Lip lift · permanent shortening of the philtrum
Lips raised subtly — permanently, without adding volume. One operation instead of repeating hyaluronic acid every six months. More teeth when you smile.
Treatment
What is Bullhorn lip lift?
The bullhorn lift, or lip lift, is surgery that permanently shortens the upper-lip distance (the philtrum) and raises the vermilion discreetly. At Ästhetik am Isartor in Munich, Dr. Fabian Weinschenk provides the medical direction. Through a bullhorn-shaped incision beneath the nose, hidden in the natural skin line of the nostril rims, a precisely defined strip of skin is resected; the muscle and skin beneath are mobilised, the upper lip moves up and the vermilion becomes more visible. More teeth show when smiling, the typical photographic effect of a shortened philtrum. A permanent alternative to hyaluronic acid lip fillers: instead of six-monthly top-ups, the anatomical distance is corrected surgically once and stays. It suits a long upper lip, whether age-related (the distance between nose and lip lengthens with age) or naturally so. Important: existing lip fillers must have subsided completely beforehand for a precise result. The outpatient operation takes 45 to 60 minutes under local anaesthetic; twilight sedation or general anaesthesia on request. No overnight stay. Sutures out after five to seven days; make-up and exercise pause two weeks; final result after four to eight weeks. With a history of cold sores, preventive antiviral treatment from 24 hours beforehand is recommended.
Suitability
Who is Bullhorn lip lift suitable for?
With age the distance between the base of the nose and the vermilion lengthens — the upper lip looks narrower and the vermilion draws inwards. In some patients this distance is also naturally long. The bullhorn lift shortens it permanently.
Suitable for
The bullhorn lift is suitable where there is an age-related lengthening of the upper-lip distance (typically from the mid-thirties), where there is a naturally long philtrum, where the vermilion is drawn inwards without a deficit of volume (so not a pure volume problem) and in particular for patients who would like a permanent solution instead of regular hyaluronic acid sessions. The requirements are stable general health, existing hyaluronic acid lip fillers completely subsided before the operation and realistic expectations — the bullhorn lift shortens the distance and raises the vermilion discreetly; it does not replace the addition of volume that a filler provides.
Not suitable for
The bullhorn lift is not advisable where only an increase in lip volume is wanted, without a problem of distance — hyaluronic acid is the right procedure there. Where there is an existing hyaluronic acid lip filler, it must have subsided completely before the operation. A tendency to keloid scarring is a relative contraindication — the scar could remain visible; we discuss that in the initial consultation. An acute episode of cold sores postpones the procedure until it has healed completely. Active anticoagulation that cannot be paused likewise postpones the procedure.
Whether a bullhorn lift, hyaluronic acid or a combination of the two procedures makes sense, we decide together in the personal initial consultation (€100) after a clinical assessment of the anatomy of the lips and the philtrum.
Method
A permanently shorter distance vs six months of volume.
The bullhorn lift and hyaluronic acid fillers solve different problems. Anyone who wants a permanently shorter upper-lip distance is in the right place with the bullhorn lift — anyone who only wants more volume, with a hyaluronic acid filler. The two complement each other.
- Standard
Bullhorn
Bullhorn lift (surgical, permanent)
- How it works
- A strip of skin beneath the base of the nose is resected, the upper lip moves up
- Strength
- Permanent · shortens the philtrum · more teeth when you smile · a one-off procedure
- Areas
- Philtrum / upper lip
- Minimally invasive
Filler
Hyaluronic acid lip filler (injectable, reversible)
- How it works
- Hyaluronic acid filler injected into the vermilion
- Strength
- Adds volume · reversible · repeatable every 6–12 months
- Areas
- Volume of the vermilion
Where the upper lip is long and the vermilion thin, a combination makes sense: first the bullhorn lift to correct the distance, then hyaluronic acid for fine adjustment of the volume (at the earliest 8 weeks after the operation). We consistently decline overdosing with hyaluronic acid and the typical 'trout pout' look it produces, and work towards subtle, anatomically coherent results with both procedures. The indication is established in the medical initial consultation (€100). Clinic fees are shown separately.
Bullhorn incision
An M-shaped line. Hidden beneath the nose.
