In short
- 🔑 The incision is horn-shaped for a reason, not for looks: by following the border of both nasal alae and the base of the columella, every stretch of the scar falls inside a crease your face already has. A straight line would be shorter and would show more.
- The published figures are reassuring. In the systematic review covering 1,754 patients, complications were “predominantly mild and transient”, revision rates ranged from 0.6% to 6.7% and mean satisfaction was 4.4 out of 5.
- And in the literature on surgery combined with rhinoplasty — 361 patients — mild scarring is among the most frequent complications, and is described as resolving within a few months.
- ⚠️ What is worth knowing: it looks worse before it gets better. Between the first and third month it turns red, thickens and hardens. That is the proliferative phase of healing, not a poor result — and it is the “hard cord” people ask about on the forums.
- 🔑 It is not left to evolve on its own. Here it is treated with CO₂ laser and intense pulsed light at the first, second and third month, plus daily sun protection.
- And one peculiarity of the face: we do not use silicone dressings in this area, because they show and are uncomfortable, despite being the standard for scars elsewhere on the body.
- You can wear make-up over it from the removal of the skin sutures, at 7 days. The deep ones are not removed: they dissolve on their own.
- A revision of the scar is not considered until the one-year mark, when it is fully mature.
It is the question that decides the operation: will it show?
The short answer is that there is always a scar, that it stays hidden in the crease at the base of the nose and that in most cases it tends to fade with the months. The long answer — exactly where it goes, what it does month by month and what is done so that it heals well — is this page.
The general treatment of a post-surgical scar is covered in the scar protocol, and a scar that has already become problematic, in scar improvement. This page deals with what is specific to this scar and to no other part of the body.
Exactly where it goes
It is worth being precise, because “under the nose” does not say very much.
The incision in the subnasal technique — the usual one — is drawn at the junction between the nose and the lip, and not in a straight line: it follows the lower contour of both nasal alae and dips around the base of the columella, the fleshy partition between the two nostrils. That path is what gives it the shape known in the literature as a “bullhorn”.
🔑 And that shape is not a design whim: it is the reason the scar hides. Every stretch of the line sits inside an anatomical groove that is already on your face. A straight incision between the two alae would be shorter — and would sit on smooth skin, in plain view.
What lies underneath matters just as much. The strip of skin is excised above the muscle, and the closure is done in layers: the deep plane is the one that bears the tension, and the superficial one merely brings the edges together. When the tension falls on the skin instead of on the deep plane, the scar widens. It is the same principle that governs any surgical scar: the single most important modifiable factor in preventing an abnormal scar is tension on the wound, and that tension is determined by the design of the incision.
What the figures say
It is worth starting here, because it puts everything else in order.
The systematic review published in 2026 — seven studies, 1,754 patients operated on between 2017 and 2025 — describes the complications of this surgery as predominantly mild and transient, puts revision rates between 0.6% and 6.7% and reports a mean satisfaction of 4.4 out of 5 on the global improvement scale.
And the review on lip lift combined with rhinoplasty — six studies, 361 patients — identifies mild scarring and temporary paraesthesia as the most frequent complications, and describes both as resolving within a few months, with no long-term functional impairment.
🔑 The honest reading: this scar, in most cases, heals well. What it demands is patience for a few months and active care from the outset — which is what the rest of this page is about.
⚠️ With the usual methodological caveat: the overall quality of those seven studies is moderate and meta-analysis was not possible because of their heterogeneity. It is the best evidence available, and it can be bettered.
A practical difference from other scars
Even though it heals well, there is something worth bearing in mind that does not apply to other operations:
This scar cannot be covered up. A breast scar is hidden by clothing; an eyelid scar is camouflaged in a fold that closes over it; a facelift scar is tucked behind the ear or into the hairline. This one is in the middle of the face.
During the first few weeks — when it is at its most visible — what there is is make-up, which can be worn from the removal of the sutures. It is not a medical problem, but it is a factor that weighs on when to schedule surgery: if you have an important engagement, it is wise to leave yourself room.
