A bullhorn lip lift is a special type of lip lift surgery, which is aimed to reveal more of the pink upper lip. This cosmetic procedure is also known as subnasal lip lift. Dr. Gary Linkov, as an experienced facial plastic surgeon, offers bullhorn lift lip surgery at City Facial Plastics, located in Manhattan, NY.
What Is a Bullhorn Lip Lift?
A bullhorn lip lift is a type of lip lift surgery. The term “bullhorn” refers to the shape of the incision which is a horizontal line with upward edges, resembling a bull’s horns. The bullhorn lift lip is also known as a subnasal lip lift, since the incision is made under the nasal base. A small piece of skin is then removed and the incision is closed, resulting in a shorter philtrum length and elevated upper lip.
What Is the History of the Lip Lift?
For decades, the cosmetic lip lift has been evolving, improving the shape and fullness of lips. Here is a timeline of the profession of lip lift techniques up to the modern-day surgical options offered by Dr. Gary Linkov in UES, Manhattan.
- 1981 – Bullhorn upper lip lift, or subnasal lift, was the first procedure of its type ever used and described. This first lift was skin only excision without any undermining of skin flaps.
- 1984 – Vermillion border lip lift was first used and described by plastic surgeons. This technique has since fallen out of favor due to high risk of unfavorable scarring and potential distortion of central aesthetic components of the upper lip.
- 1986 – A modification is presented for the bullhorn upper lip lift, which is to add a vertical midline component for patients with poor cupids bow definition.
- 1994 – An extended upper lip lift procedure was used and described in Brazil that incorporated the nasolabial folds into the excision. This technique did not catch on due to the degree of scarring in a very visible central portion of the face.
- 2000 – Adjunct and alternatives procedures were used and described for lip enhancement – implantation of crystal silicone, polyacrylamide hydrogel, Gore-Tex tubes, autologous fat, and dermis-fat graft. Silicone in the lip has since been completely abandoned in most parts of the world due to migration, scarring, and nodule formation problems.
- 2002 –SMAS (superficial musculoaponeurotic system) grafts obtained from a facelift reported as a tool for lip augmentation into the red portion of the lip.
- 2004 – V-Y mucosal lip advancement used and described with incisions placed on the inside of the mouth. No major change to philtral length procedure. Implants such as silicone and alloderm introduced to augment the fullness of the red lip. The Italian lip lift is used and described, which does not include an incision under the columella (in the middle), only on the sides.
- 2010 – SCM (sternocleidomastoid) muscle used and described by plastic surgeons as another graft material for enhancing the red portion of the lips.
- 2011 – An upper lip suspension technique is used by plastic surgeons for patients not interested in a visible scar. The upper lip is shortened via an intranasal incision and suspension suture inside the nose. A single suture is used, which raised concern about the longevity of results.
- 2013 – A corner lip lift is described to correct the “sad” appearance that can occur with aging. While a subnasal lip lift addresses the portion of the lip under the nose, the corner lift addresses the sides of the lip, but incisions are made in a visible location.
- 2014 – The traditional subnasal upper lip lift is modified with endonasal flaps to hide portions of the incision by bringing them into the nose. A disadvantage is destruction of the nasal sill, a natural structure at the base of the nose that cannot be recreated and leads to a widened nostril appearance.
- 2016 – A combination of the Italian lip lift and upper lip suspension technique with several sutures is used with screw fixation to minimize visible scarring.
- 2017 – A “T-shaped” orbicularis muscle segment is removed in addition to skin with a subnasal approach. There is still concern about functional changes to the upper lip with this procedure.
- 2019 – Dr. Gary Linkov is the first to publish on simulated upper lip augmentation, including upper lip lift, and social perception analysis.
- 2019 – Dr. Gary Linkov invents the Elelyft, a version of the bullhorn upper lip lift that combines deep release technique with undermining of skin flaps and meticulous closure with special surgical ink marking. Dr. Linkov also begins combining lip lifts with alar base reduction and philtrum defining surgery to enhance the junction of the lower and middle face near the mouth and nose.
Should I Get a Bullhorn Lip Lift?
A bullhorn lip lift in New York City may be the right lip lift surgery for you if you desire an enhanced upper lip. A bullhorn lift lip can not only improve your mouth, but also create a more balanced appearance to your face as a whole.
You may benefit from subnasal lip lift procedure if you desire specific changes to your smile, such as:
- Enlarged upper lip
- Shorter philtrum
- Increased dental show
- Defined cupid’s bow
Bullhorn Lip Lift vs Other Lip Lift Surgeries
The bullhorn lift lip is the most popular type of lip lift surgery. There are several advantages to the bullhorn lift lip compared to other approaches to lip lift surgery. These advantages include:
- Incision is less noticeable, as it is hidden under the nose
- Tension is well distributed when closing the incision, resulting in better scar formation
- Gives a more natural appearance to the upper lip.
Who Should Not Get a Bullhorn Lip Lift?
The bullhorn lip lift is not the right lip lift surgery for everyone. People who are not comfortable with or who do not desire any scarring whatsoever should not undergo this subnasal lift procedure as there will always be some amount of scar even if it is not noticeable. People with connective tissue diseases may have excess stretching of skin resulting in poor wound healing and need for revision surgery. People on blood thinner medications are at increased risk of bleeding during the procedure and bruising during the recovery period.
