidence, not an opinion: patient selection in this surgery “remains unstandardised”. That is what the 2026 systematic review that gathered the seven available studies says. There is no magic number of millimetres that decides.
- What is looked at is three things: how long your philtrum is, how much tooth shows at rest and — the one almost nobody mentions — what happens when you smile.
- 🚨 The most important relative contraindication is a gummy smile. A lip lift increases the amount of gum on show. In someone who already shows a lot when they smile, it can worsen exactly what bothers them. In that profile, it is advised against here — although it can be done if the limitations are properly understood.
- And one finding connects them: among the factors significantly associated with a gummy smile is the length of the stretch between the base of the nose and the lip — that is, the very measurement this surgery acts on.
- If what you want is volume, this is not your operation. A lip lift does not make the lip bigger: it makes more of the one you have show.
- ⚠️ The asymmetry that governs the whole indication: coming up short can be touched up; going too far cannot. The skin removed is not put back.
- 🚨 And the least anatomical and most decisive criterion: the expectation. In the accounts of dissatisfied patients, the emotional impact was high — 59.3% in the severe distress range on the scale used.
- What we measure here is the length of the philtrum — but the figure alone decides nothing: it is weighed against the proportions of your face. There are long faces in which an elongated philtrum still looks harmonious and faces in which a minimal lengthening is very noticeable. Each person’s harmony governs, not a table.
The question is usually asked the wrong way round. It is not “can I have a lip lift?” — almost anyone can — but “is this what solves what is happening to me?”. And quite often the answer is no.
This page is the one that says no. It is the information least often published and the one that saves the most money and upset.
First of all: there is no standardised criterion
It is worth starting here because it changes how every website in the sector reads, this one included.
The most complete systematic review published to date — seven studies, 1,754 patients, published in 2026 — concludes in as many words that patient selection and outcome assessment remain unstandardised in this surgery. Its authors expressly call for more prospective studies with standardised outcome measures.
✅ And it is not just one review saying it. Another independent systematic review, published in 2023 in a plastic surgery journal, concludes the same thing from another angle: there is a lack of consistency in the measurements used to assess how far the lip rises, and its authors call for a uniform quantitative assessment that does not exist today.
🔑 Practical translation: when a page tells you “you are a candidate if your philtrum measures more than X millimetres”, it is publishing a criterion that does not exist as a consensus. The figures circulating on information sites contradict one another, and this page is not going to add another.
What does exist are the measurements the studies recorded before surgery: the patients operated on had philtrums of around 14.0–14.5 mm on average. That is a descriptive figure about who was operated on, not a threshold for indication.
So what is measured here?
The length of the philtrum is measured: the stretch between the base of the nose and the edge of the lip. That is the number. But the number on its own indicates nothing — it is weighed against the proportions of the rest of the face.
🔑 And that is the difference between measuring and assessing. There are long faces in which a more elongated philtrum still looks perfectly harmonious. And there are faces in which a minimal lengthening is extremely noticeable. The same figure can be normal on one face and wrong on another, which is why no published threshold works.
⚠️ The consequence is awkward for anyone wanting a quick answer online: there is no millimetre figure beyond which “it is time for surgery”. Each person’s harmony governs. That is why the assessment is done looking at the whole face, in movement, and not at the lip in isolation in a photograph.
The three things that are looked at
1. The length of the philtrum. The stretch between the base of the nose and the edge of the red lip. It is what determines whether there is scope to shorten and how much. A philtrum that is already short has nothing to trim. And it is always read in relation to the rest of the face, never as a figure on its own.
2. How much tooth shows at rest. With the mouth relaxed and not smiling, a young upper lip lets a few millimetres of incisor show. When none shows, there is scope; in the studies, the show went from 1.5–2.0 mm to 3.5–5.0 mm.
3. What happens when you smile. 🔑 This is the decisive one and the one that does not show in a photograph at rest. When you smile, the lip rises on its own. If it already rises a great deal — what is called lip hypermobility — and shows gum, surgically shortening it adds rise to a rise that was already excessive.
⚠️ That is why a lip lift assessment cannot be done from a photograph. The face has to be seen talking and smiling, not still.
✅ A video consultation does work for this, because it shows the face in movement, and it is accepted here as an assessment. ⚠️ Even so, an in-person assessment is always advisable before surgery: the quality of the skin and palpation of the area cannot be seen on a screen.
🚨 The gummy smile: the contraindication almost nobody mentions
It is the most important point on this page.
A gummy smile — showing gum when you smile — is usually defined as more than 3 millimetres of visible gum. It is common: in a cross-sectional study of 299 people aged 10 to 50, 44% had one, mostly women aged 20 to 30. ⚠️ It is a high figure from a single population, so it gives an idea that this is not rare, not something to extrapolate.