⚠️ And that is why this page insists on the same thing as the pillar page: if the idea of a permanent scar in that area strikes you as unacceptable, this surgery is not for you. That is a legitimate conclusion, and better reached sooner than later.
The curve: what happens month by month
The timings below are those of surgical healing in general, which is what has been published. They are not a lip-lift-specific calendar, because no validated one exists.
At suture removal. Fine, flat and discreet.
Between the first and third month. The most visible point. It turns red or purple, thickens, hardens and sometimes itches. This is the proliferative phase: the body lays down collagen in excess before reorganising it.
From the third to the sixth month. It begins to flatten and lose colour. The improvement is slow and uneven, and it is common for one stretch to run ahead of another — especially in a scar that, like this one, has stretches running in different directions.
From the sixth month to the year. It keeps improving, paling and flattening. The published recommendation is to keep up the care for a full year, precisely because the process is not over at six months.
🔑 The corollary: if at two months your scar looks worse than it did at two weeks, that is what is meant to happen. And that is not the moment to judge it.
The “hard cord” at three months
It is one of the questions asked word for word on patient forums, and it deserves a direct answer: feeling the scar hardened, like a cord under the skin, at around two or three months is the expected phase of healing, not a complication.
It corresponds to the point at which collagen has been laid down in excess and has not yet been reorganised. With remodelling, that hardness gives way.
🔑 The protocol: what is done and when
The scar is not left to evolve on its own. This is the protocol applied at the centre for this area:
| When | What |
|---|---|
| From the next day | Daily sun protection over the whole face |
| At 7 days | Removal of the skin sutures — and from here on you can wear make-up (the deep ones are absorbable and are not removed) |
| At 1 month | 1st session of CO₂ laser + intense pulsed light (IPL) |
| At 2 months | 2nd session |
| At 3 months | 3rd session |
| At one year | Mature scar: this is when any revision is considered |
Why at the first month and not later. It is not a preference: it is the moment when the treatment works. A meta-analysis of 14 controlled trials on post-surgical scars found that fractional CO₂ laser applied within the first month significantly reduces the scar, whereas started after three months it shows no significant improvement.
🔑 In other words: treating the scar is not a plan B in case it turns out badly. It is part of the surgical plan from the start, and it is scheduled before the operation.
Why both technologies together. IPL acts on the vascular component — the redness — and CO₂ on the raised texture. Each is explained in the post-surgical scar protocol and in CO₂ laser or intense pulsed light.
⚠️ What is NOT used here: silicone dressings
It is a deliberate departure from the general standard, and it is worth explaining because it will clash with what you read elsewhere.
Silicone sheets and dressings are a routine scar treatment and appear as recommended in the general guidelines. On the face we do not use them, for two practical reasons: they show — they sit on the upper lip, in the middle of the face — and they are uncomfortable in an area that moves constantly while talking, eating and smiling.
🔑 A treatment that is not worn does not treat anything. In this location, that job is done by the laser and by sun protection.
What depends on you
- Not smoking. It is the modifiable factor that weighs most on a facial scar: in active smokers, the risk of a wound complication in facial surgery is multiplied by between 1.8 and 12 according to the available review of studies. Here we require one month without tobacco before surgery and two weeks afterwards.
- Strict daily sun protection. A recent scar exposed to the sun pigments, and on the face there is nowhere to hide it. In Valencia this is no small detail: it is the part of the face that gets the most sun.
- Not pulling on the area. Wide movements of the mouth in the first few weeks put tension exactly where it is not wanted.
- Attending the sessions. The three in the protocol are where they are because that is the window in which they work.
What can go wrong in this area
Besides the scar itself, there are two described problems that are specific to operating right on the border between the nose and the lip:
Distortion of the nose or the nasal ala. On closing the incision, the traction can alter the shape of the alae or of the nostril. It is the aesthetic complication specific to this location, and it explains why this surgery and rhinoplasty share territory.
Lip asymmetry. The two sides do not always settle at the same rate or heal alike: the swelling goes down asymmetrically, and that is a clinical description from the team, not a figure from the literature — no article measuring it has been found. The asymmetry of the first few weeks is usually temporary; the one that persists beyond a year is another matter.
