In short
- The order of magnitude first: in the systematic review covering 1,754 patients, complications were “predominantly mild and transient” and revision rates ranged from 0.6% to 6.7% depending on the series.
- The common complications are those of any surgical wound: infection, bleeding, impaired healing, dehiscence — the wound opening — prolonged pain in the area and reactions to the anaesthetic such as itching or redness.
- 🔑 Keloid has a measured genetic component, and that changes how it has to be read. The largest genetic study published — 7,837 cases and more than 1.5 million controls — puts heritability at between 6% and 34% depending on ancestry. It can appear with no previous history and without the technique having been inadequate.
- What is specific to this area is two things: distortion of the nose or the nasal ala and lip asymmetry, which were the second and third reasons for dissatisfaction in the analysis of accounts from unhappy patients.
- Paraesthesia — numbness — is frequent and temporary: in the review of surgery combined with rhinoplasty it appears, alongside mild scarring, as the most common complication, and both resolved within a few months.
- ⚠️ There is a list of serious, rare risks — reactions to the local anaesthetic, cardiovascular complications, neurological injury — that appears in any consent form for a procedure under local anaesthetic. They are not risks specific to the lip lift, and this page explains the difference.
- 🚨 The risk is higher in smokers, and in their case it has been quantified: in facial surgery, between 1.8 and 12 times the risk of a wound complication. Also in people with diabetes and people with immune system disorders, for the same underlying reason: the wound heals less well.
- And what has not been measured: there are no published figures for how many people are left with permanent asymmetry or for how many scars end up visible in the long term.
The lip lift is a small operation, under local anaesthetic and done as a day case. None of that makes it a procedure without risks, and the phrase “but it is only a local anaesthetic” has done more harm in this field than any complication.
This page gathers what has been published: the figures from the two systematic reviews available, the literature specific to each risk — tobacco, local anaesthetic, keloid — and what actually ends up bothering those who are not happy.
First of all: the order of magnitude
Before the list, the scale. The systematic review published in 2026 that brought together the seven available studies — 1,754 patients operated on between 2017 and 2025 — concludes that the complications of this surgery were predominantly mild and transient, and puts revision rates between 0.6% and 6.7%.
⚠️ With two caveats the authors themselves point out: the methodological quality of the set is moderate and they could not carry out a meta-analysis because of the heterogeneity of the studies. It is the best evidence available on this procedure, and it can be bettered.
🔑 And one distinction worth being clear about when reading the rest of this page: “revision rate” measures how many people go back to theatre. It does not measure how many are left unhappy, which is another thing and much more poorly measured.
The common complications
They are those of any surgical wound, and they match the ones the facial surgery literature studies as its main outcome — infection, dehiscence and impaired healing:
- Infection.
- Bleeding.
- Impaired healing of the surgical wound.
- Dehiscence, that is, the wound opening.
- Prolonged pain in the operated area.
- Adverse reactions to the anaesthetic, such as itching or redness of the area.
- Keloid or hypertrophic scarring.
None of these is exclusive to the lip lift. What is specific to this operation is where they happen: in the middle of the face, along a line two or three centimetres long that cannot be covered up. A dehiscence on the abdomen is a dressings problem; a dehiscence here is an aesthetic problem as well.
🔑 Keloid: what genetics already explains
It is the complication that causes most anxiety and the one least well understood, and there is a recent finding that changes how it should be explained.
The largest genetic study published on keloids — a genome-wide analysis with 7,837 cases and more than 1.5 million controls, published in 2025 — identified 26 regions of the genome associated with the risk of developing them, and estimated heritability at 6% in people of European ancestry, 21% in East Asian and 34% in African. The authors themselves begin by acknowledging that the reasons a keloid appears are still not well understood.
🔑 Translated into what matters to someone having surgery, it is three things:
- There is a personal predisposition you did not choose and which, in part, comes written from home.
- It can appear with no previous history, because a genetic predisposition is not a diagnosis: it is a probability.
- 🚨 And its appearance does not mean the surgical technique was inadequate. This is not a pre-emptive excuse: it follows from the risk being partly determined before you enter theatre.
🔑 And why it matters so much in this particular operation: because here the scar is the result. In a lip lift, a scar that becomes hypertrophic is not a side effect — it is the result itself.
⚠️ What this finding does not license is the opposite: nor does it turn every bad scar into “a matter of genetics”. Tension on the wound and the design of the incision still weigh, and those do depend on whoever operates.
What can be done: identify any history of poor healing at the pre-operative consultation, not smoke, protect from the sun and start caring for the scar early. It is covered in the scar protocol and, if it has already become a problem, in scar improvement.
And if you have had a keloid before
✅ The centre’s position is specific, and it is not the one many expect: it does not contraindicate surgery. The operation is done with precautions and, above all, followed closely so that any sign of hypertrophy is treated the moment it appears.
🔑 That distinction — treating the early sign, not the fully formed keloid — is the whole argument. A scar that is beginning to thicken responds far better than one that has been doing so for months, which is why in this profile the schedule of review appointments stops being a formality. What changes is not whether to operate: it is how closely it is watched.