What it has to do with a lip lift: the surgery raises the upper lip. That means more tooth shows and more gum too. In someone whose underlying complaint is “I show too much gum when I smile”, a lip lift can accentuate precisely that.
🔑 And there is a finding that links the two uncomfortably. In that same study, among the factors statistically significantly associated with a gummy smile are the interlabial distance, upper incisor show, lip hypermobility and — the one that matters here — the length of the subnasal-philtral stretch (p = 0.048). In other words: the very measurement a lip lift operates on is related to a gummy smile.
⚠️ What this does not mean. It does not mean that anyone with a gummy smile can never have surgery, or that a lip lift causes it. It means that the indication in that profile requires a particularly careful assessment, and that it is a conversation for the consulting room, not a web page.
And this is the house position, so that it is not left hanging: in a profile with a gummy smile, a lip lift is advised against here.
⚠️ Advising against is not forbidding. The surgery can be carried out — there are people who, knowing what they know, still want it — but only if the limitations are properly understood: that the gum will show more, that the scope for raising is smaller and that part of what is gained in tooth is paid for in gum. If that is not clear and accepted before going into theatre, the answer is no.
And if what really bothers you is the gum, the conversation is a different one — and it starts with knowing where it comes from. It is in lip lift, gummy smile and teeth, which also explains that cases of dental origin are referred to dentistry.
When the answer is “this is not what you need”
Four frequent situations in which the consultation ends with a different recommendation:
You want more lip volume. A lip lift adds nothing: it rearranges. If your lip is genuinely thin — little tissue, not little showing — what you need is something else. It is compared in lip lift or hyaluronic acid.
The vertical lines above your lip bother you. The “barcode” is a problem of skin quality, not of length. Stretching the skin does not erase lines that are in its texture. It is in the barcode above the upper lip.
What bothers you is the drooping corners. That happens at the ends of the mouth and a subnasal lip lift does not reach there. There are different techniques for that, in the variants of the lip lift.
Your philtrum is already short. If the distance between nose and lip is short to begin with, shortening it further produces a disproportionate face — an upper lip that is too brief ages badly and draws attention.
When the answer is “not yet”
- If you are pregnant or breastfeeding. This is elective surgery.
- If you smoke. This is not generic health advice: a review of studies on facial surgery found that in active smokers the risk of a wound complication is between 1.8 and 12 times higher, with infection and dehiscence among the most frequent. ⚠️ The range is wide and several of those studies found no significant difference in particular settings — but the direction is always the same. The interval recommended here is a month without tobacco before surgery.
- If you have an active infection in the area or a recent cold sore outbreak.
- If you are at a point in life where you cannot afford two or three months with a visible mark in the middle of your face. It is not a medical criterion, but it is real and worth bearing in mind.
What weighs most and is not anatomical
The most serious contraindication for this surgery is not measured in millimetres.
In the analysis of accounts by patients dissatisfied after a lip lift, assessment of emotional impact with a validated scale of depressive symptoms placed 59.3% in the severe distress range and a further 25.9% in the moderate one. And by domain: 54.8% reported appearance-related distress, 35.7% psychological and 9.5% social.
⚠️ It is a sample of 25 accounts selected for being negative, so those figures say nothing about how often the problem occurs. What they do say, usefully, is how great the harm is when it does: it is not a minor aesthetic disappointment.
🔑 And how that is assessed, in practice: by looking at the person and their overall situation. There is no questionnaire that says whether someone is at the right moment to have surgery. There is a conversation in which we listen to what you expect, why now and what would happen if the result were subtle — and that conversation yields as much information as the examination.
🔑 The clinical consequence is simple: the greater the gap between what you expect and what this surgery can do, the greater the risk. And an operation of two or three millimetres in the middle of the face does not change anyone’s face or life. Anyone looking for that will be disappointed even if the surgical result is impeccable.
The asymmetry that governs everything: short can be fixed, long cannot
If this page had to be reduced to one sentence, it would be this one.
A lip lift that has come up short — that has raised less than it could have — is a subtle result. A touch-up can be considered later, once the tissues have matured.
A lip lift that has gone too far is a difficult problem. The skin removed is not put back. An upper lip that is too short, with too much tooth and too much gum on show, is a result that draws attention and has no easy way back.
🔑 That is why, in this particular operation, conservative wins. And it is why a surgeon who proposes raising less than you expected is not being timid: they are applying the asymmetry of the risk. The literature on the design of this operation insists on precisely that — on a marking that avoids accelerating ageing and exaggerating the appearance, and that reduces the need for revision.
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Frequently asked questions
Is there a minimum age?
It is aesthetic surgery: adults only. Beyond that, there is no “correct” age: some people have a long philtrum at 22 through genetics and others develop one at 60 through ageing. They are covered separately in lip lift at 20–35 and lip lift from 50.
And if my lip is very thin?