Both appear, alongside the scar, among the reasons that come up when someone is unhappy after this surgery: in a qualitative analysis of 25 accounts published by dissatisfied patients, the scar was the most cited, followed by nasal distortion and asymmetry.
⚠️ How that study has to be read: it analysed negative accounts only, selected for being negative, and there are 25 of them. It is useful for knowing what worries people when something worries them — it says nothing about how often it happens. That is what the figures at the top are for: revision between 0.6% and 6.7% across 1,754 patients.
Book an appointment
You can book your own appointment. Pick the day and time from the free slots in the diary, in a panel that opens right here, without leaving this page.
Frequently asked questions
Can a lip lift be done without a scar?
No. To shorten the lip you have to remove skin, and removing skin leaves a scar. Any technique promising a real lift of the lip with no scar should raise suspicion. What can be chosen is where it goes and how it is drawn.
When can I wear make-up over it?
From the removal of the skin sutures, at 7 days. Not before, because the wound is still closing. (The deep sutures are not removed — they are absorbable.)
How long until it stops showing?
There is no guaranteeable timescale and it depends on the individual. What is known is the shape of the curve: most visible between the first and third month, improving steadily from the sixth and maturing up to the year. A mature scar ends up as a pale, fine line — but a permanent one.
Why are you not giving me silicone patches when my sister was given them?
Because her scar was probably not on her face. In other locations they are a routine treatment; on the upper lip they show and they bother, and here that job is done by the laser and by sun protection.
When can the scar be revised?
From one year onwards, when it is fully mature. Before that point what you see is still changing, and revising an immature scar makes it worse.
Does it show more on darker skin?
Scars in higher phototypes have a greater tendency to hyperpigmentation and hypertrophy. It is a point that must be raised explicitly at the pre-operative consultation, not discovered afterwards, and it makes sun protection weigh even more.
I have a moustache — does it show less?
On the male upper lip the scar falls within the hair-bearing area, which changes things considerably — and it also changes the technique, because the direction of the follicles has to be respected. It is covered in lip lift in men.
And what if the scar does not heal well even so?
It can happen without anyone having done anything wrong — the heritability of keloid is estimated at between 6% and 34% depending on ancestry. A keloid or hypertrophic scar is an unforeseeable complication, tied to each person’s genetic make-up. There is treatment for it, and it is in scar improvement.
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 covering 7 studies and 1,754 patients published between 2017 and 2025; predominantly mild and transient complications, with revision rates between 0.6% and 6.7%; mean GAIS satisfaction of 4.4/5; moderate overall methodological quality and meta-analysis not feasible because of heterogeneity.
- 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.
- 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, with no long-term functional impairment of nasal airflow or lip function.
- Son D, Harijan A. Overview of surgical scar prevention and management. Journal of Korean Medical Science, 2014. PMID 24932073. — Scar management is tied to the phases of healing; the most important modifiable factor in its prevention is tension on the wound during the proliferative and remodelling phases, determined by the design of the incision; care should be maintained for a year.
- Ji Q, Luo L, Ni J, et al. Fractional CO₂ Laser to Treat Surgical Scars: A Systematic Review and Meta-Analysis on Optimal Timing. Journal of Cosmetic Dermatology, 2025. PMC11711943. — Meta-analysis of 14 controlled trials and 492 scars on the optimal timing of treatment: treatment within the first month significantly reduces the scar, whereas started after three months it shows no significant improvement.
- 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. — Qualitative thematic analysis of 25 public accounts from dissatisfied patients; scar-related concerns were the most cited, followed by nasal or alar distortion and lip asymmetry. Small sample, selected by design: it describes reasons for dissatisfaction, not population frequencies.
Book your consultation
The scar is the point on which this surgery is decided, and it is a conversation to have beforehand, with the incision drawn on your own face and not on a photograph. At an in-person assessment you can see where it would fall in your case, how long it is, what creases your nasal base has to hide it and on what schedule it will be treated from the first month.
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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.