⚠️ And it remains a real risk to be accepted beforehand, not discovered afterwards. A history of keloid cannot be erased with technique.
What is specific to this area
Two problems that exist only here, and that appear as the second and third reasons for dissatisfaction in the analysis of 25 accounts from unhappy patients:
Distortion of the nose or the nasal ala — 6 of 25 accounts. The incision is drawn right on the border between the nose and the lip, and the traction of the closure can alter the shape of the alae or of the nostril. It is why this surgery shares territory with rhinoplasty and why the two are sometimes considered together.
Lip asymmetry — 5 of 25 accounts. Here two things that are constantly confused have to be separated:
- The asymmetry of the first few weeks is expected. The swelling goes down asymmetrically and one side can look different from the other.
- Asymmetry that persists once the swelling has gone is another matter, and that one does warrant assessment. But you do not know which it is until several months have passed.
⚠️ On those two figures, the obligatory caveat: they come from 25 accounts published by dissatisfied patients, selected precisely for being so. They tell you what worries people, not how often it happens.
Sensation
Numbness of the upper lip area and the base of the nose is common after this surgery, and it is temporary in the normal course of things.
The systematic review on lip lift combined with rhinoplasty — 6 studies and 361 patients — identifies temporary paraesthesia, alongside mild scarring, as the most frequent complication, and notes that both resolved within a few months. That same paper found no long-term functional impairment of nasal airflow or of lip function.
⚠️ What there is not is a figure for how many people keep some permanent alteration of sensation. It has not been published.
The serious, rare risks
There is a second list, and it is worth explaining exactly what it is before reading it: it is the standard block of risks for any procedure performed under local anaesthetic, the same one that appears in a consent form for removing a mole or for dental surgery. They are not risks specific to the lip lift.
It includes serious adverse reactions to the local anaesthetic of an allergic or toxic kind; psychomotor, vasovagal, sympathetic stimulation or idiosyncratic reactions; cardiovascular complications due to the use of adrenaline; thrombophlebitis; and temporary or permanent neurological injury, sensory or motor. These usually require medical treatment or a further operation and, very exceptionally, as a remote possibility, they can cause death.
🔑 And here there is something more useful than the list, which is what the local anaesthesia literature says: the risk of those reactions is not eliminated, it is managed — it depends on the cumulative dose, on the vascular state of the area and on each person’s pharmacokinetics. And it depends on one more thing, which you can check beforehand: that the place injecting you is equipped to treat them.
The standard review on the use of local anaesthetics in high-risk settings is explicit on that point: intravenous lipid emulsion has turned severe local anaesthetic toxicity from an often fatal event into a manageable emergency, and it concludes that safe local anaesthesia requires stratifying the patient’s risk and that the centre holds phentolamine and lipid emulsion.
⚠️ With the honest qualification: that review is about high-risk settings — end-arterial areas, skin without a barrier, large surfaces — and a lip lift is none of them. The principle, though, does carry over: local anaesthetic is a drug with a dose ceiling, not a synonym for “no risk”.
✅ And here that is covered: the centre has its own operating theatre and all the anaesthetic medication that might be needed, so the procedure is carried out under the highest safety conditions. It is a question you can ask anywhere you go, and the answer should be immediate.
🔑 Why this is published here rather than left out: because it is what you are going to sign. A consent form that lists these risks is not a sign that the operation is dangerous — it is a sign that the document is properly written. The worrying thing would be the opposite. And because the argument “it is only a local anaesthetic” falls apart on reading this list, which is precisely the list for local anaesthesia.
Who is at greater risk
There are three profiles, and the underlying reason is the same in all three: the wound heals less well. Smokers, people with diabetes and people with immune system disorders. In the first the magnitude has been measured; in the other two it is clinical judgement and is assessed case by case in the consulting room.
✅ And in diabetes the centre’s criterion is a figure, not an impression: glycated haemoglobin is required to be below the laboratory’s upper limit. “Well controlled” is not enough: there is a test, there is a value and there is a threshold. If it is above, what is called for is adjusting the control and coming back, not operating and hoping.
🚨 Tobacco is the only one of the three that can be changed completely. And this is not a soft recommendation: a review of nine observational studies on facial procedures found that in active smokers the risk of a wound complication is between 1.8 and 12 times higher, with necrosis, infection and dehiscence the most frequent. ⚠️ The range is very wide and several of those studies found no significant difference in their own particular setting — but none points the other way.
The interval required here is one month without tobacco before surgery and two weeks afterwards.
In an operation whose result is a scar in the middle of the face, compromising the blood supply to that scar is the worst decision available. It is set out in full in lip lift recovery.
Signs that warrant a call
✅ And before the list, the part that reassures most: who you call. At this centre the patient has their surgeon’s direct contact, 24 hours a day, seven days a week. There is no switchboard in between and no consulting hours to wait for. And if your surgeon is not reachable at that moment, the team is six plastic surgeons and any of them can see you.
