In short
- 🔑 The distinction that matters is not between “better” and “worse” techniques, but between ones that solve different problems. The subnasal acts on the length of the lip; the corner lift, on the drooping ends of the mouth. They are not competing.
- The subnasal (bullhorn) is the reference technique and the only well-documented one: it is what underpins the results of the 1,754 patients in the 2026 systematic review.
- The corner lift acts on the two ends of the mouth. In the largest series on lip lift design — more than 2,440 consecutive procedures — it describes when it is worth adding to the lift of the lip.
- The deep plane variants work beneath the skin in pursuit of other aims, and their authors publish good results of their own.
- 🚨 What no website says: there is no comparative study between techniques. The systematic review states it expressly — choice of technique and outcome assessment unstandardised — and calls for prospective studies.
- ⚠️ In other words: anyone presenting their variant as the best is running ahead of the evidence. What does exist is the recommendation to choose the technique individually, guided by the anatomy.
- And the practical criterion for a consultation: the best variant is the one whoever is going to operate on you practises routinely.
Look for information on this operation and half a dozen names come up — bullhorn, Italian, corner lift, direct, gullwing, deep plane — presented as though they were options on a menu.
They are not. Some solve different problems, others are the same procedure under another name, and none has been compared with the rest in print. This page puts them in order.
✅ At the Instituto de Cirugía Plástica del Mediterráneo all of these variants are performed where there is an indication, and the choice is adapted to each case. ⚠️ But that does not make this page a menu. The variant is not chosen by the patient over the internet: it comes out of the anatomy, and that conversation is in person. What follows is there to understand what is being talked about, not to order a technique by name.
The subnasal (bullhorn): the reference
It is the classic technique and the only one with a body of evidence behind it. The incision is drawn following the lower border of the nasal alae and the base of the columella, a strip of skin is removed and the closure is done in layers.
What it solves: the length of the upper lip. It shortens the philtrum, unfurls the red border and increases the tooth visible at rest.
What we know about it: in the 2026 systematic review — 7 studies, 1,754 patients — subnasal techniques and their modifications reduced the philtrum from 14.0-14.5 mm to 10.8-12.0 mm, with mean satisfaction of 4.4/5 and revision of 0.6-6.7%.
It is set out in full in the subnasal technique.
⚠️ And a note on vocabulary: when a website says “Italian lip lift”, in most cases what is being described is a variant of the subnasal line, not a different procedure. Trade names for incision shapes multiply faster than the evidence about them.
The corner lift: a different problem
This one acts in a completely different place: the two ends of the mouth.
What it solves: drooping corners — that sense that the mouth “points downwards” even with the face relaxed. It does not shorten the lip or change the philtrum.
🔑 So it is not an alternative to the subnasal: it is an addition for a different problem. Someone may need one, the other, both or neither.
In the design analysis carried out on more than 2,440 consecutive lip lifts — the largest series published on the subject — the authors describe precisely a criterion for deciding when to add the corner lift to the lift of the lip, within a design approach that aims to avoid exaggerating the look and to reduce the need for revision.
⚠️ It leaves a scar of its own, at the ends of the mouth, where there is less crease available than at the base of the nose.
The deep plane variants
Under various names, there are techniques that do not confine themselves to removing skin but also work in deeper planes, seeking a more stable lift or an effect on the shape of the lip.
What can honestly be said: their authors publish series of their own with good results, and some are included in the 2026 systematic review as “modifications” of the classic approach.
What cannot be said: that they are better. There is no published comparison to support it.
🚨 And there is a technical principle worth bearing in mind when you hear about deep planes: the standard literature on this operation lists among the keys to a good result not invading the orbicularis oris muscle, which is what moves the mouth. Any variant working at depth must respect that limit, and it is a perfectly legitimate question to ask in the consulting room.
The direct approach and the techniques now out of use
The direct lip lift — also called “gullwing” after the shape of the drawing — places the incision on the border of the red lip itself, rather than beneath the nose.
Its theoretical advantage: it allows very fine control of the vermilion contour.
