The Bullhorn and Beyond: Evidence‐Based Review and Clinical Recommendations for Lip Lift Techniques

BACKGROUND: The upper lip plays a central role in facial harmony and youthful appearance. Aging-related changes include elongation of the philtrum, thinning of the vermilion, and reduced maxillary incisor show. Surgical lip lift shortens the cutaneous upper lip and enhances vermilion exposure, yet patient selection and outcome assessment remain non-standardized. OBJECTIVES: To critically evaluate current evidence on surgical lip lift techniques, including the classical subnasal bullhorn approach and its modifications, and to provide evidence-based recommendations for anatomy-driven technique selection. METHODS: A PRISMA 2020-compliant systematic review was conducted, with protocol registration in PROSPERO. Studies included adult patients (≥ 18 years) undergoing lip lift for aesthetic or aesthetic-functional indications. Prospective and retrospective clinical studies and case series (≥ 5 patients) published between 2017 and 2025 were identified through database searches. Data extraction focused on surgical technique, morphometric outcomes, patient satisfaction, and complications. Meta-analysis was not feasible due to heterogeneity. Methodological quality was assessed using the MINORS instrument and JBI checklists. RESULTS: Seven studies comprising 1754 patients were included. Subnasal bullhorn techniques and their modifications reduced philtral length from 14.0-14.5 mm to 10.8-12.0 mm, increased vermilion height from 5.0-6.0 mm to 7.0-9.0 mm, and improved maxillary incisor show from 1.5-2.0 mm to 3.5-5.0 mm. Patient satisfaction was high (mean GAIS score 4.4/5). Complications were predominantly mild and transient, with revision rates of 0.6%-6.7%. Overall study quality was moderate. CONCLUSIONS: Surgical lip lift is a safe and effective procedure for restoring upper-lip proportions. Technique selection should be individualized, and further prospective studies with standardized outcome measures are needed. TRIAL REGISTRATION: CRD420251232005.