How Is Bullhorn Lip Lift in New York Done?
The bullhorn lip lift is typically performed in the office under local anesthesia. There are several steps Dr. Linkov will take before the surgery actually starts in order to ensure the best results. These steps are referred to as the preparation phase. Once the preparation phase is complete, Dr. Linkov will proceed with surgery.
Dr. Linkov will spend a decent amount of time in the preparation phase of your surgery. The preparation phase may take up to an hour prior to the incision being made. There are several parts of the preparation phase, as outlined below.
The first step in preparation of the bullhorn lip lift is marking the skin. Dr. Linkov will draw a curved line with a marking agent under the nose outlining where the incision will be made. The incision design and marking typically takes 20 – 30 minutes. Dr. Linkov will show you how much skin will be removed and what the new philtrum length will be. You and Dr. Linkov must be in agreement with the incision design and measurements prior to moving on to the next part of surgery.
Once the marking of the incision is complete, Dr. Linkov will inject local anesthesia to the anticipated surgical site. You will feel a pinch of the needle entering the skin, but after several seconds the anesthesia will start to take effect and the area will be numb. The inside of the upper lip is also numbed. The use of local anesthesia eliminates pain during the surgery, and since the anesthesia is only delivered locally, you will not feel drowsy once the surgery is complete.
Clean the area
While the anesthesia is settling in, Dr. Linkov will wash or prep the surgical site with an antiseptic agent. Most doctors will use betadine swabs, which clean the area and kill any bacteria that may be on the skin. Cleaning the surgical site with an antiseptic solution helps reduce the risk of infection.
Drape the patient
After antiseptic solution is applied to the surgical site, Dr. Linkov will place a drape over the remaining parts of your face and rest of your body. The drape is placed in sterile technique, which is a specific style of covering the patient that has been shown to dramatically reduce the risk of infection. You will be able to breath under the drape. Your eyes will not be covered by the drape, but they will be covered by a moist gauze cloth for protection.
The bullhorn lip lift surgery will vary from person to person depending on the complexity of the surgery. In general the actual surgical time is approximately one to two hours. The steps of the bullhorn lift lip surgery are outlined below.
A scalpel is used to cut along the incision. Dr. Linkov will remove the previously discussed amount of skin.
Create tunnel under the skin
The doctor will then use a different surgical instrument to loosen the skin below the lower incision line. This is done by inserting the instrument under the skin and creating a tunnel. By loosening the skin, there will be less tension when the incision is closed, resulting in less scar formation.
A cautery device is used to stop any bleeding that may have occurred during bullhorn lip lift surgery. The cautery device effectively burns the endings of broken blood vessels, thus stopping any more blood from coming out.
Close the incision
The incision is closed by suturing, or stitching, multiple layers of skin that have been cut. Dr. Linkov uses different kinds of suture for each layer that is closed, starting with the deepest layer and ending with the skin surface. The sutures under the skin are dissolvable, and the sutures on the skin surface are typically not dissolvable. The sutures are placed in a very meticulous fashion in order to reduce the amount of tension and result in the thinnest scar possible.
Bandage over the area
Once the incision is closed, the doctor will place a bandage over the area. The bandage will need to stay on until the morning after your surgery. Once the bandage has been removed, you may shower that evening.
Where Exactly Is the Incision Placed in a Bullhorn Lip Lift?
The incision is custom designed per patient and follows the curvature of the base of the nose. The width of each nasal ala and the width of the columella (central portion of the nose) will affect the incision design. The bullhorn lip lift incision will be near the junction of the nose and upper lip and the central portion is at the base of the columella.
Some doctors choose to extend the incision inside of the nose to better hide it, some refer to this as the M-type incision. The problem is that the upper lip then gets pulled into the nose which leads to an artificial appearance and also destroys the nasal sill contour which cannot be replaced. Dr. Linkov believes in making the incision for the bullhorn lip lift procedure at the base of the nasal sill to preserve the natural appearance of the nose.
What Are the Complications of Bullhorn Lip Lift Surgery?
As with any procedure or surgery, there may be complications after bullhorn lip lift procedure. Complications after this subnasal lip lift surgery are typically minor. These complications include:
- Pronounced scarring
- Stiffness of upper lip
- Abnormal sensation
- Changes to the nostrils
- Changes in speech
Who Does Bullhorn Lip Lift Surgery Near Me in NYC?
There are many facial plastic surgeons who perform bullhorn lip lift procedure. You can go on websites such as RealSelf to research facial plastic surgeons in your area and elsewhere who perform bullhorn lip surgery. It is important to find a plastic surgeon with an expertise in this particular type of upper lip lift surgery.
Dr. Linkov is a board certified facial plastic surgeon and the only medical reviewer for the lip lift category on RealSelf located in Manhattan, NYC. He would be happy to discuss if bullhorn lift lip surgery is right for you during your consultation.
Bullhorn Lip Lift Before and After
A lip lift can do more than just improve your mouth. It can create a more balanced, beautiful appearance to your facial features. To learn more about the bullhorn lip lift procedure or any of our other cosmetic solutions, schedule a consultation with a top-rated facial plastic surgeon in Midtown, Manhattan Dr. Linkov. If you have been considering a bullhorn lip lift to improve the symmetry and fullness of your lips, City Facial Plastic in Manhattan’s Upper East Side can create the results you desire.