The incision runs as a gentle M shape (or bullhorn silhouette) directly beneath the base of the nose — the two arcs follow the natural line where the nostril rims meet the skin, and the central low point lies beneath the columella. This precise incision hides the scar along the natural transitions of the skin; with a properly performed operation and normal wound healing it is barely visible after six to twelve months.
Permanent — no more six-monthly hyaluronic acid. Natural — no trout pout.
Procedure
How the procedure works
Four steps, clearly separated — from the initial consultation with the assessment of the anatomy, through the 30-60-minute operation under local anaesthetic, to aftercare with sparing of facial movement and antiviral prophylaxis.
Schritt 01approx. 45 min.Consultation
In the personal initial consultation (€100) we assess the upper-lip distance, the volume of the vermilion and the philtrum clinically. We discuss whether an isolated bullhorn lift, a hyaluronic acid filler or a combination of the two procedures makes sense. Where hyaluronic acid lip fillers are present, we clarify when they will have subsided completely; where there is a history of cold sores, the antiviral prophylaxis. You receive a written cost estimate afterwards.
Schritt 02Preparation
No blood-thinning medication for 7 days before the operation. Where there is a history of cold sores: start the antiviral treatment from 24 hours before the operation. Existing hyaluronic acid lip fillers must have subsided completely before the operation (please clarify with us beforehand whether dissolving them with hyaluronidase would make sense). With local anaesthetic you can travel to the practice on your own; with twilight sedation or general anaesthesia you need someone to accompany you home.
Schritt 0345–60 minOperation
Marking of the bullhorn-shaped incision with you sitting upright and awake — we determine the width of the resection (typically 4-8 mm) individually, on your anatomy. Local anaesthetic (twilight sedation or general anaesthesia on request). Resection of the strip of skin, mobilisation of the muscle and skin tissue, shifting of the upper lip upwards, wound closure in layers with fine non-absorbable sutures.
Schritt 04Aftercare
Spare the mouth and lip area consistently for 7 days — no strong facial expressions (loud laughing, wide yawning), no make-up on the scar. Sutures out after 5-7 days. Where there is a history of cold sores, continue the antiviral treatment through the healing phase. Exercise after 2 weeks. Final result visible after 4-8 weeks.
Facts
Key facts
- Type
- surgical, outpatient
- Anaesthesia
- local · twilight sedation or general anaesthesia on request
- Duration
- 45–60 minutes
- Stay
- outpatient — no hospital bed
- Incision
- M-shaped (bullhorn) beneath the base of the nose
- Width of resection
- typically 4–8 mm, individual
- Visible scar
- beneath the base of the nose, barely visible once healed
- Suture removal
- after 5–7 days
- Sparing facial movement
- 7 days consistently
- Make-up
- 2-week pause
- Exercise
- after 2 weeks
- Final result
- after 4–8 weeks
- Duration of effect
- permanent
- History of cold sores
- antiviral prophylaxis from 24 h before the operation
- Consultation
- €100 · required before every treatment
Recovery
Recovery & final result
DAY
0–2.
Cool it, spare the face.
The operation is carried out as an outpatient procedure; cooling compresses for 24-48 hours keep the swelling to a minimum. Spare your facial movement consistently — no loud laughing, no wide yawning. Where there is a history of cold sores, continue the antiviral treatment. Pain is usually slight — a mild feeling of tension in the philtrum area.
DAY
3–7.
Swelling, patience.
Haematomas and swelling in the lip and philtrum area are at their strongest in this phase — they recede steadily. Sparing your facial movement remains decisive. Sutures out after 5-7 days. Social life is still limited during this week.
WEEK
2.
Back in everyday life.
Social life is possible again after 7-10 days (once the sutures are out). The swelling subsides step by step. From day 14 light exercise is possible again. Make-up stays paused for another week, because the scar is still in its maturing phase.
WEEK
3–6.
The shape becomes visible.
Make-up is possible again. The swelling continues to recede; the definitive contours of the raised upper lip become visible. The scar begins to fade.
WEEK
6–12.
A stable final result.
The final result is stable after 4-8 weeks. The upper lip is permanently raised, the vermilion is more visible, and more teeth show when you smile (the photographic effect of the shortened philtrum). The scar goes on fading over 6-12 months — with a properly performed operation and normal wound healing it is barely visible after a year.
Endergebnis
The final result is stable after 4 to 8 weeks — permanent. The scar goes on fading over 6–12 months.
