Lip Filler or Lip Lift? The Solution for a Long Philtrum

Attractive, full, and youthful-looking lips are one of the most desired elements of facial aesthetics. Many patients seeking this goal first consider lip filler applications. As a fast, non-surgical, and effective method for adding volume, hyaluronic acid fillers are used safely by millions.

However, not every patient is an ideal candidate for lip filler. Especially in individuals where the distance between the base of the nose and the upper lip (the philtrum) is structurally long, adding volume with lip filler can create the exact opposite of the desired result: an elongation of the upper lip, a heavy appearance, and an artificial look often described as "duck lips."

So, if your problem isn't a lack of volume but rather the length of your upper lip, what is the right solution? At this point, a procedure completely different from lip filler, the Lip Lift Surgery, is preferred.

In this article, from the expert perspective of Plastic Surgeon Assoc. Prof. Dr. Yalçın Bayram, we will examine in detail the fundamental differences between lip filler and lip lift, in which situations each is preferred, and why surgery is often the only permanent solution for a long upper lip (philtrum).

The Core Problem in Lip Aesthetics: Volume or Distance?

In planning lip aesthetics, the first thing Assoc. Prof. Dr. Yalçın Bayram evaluates is not what the patient "wants," but what they "need." Is the problem the thinness of the pink part of the lip (vermilion), or is it the position of the lip on the face?

Why is Philtrum Distance So Important? The philtrum is the vertical distance between the base of the nose and the red border of the upper lip. In ideal facial proportions, this distance should generally be around 12 to 15 millimeters.

• Short Philtrum: Considered a sign of youth and attractiveness.

• Long Philtrum: This distance naturally lengthens with age due to gravity. In some people, this condition is genetic and structural. As the philtrum lengthens, the upper lip thins, turns inward, and prevents the upper teeth from showing (tooth show) even when smiling. This gives the face an older, tired, and more severe expression.

This anatomical fact is the fundamental dividing line between fillers and a lip lift.

Lip Fillers: Temporary Volume and Its Limitations

Lip filler is a procedure that adds volume by injecting hyaluronic acid-based gels into the pink part of the lip.

When Are Lip Fillers Ideal?

They are an excellent option for individuals who:

• Have a normal or short philtrum distance (upper lip length).

• Are dissatisfied with the overall volume of their lips.

• Desire a fuller and more defined lip contour (Cupid's bow).

• Wish to correct asymmetries in the lips.

• Are looking for a non-surgical, fast, and temporary solution.

The "Long Philtrum" Problem with Lip Fillers

If a patient's philtrum distance is already long (e.g., 18 mm), adding volume to this area with lip filler will only worsen the existing problem. The lip, now heavier with volume, will sag even more in this already long space due to gravity. Instead of lifting up, the lip is pushed outward. This leads to the "duck lip" or "simian" appearance that patients fear most. Volume increases, but the aesthetic proportion is completely lost.

Lip Lift (Dudak Kaldırma): A Permanent Positional Change

Lip Lift Surgery is not a volume procedure; it is an operation to correct position and proportion.

When is a Lip Lift Ideal?

It is the gold standard for patients who:

• Have a structurally long upper lip (philtrum) distance.

• Have experienced thinning and elongation of the upper lip due to aging.

• Are unhappy that their upper teeth do not show sufficiently when they smile.

• Are looking for a permanent solution.

• Have noticed that lip fillers look artificial or heavy on them.

How Does Lip Lift Surgery Work?

In this procedure, the most popular technique, called the Bullhorn (Subnasal) Lip Lift, is used. A small strip of skin, shaped like a "bull's horn," is removed from just under the base of the nose, hidden in the natural creases. The upper lip is then sutured into its new, elevated position.

This simple yet effective surgical intervention provides:

1. A Shorter Philtrum: The middle part of the face is instantly shortened, and proportions are balanced.

2. Lip Eversion (The "Flip"): The pink part of the upper lip (vermilion) gently rolls outward, making the lip appear naturally fuller without adding volume.

3. Increased Tooth Show: Because the upper lip is lifted, the upper teeth become visible in an ideal proportion at rest and when smiling. This is one of the most important elements of a youthful, attractive smile.

4. Permanent Results: Since the removed skin does not grow back, the result is permanent.

What About the "Lip Flip"? Is It an Alternative to a Lip Lift?

Another non-surgical method patients often ask about is the Lip Flip procedure.

• What is a Lip Flip? This is a Botox application. Very small doses of Botox are injected into the muscle just above the upper lip (orbicularis oris).

• How Does It Work? The slight relaxation of this muscle causes the upper lip to roll minimally upward (eversion). The lip appears slightly more lifted.

• The Difference from a Lip Lift: A Lip Flip does not shorten the philtrum distance. It only slightly everts the pink part of the lip. Its effect is much less pronounced and is temporary (lasting 3-4 months on average). A Lip Lift, conversely, is the surgical solution that permanently shortens the philtrum distance.

The Surgeon Factor in Facial Proportions: The Importance of Correct Diagnosis

Many patients come to the clinic requesting "lip fillers," unaware that what they actually need is a Lip Lift. Correctly analyzing why the patient's lip appears thin is related to the surgeon's artistic eye and experience.

During the consultation, Assoc. Prof. Dr. Yalçın Bayram carefully measures your facial proportions, especially your philtrum distance.

• If the problem is purely a lack of volume, he will plan a lip filler application that gives you the most natural result.

• However, if the problem is a long philtrum, he will honestly explain why lip filler would look artificial and why your real need is a permanent solution like Lip Lift surgery.

The millimetric planning of the incision location and the amount of skin to be removed in a Lip Lift is critical for hiding the scar perfectly at the base of the nose. This precise planning depends on the surgeon's expertise.

Which is the Right Solution for You? Lip Filler or Lip Lift?

If you look in the mirror and notice that your lips are not only "thin" but also that the distance between your nose and lip is "long," if your upper teeth don't show when you smile, or if you feel that fillers you've had in the past looked "duck-like," the right solution for you is likely not lip filler, but Lip Lift surgery.

If your philtrum distance is normal, but you simply want fuller lips, lip filler offers a quick and effective solution.

For more detailed information on Lip Lift surgical techniques, the recovery process, and scar care, you can review our main Lip Lift Surgery service page. For information on lip fillers, you can visit our Dermal Fillers page.