Lifelong lift

Mr Naveen Cavale

Mr Naveen Cavale is a plastic and reconstructive surgeon, currently a consultant at King’s College Hospital London. He also operates privately from the Cadogan Clinic in Sloane Square. He is the UK representative for the International Society of Aesthetic Plastic Surgery (ISAPS) and president of the plastic surgery section of the Royal Society of Medicine. He frequently visits Gaza to provide surgery to those affected by blast and gunshot injuries. Follow him on Instagram: @realplastics

T he lip lift –a surgical procedure that involves shortening the amount of skin on show between the nose and the mouth to make the upper lip look fuller and lifted – is not a new procedure, but demand has increased among my clients within the last two years or so. [At the time of writing, the hashtag “lip lift” has 14.6 million views on TikTok]. It’s not one of my “signature” procedures, yet I have definitely seen an uplift in patients enquiring about it. I believe the reasons for this are the same as to why rhinoplasties have massively risen in popularity over the last year, too. With us spending a lot of time staring at a mirror image of ourselves on video conferencing calls and webinars, people may have noticed things about themselves that previously they wouldn’t have done. I think a secondary reason for the lip lift’s rise in popularity is that many people now want a more natural enhancement for their lips, which the lip lift procedure does very well Lastly, it’s permanent, so for someone who spends a lot of money on fillers, and providing they’re the right candidate for treatment, it can be a great, cost-saving alternative in the long run, as long as they get it done for the right reasons. You’re also much more likely to get a more naturallooking result with a lip lift compared to injectables as the skin is pulled up rather than pushed out.

It’s somewhat obvious but important to point out that unlike injectables, this is a permanent treatment. In select cases, a lip lift can be performed on patients who have previously received filler. Therefore, those that have fillers regularly seem to be the most interested in the procedure as this is a permanent way to achieve a fuller-looking upper lip, negating the need for further regular injectables. If desired, patients are able to receive filler after a lip lift, but I’d always refer them to a specialist in lip filler, as it would obviously be a more complex treatment than usual.

Sculpting shape

My approach to this procedure is not about volume, especially in the upper lip. Rather, it is all about shape and proportions – the lower lip is naturally larger than the upper. Bad filler to the upper lip swaps this relationship and can make things look quite fake. Lip lifts are fantastic at improving shape, proportion and perception; however, careful patient selection is key. An example of someone who wouldn’t be suitable is a patient with a long upper lip where the mouth has a natural gape.

This gape is very attractive and tends to be desirable to patients, but if it is already there, doing a lip lift can increase it and make closing the mouth difficult, making things look unnatural. The lip lift is potentially suitable for a patient with lax skin around the mouth, but as above, patients suitable for this procedure have to be very carefully selected. It won’t be right for everyone.

During the procedure, a “bullhorn”- shaped piece of skin is removed from just under the nose. This can be done as skin only, and it can also be combined with moving the underlying muscle upwards as well (a “deep plane” lip lift). A lip lift can be done under local anaesthetic (unless the patient has real objection to this, in which case it can be done under general). The area to be removed will be drawn up on the skin and we can pinch the area to show the effect. The marked-up skin is then removed. The operation takes roughly 45 minutes to 1 hour.

Lift off

The trickiest part of this operation is stitching everything back together. We have to do this in layers so it looks natural and use certain techniques so it doesn’t pull down on the nose. We almost never use just one layer to close after surgery. Instead, we close the different layers – muscle, fascial, deep skin, and the outside skin layer. With a lip lift it will be most common to close in two or three layers. The outside layer will be closed with non-dissolving stitches; everything inside will tend to be dissolvable sutures. As this procedure is most commonly performed under local anaesthetic, patients can be out of the operating room once the procedure is finished. Stitches will need to be removed after a week. I advise patients that they may wish to take 10 days to two weeks off work as downtime. Once the stitches are out and the area is dry, the scar can be hidden with concealer.

The main side effects seem to be mild scabbing and swelling as the incision settles down. Patients often recall the sensation as a bit like having a thick lip –a similar sensation as following dental work. Swelling is usually completely gone after three weeks and there is a risk of bruising following the procedure. Again, it’ll usually disappear after a couple of weeks. I normally advise patients to drink from a straw for a couple of weeks post-surgery, but other than that, it’s a fairly straightforward procedure with minimal downtime or impact on everyday life during recovery.