Permanent, without a 'trout pout' — that is the line we hold with the bullhorn lift. One operation replaces the six-monthly ritual of repeating hyaluronic acid; the vermilion is raised discreetly, more teeth show when you smile, and the overall result stays anatomically coherent and natural. The natural process of ageing continues from a younger starting point — the anatomical shortening of the upper-lip distance, however, is retained permanently.
Seven days
Spare your face. Antiviral. Patience.
The first seven days are shaped by consistently sparing your facial movement: no loud laughing, no wide yawning, no make-up on the scar. Where there is a history of cold sores, antiviral prophylaxis accompanies the healing phase — otherwise the operation could reactivate the cold sore. A gentle lip balm (fragrance-free) keeps the area around the lips supple.
Consultation
100€
approx. 45 min · medical · mandatory before every treatment (§ 8 HWG)
Let us establish the indication together.
Which method suits your situation can only be established reliably in a personal examination and consultation.
What is included
- Examination & establishing the indication
- Choice of method, risks & alternatives
- Written cost estimate afterwards
Risks
Risks & informed consent
When carried out properly, the bullhorn lift is a short outpatient procedure with a low risk profile. We discuss all risks in detail in the personal informed-consent consultation in accordance with § 8 HWG (German Health Advertising Act).
- General
Swelling in the philtrum area and slight haematomas around the base of the nose are part of the expected course in the first one to two weeks and subside steadily with cooling compresses and with sparing of facial movement. Disturbances of wound healing at the bullhorn-shaped suture line are rare in a modern practice where the operation is performed properly.
- Specific
A temporary change of sensation in the upper-lip area is possible and as a rule resolves within weeks. Where there is a tendency to keloid scarring the scar can remain visible — we clarify this relative contraindication clinically in the initial consultation. Asymmetrical results are minimised by the careful pre-operative marking, carried out with the patient sitting upright and awake. Reactivation of cold sores through the strain of the operation is minimised by preventive antiviral treatment from 24 hours before the operation.
- Very rare
An exaggerated, 'over-lifted' appearance arises where the resection is too radical — we deliberately avoid it by determining the width of the resection conservatively and individually (typically 4-8 mm; never more than the anatomy allows). Functional limitations of the mobility of the upper lip are very rare where the tissue beneath is mobilised properly.
All individual risks are documented in detail during the personal informed-consent consultation in accordance with § 8 HWG (German Health Advertising Act).
Costs
Costs at a glance
The bullhorn lift starts from €3,300. The specific calculation depends on the choice of anaesthesia (local vs. twilight sedation vs. general anaesthesia) and on the effort involved in the pre-operative assessment.
Starting price
from €3,300 permanent · an anti-'trout pout' philosophy
Bullhorn lift vs. hyaluronic acid
A permanent operation versus a reversible filler
| Aspect | Bullhorn lift (surgery) | Hyaluronic acid (filler) |
|---|---|---|
| Mode of action | Shortens the philtrum — the vermilion moves up | Adds volume — the vermilion becomes fuller |
| Duration of effect | permanent | 6–12 months, reversible |
| Repetition | a one-off procedure | every 6–12 months |
| Photographic effect | more teeth when you smile | a fuller lip |
| Incision | bullhorn-shaped beneath the base of the nose | none — an injection |
| Recovery | 7–14 days, sparing facial movement | 1–2 days, slight swelling |
| Anti-'trout pout' | naturally anatomical | depends on the dose |
| Starting price | from €3,300 | see the hyaluronic acid page |
Where the upper lip is long and the vermilion thin, a combination makes sense: the bullhorn lift first, hyaluronic acid at the earliest 8 weeks after the operation for fine adjustment of the volume. Clinic fees are shown separately. Where the indication is purely aesthetic, this is a self-pay service.
All starting prices are net · plus 19% VAT · excluding clinic fees for anaesthesia and overnight stay. Individual cost estimate in the personal initial consultation (€100).
Questions
Frequently asked questions
What is the difference from a hyaluronic acid lip filler?
The bullhorn lift shortens the upper-lip distance permanently and raises the vermilion mechanically — without adding volume. A hyaluronic acid filler increases the volume of the vermilion reversibly over 6-12 months, without changing the distance. Where the upper lip is long and the vermilion thin, a combination of the two procedures can make sense: first the bullhorn lift, then hyaluronic acid (at the earliest 8 weeks after the operation). Which procedure comes into question, we decide in the initial consultation (€100).