It depends why. If it is thin because the vermilion is rolled inwards and does not show, a lip lift unfurls it. If it is thin because there is little tissue, a lip lift will make it more visible but not thicker. Telling the two apart is exactly what the examination is for.
Can I have a lip lift if I already have filler?
Yes, but it needs planning, because measuring on a lip with recent filler is no good: the product changes the shape and distorts the assessment.
The recommendation is to dissolve it before surgery, with at least a week’s margin, so that the assessment and the operation are carried out on the real lip. That profile is set out in after years of filler.
Will you advise against it if I do not need it?
You should be. An assessment consultation that ends in “no” is a consultation that has worked. It is also the standard by which a centre can be judged: it is set out in how to choose a clinic and surgeon.
Can you tell from a photograph whether I am a candidate?
From a photograph, no. What decides the indication is not how your lip sits at rest, but how far it rises when you smile — and a photograph does not capture that.
By video consultation, yes, because the face is seen in movement, and it is accepted here as an assessment. ⚠️ Before surgery, even so, it is always advisable to meet in person.
Sources
- Komisarek O, Banasiak Ł, Olichwer V, Burduk P. The Bullhorn and Beyond: Evidence-Based Review and Clinical Recommendations for Lip Lift Techniques. Journal of Cosmetic Dermatology, 2026. PMID 41731334. — A PRISMA 2020 systematic review of 7 studies and 1,754 patients; the authors state expressly that patient selection and outcome assessment remain unstandardised; philtrum length of 14.0–14.5 mm before surgery and upper incisor show of 1.5–2.0 mm rising to 3.5–5.0 mm; they recommend individualised, anatomy-guided selection of technique.
- Chouksey G, Agrawal A, Bhargava S, Karna ST. Review on the impact of smoking on wound healing following facial procedures. Archives of Craniofacial Surgery, 2026;27:1-9. PMID 41787902. — A scoping review of observational studies on facial procedures, with methodological appraisal using the JBI checklists; of 129 records screened, 9 studies were included. Active smoking was consistently associated with poorer healing, with complication risks between 1.8 and 12 times higher in smokers; the most frequent adverse events were flap necrosis, infection and wound dehiscence, although several studies found no statistically significant association in particular settings. The authors stress the importance of stopping smoking in the perioperative period.
- Zhao H, Wang X, Qiao Z, Yang K. Different Techniques and Quantitative Measurements in Upper Lip Lift: A Systematic Review. Aesthetic Plastic Surgery, 2023;47:1364-1376. PMID 36856780. — PRISMA systematic review published in a plastic surgery journal; of 495 studies screened, 9 were included, eight of surgical techniques and one of a non-surgical technique. The surgical techniques show a longer-lasting effect than the non-surgical ones, with an unavoidable scar; reported satisfaction was good in both groups, with no serious complaints; and the authors note a lack of consistency in the measurements used to assess how effective the lift is, and call for a uniform quantitative assessment. Level of evidence III.
- Ghafary ES, et al. Prevalence and Contributing Factors of Gummy Smile: A Cross-Sectional Study in Kabul, Afghanistan. BioMed Research International, 2026. PMID 42338152. — A cross-sectional study in 299 participants aged 10 to 50; a gummy smile is defined as more than 3 mm of gingival show on smiling; a prevalence of 44%, predominantly in women aged 20 to 30; significant differences in interlabial distance (p = 0.001), upper incisor show (p = 0.001), subnasal-philtral length (p = 0.048), lip hypermobility (p = 0.029) and the ratio of the lower to middle facial third (p = 0.001).
- Hayat J, Alfadhly A, Jafar AB. Patient-Reported Dissatisfaction After Lip Lift: Insights From a Thematic Analysis of RealSelf Reviews. Aesthetic Surgery Journal Open Forum, 2025. PMID 41230113. — 25 accounts by dissatisfied patients; PHQ-9 scores with 59.3% in severe distress and 25.9% in moderate; by FACE-Q domain, 54.8% reported appearance-related distress, 35.7% psychological and 9.5% social.
- Talei B, Pearlman SJ. CUPID Lip Lift: Advanced Lip Design Using the Deep Plane Upper Lip Lift and Simplified Corner Lift. Aesthetic Surgery Journal, 2022. PMID 35583637. — An analysis of lip lift design across more than 2,440 consecutive procedures; the stated aim of the design is to avoid accelerating ageing and exaggerating the appearance, and to reduce the need for revision.
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A lip lift assessment is done talking and smiling in front of the surgeon, because what decides the indication cannot be seen with the face still. At our practice in Valencia that examination is the first step, and its outcome may perfectly well be that this surgery is not the one for you — which is as useful an answer as the opposite.
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Last reviewed: 6 September 2026. This content is for information only and does not replace an individual assessment by a healthcare professional.