🔑 That is exactly what is worth asking at any centre before surgery, and almost nobody publishes it: who answers on a Sunday night. It is set out in full in how to choose a clinic and surgeon.
It is worth getting in touch without waiting for the next review appointment if any of these appear:
- Pain that increases rather than decreasing as the days pass.
- Spreading redness, local heat or discharge from the wound.
- Fever.
- Bleeding that does not stop with gentle pressure.
- The wound opening, even partially.
🔑 What is NOT a warning sign: one side being more swollen than the other in the first few weeks, the scar turning red and hard between the first and third month, or the area feeling numb. All three are described as part of the normal course.
What has not been measured
To finish where the evidence finishes, and no further:
- There are no figures for how many people are left with permanent lip asymmetry.
- There are no figures for how many scars are still visible at five years.
- There are no figures for permanent alteration of sensation.
- And there are no prospective studies with standardised outcome measures: that is exactly what the authors of the 2026 systematic review ask for.
⚠️ That does not mean those things are frequent. It means that anyone who gives you a percentage for any of them is making it up.
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Frequently asked questions
Is it a safe operation?
The published figures are good: predominantly mild and transient complications and revision between 0.6% and 6.7%. But it is surgery, with its list of risks, and the result depends on a visible scar. Safe does not mean without consequences.
What happens if the wound opens?
Dehiscence is among the described complications. Most openings are partial and are managed with dressings; what has to be avoided is leaving it to run its course without anyone seeing it. It is a reason to get in touch, not to wait for the review appointment.
Could my lip end up crooked?
The asymmetry of the first few weeks is expected and is described as such. The one that persists once the swelling has gone is another matter. No correction is considered before 8 to 12 months: that is how long a scar takes to mature fully, and until then what you see is still process.
And what if my scar turns out badly?
It can happen without anyone having done anything wrong: the largest genetic study published puts the heritability of keloid at between 6% and 34% depending on ancestry, and it can appear with no previous history. There is treatment for it, and it is in scar improvement. The case of a result that does not convince is in a badly done lip lift and revision.
Can I have surgery if I am diabetic?
There is an increased risk in patients with diabetes, which is not the same as a contraindication: it is a factor to be assessed and controlled before surgery, and the specific criterion is set by the surgeon after seeing your situation.
Will I lose sensation in my lip for good?
What is described is temporary paraesthesia, resolving within a few months in the literature on combined surgery. There are no published figures on permanent alterations, and this page is not going to invent one.
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. — PRISMA 2020 systematic review with PROSPERO registration; 7 studies and 1,754 patients published between 2017 and 2025; predominantly mild and transient complications, with revision rates of 0.6% to 6.7%; moderate overall methodological quality, meta-analysis not feasible because of heterogeneity, and an express call for prospective studies with standardised outcome measures.
- Shojaei S, Heidari K, Alobaidi A, Agrawal DK. Risk-Stratified Use of Topical and Infiltrative Local Anesthetics in High-Risk Dermatologic Surgery. Journal of Surgery and Research, 2026;9:54-75. PMID 41808674. — Narrative review on the use of local anaesthetics in high-risk dermatological settings. It details the risk factors, recognition and management of systemic local anaesthetic toxicity, and notes that intravenous lipid emulsion has turned severe toxicity from an often fatal event into a manageable emergency. Its conclusion is that safe local anaesthesia depends on risk stratification — vascular state, integrity of the skin barrier and the patient’s pharmacokinetics — combined with the preparedness of the centre, which must hold phentolamine and lipid emulsion. It also addresses cumulative dose across routes and the paediatric and geriatric populations. ⚠️ A narrative review, not a systematic one, and about high-risk contexts, not the lip lift.
- Greene CA, Hampton G, Jaworski J, Shuey MM, et al. Multi-ancestry meta-analysis of keloids uncovers novel susceptibility loci in diverse populations. Nature Communications, 2025;16:7770. PMID 40835838. — Genome-wide association study (GWAS) of 7,837 cases and 1,593,009 controls across several continental ancestry groups; it detects 26 loci, of which 12 replicated in an independent set. Heritability estimates were 6% in European ancestry, 21% in East Asian and 34% in African. Keloids are more frequent in people with darker skin of African and Asian ancestry than in Europeans, and the pathway analyses implicate integrin signalling and regulators related to fibrosis and sex hormones. The authors stress that the reasons a keloid develops are still not well understood.
- 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.
- Alnami R, et al. Aesthetic and Functional Outcomes of Simultaneous Rhinoplasty and Lip Lift Surgery: A Systematic Review. Cureus, 2024. PMID 39659329. — PRISMA systematic review of 6 studies and 361 patients; mild scarring and temporary paraesthesia were the most frequent complications, both resolving within a few months; no long-term functional impairment of nasal airflow or lip function.
- 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 from dissatisfied patients; the scar was the most frequent concern (15 of 25), followed by nasal or alar distortion (6) and lip asymmetry (5).
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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.