How visible does the scar become?
The scar runs along the natural line of the skin directly beneath the base of the nose and follows the contour of the nostril rims — where the skin shows natural transitions. With a properly performed operation and normal wound healing it is barely visible after 6-12 months. Where there is a tendency to keloid scarring it can remain recognisable somewhat longer — we clarify that in the initial consultation.
How long does the result last?
Permanently. The anatomical shortening of the upper-lip distance is retained for good. The natural process of ageing continues from the new, fresher starting point — a refresh of the bullhorn lift is as a rule not required.
What if I currently have hyaluronic acid fillers?
Existing hyaluronic acid lip fillers must have subsided completely before the operation — that is a precondition for a precise result. Hyaluronic acid as a rule lasts 6-12 months; depending on the type of filler, dissolving it with hyaluronidase can make sense in order to allow the procedure sooner. We clarify that in the initial consultation.
How long is the make-up pause?
2 weeks. In the first 7 days, make-up on and around the scar is paused completely (wound healing). From day 7-14 it is reintroduced slowly, with mild, hypoallergenic products. From week 3 make-up is possible again without restriction.
What does a bullhorn lift cost in Munich?
The procedure starts from €3,300. The specific calculation depends on the choice of anaesthesia (local vs. twilight sedation vs. general anaesthesia) and on the effort involved in the pre-operative assessment. You receive a written cost estimate in the initial consultation (€100).
What risks are there?
General surgical risks (swelling in the philtrum area, slight haematomas around the base of the nose, very rarely a disturbance of wound healing). Specifically: a temporary change of sensation, a visible scar where there is a tendency to keloids (a relative contraindication), reactivation of cold sores — minimised by preventive antiviral treatment from 24 h before the operation. All risks are documented in the informed-consent consultation in accordance with § 8 HWG.
Can the result look 'exaggerated'?
With a correct indication and a properly placed incision, no. We consistently decline the typical 'trout pout' risk of an overdosed filler and work with conservatively and individually determined widths of resection (typically 4-8 mm). Where the resection is too radical, an exaggerated, 'over-lifted' appearance could arise — we deliberately avoid that through the individual anatomical assessment.
Why don't you show before-and-after photographs on your website?
For two reasons — one legal, one ethical. First, the German Heilmittelwerbegesetz (§ 11 HWG, the Health Advertising Act) prohibits advertising surgical plastic procedures with before-and-after photographs on publicly accessible websites — a rule in force since 2012 that protects patients from distorted promotional depictions. Second, we respect our patients' privacy: even where written consent exists, many would rather intimate photographs of their body did not circulate on the open web. What you can expect instead: in the personal initial consultation (€100) we show you anonymised examples from our own practice documentation — matched to your indication, your build and your aesthetic goal. Those images are shown with the written consent of the patients concerned, exclusively within the protected setting of the consultation, and are never published online. You get a realistic sense of what to expect without anyone having to give up their privacy for someone else's advertising.
What should I look for when choosing a doctor for aesthetic plastic surgery in Munich?
Three objective criteria help you get your bearings. First, the specialist qualification: "Facharzt für Plastische und Ästhetische Chirurgie" is a legally protected German specialist title requiring several years of specialist training — unlike general, unprotected descriptions such as "cosmetic surgeon". Second, membership of a medical professional society such as the DGPRÄC (the German Society of Plastic, Reconstructive and Aesthetic Surgeons), which requires binding professional standards and continuous further training. Third, the quality of the consultation: a reputable practice takes its time, is honest about risks, alternatives and realistically achievable results, and does not push you towards a decision. At Ästhetik am Isartor the medical direction lies with Dr. Fabian Weinschenk, specialist in plastic and aesthetic surgery (Facharzt) and a member of the DGPRÄC. Procedures are carried out personally by the specialist, and every treatment is preceded by a detailed medical informed-consent consultation (chargeable at €100).
Related
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Upper eyelid surgery
Where there are hooded upper lids — completes the contouring of the face.
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In the consultation we establish what is possible — and what is not. In person at the Isartorplatz, unhurried, with no sales pressure.
Dr. Fabian Weinschenk
Specialist in plastic and aesthetic surgery (Facharzt)