🚨 Its decisive drawback, and the reason it is marginal in aesthetic surgery today: the scar sits right on the border of the lip, which is not a crease. Every other line in this surgery hides in a feature of the contour that already exists; this one has nowhere to hide.
That is why its use in purely aesthetic work is exceptional and reserved for particular cases, often reconstructive ones.
How it is really chosen
The evidence gives one answer and it is a dull one: individually, guided by the anatomy. That is literally the recommendation of the 2026 systematic review.
What that means in practice:
- If the problem is the length of the lip, the territory is the subnasal.
- If the problem is the corners, the territory is another, and it can be combined.
- If the problem is volume, none of these operations is the answer: it is covered in lip lift or hyaluronic acid.
- And if you are offered a technique with a brand name as the main argument, the useful question is: what does it do in my case that the classic one would not?
The criterion of the house, variant by variant
✅ The short answer is that all of them are performed, where there is an indication. The long one is more useful, because it says when:
The corner lift: yes, and in one specific situation. It is used when it is needed to restore appropriate anatomical proportions — not as a cosmetic add-on or to “finish off” a result. If the corners are where they should be, they are left alone.
Deep plane techniques: it depends on the volume of the upper lip. And the reasoning is worth explaining, because it is the underlying argument of this whole page:
When more tissue is excised and the fat attached to the muscle is not preserved, the volumes of the fat planes stop overlapping. In a lip with enough volume that is exactly what is wanted; in another it is not. So, depending on the case, it can be a good option — and that is why it is not always one.
🔑 That is the difference between a technique and a brand. A deep plane is not “better” or “more advanced”: it does something different with the fat, and whether that is right depends on how much volume there is underneath. Anyone offering it as superior without looking at your lip is selling you a name.
⚠️ And that is why this page recommends none of them. The right variant is the one that fits your anatomy, and that is decided by looking at it.
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Frequently asked questions
Is the “Italian lip lift” different from the bullhorn?
In most uses, it is a way of referring to a variant of the subnasal line, not to another procedure. It is worth asking what exactly is meant by the name at each place, because it is not standardised.
Which one leaves the least scar?
All of them leave a scar. The difference is where: the subnasal and the corner lift hide in creases; the direct does not. Comparing scar lengths without comparing where they sit does not say much. It is covered in the lip lift scar.
Can I ask for a particular technique?
You can ask about it, and that is reasonable. What is not a good idea is to choose it: the best technique for you is the one that solves your anatomical problem and the one whoever operates on you practises routinely. An excellent technique in hands that rarely perform it is not an advantage.
Can they be combined?
The subnasal and the corner lift can, and there is literature on when it makes sense to add the second. They are different problems that can coexist.
And the “scarless” techniques?
They do not exist. Shortening the lip requires removing skin, and removing skin leaves a scar. Any technique advertised as a real lift of the lip with no scar should raise suspicion. What does exist without surgery is another thing, and it is covered in lip flip, threads and “permanent augmentation”.
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; it assesses the classic subnasal bullhorn approach and its modifications; patient selection and outcome assessment remain unstandardised; meta-analysis was not feasible because of heterogeneity; it expressly recommends an individualised, anatomy-guided choice of technique, and calls for prospective studies with standardised outcome measures.
- 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 the design of the upper lip and corner lift across more than 2,440 consecutive lip lifts; it proposes a criterion for deciding when to add the corner lift, with the stated aim of avoiding accelerating the appearance of ageing and exaggerating the look, and of reducing the need for revision; the authors note that lip lift design is more complex than most practitioners acknowledge.
- Sturm A. Lip Lift. Otolaryngologic Clinics of North America, 2022. PMID 35750522. — Among the keys to a good result is not violating the orbicularis oris muscle, alongside an incision design that respects the natural anatomy, placing the tension below the dermis and determining the amount of lift appropriate to the patient’s anatomy.
Book your consultation
If you have got this far with a list of technique names, the good news is that you do not have to choose any of them. What is useful to take to a consultation is your problem described precisely: whether what bothers you is the length, the corners or the volume. The technique comes out of that, not the other way round.
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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.
