Upper lip lower after rhinoplasty?

“The upper lip has dropped and lengthened,” “the smile has become stiff” — such complaints are often found on forums dedicated to upper lip droop rhinoplasty discussions. For many patients, this becomes an unexpected and worrying change after a nose job. We decided to figure out what lies behind these phenomena.

Real lengthening or optical effect?

Real physical lengthening. It occurs only in cases where the patient initially has a so-called “tension nose,” in which the anterior part of the septum is pushed too far forward. Because of this original feature, the distance from the lip to the nose is excessively short. Therefore, the surgeon’s maneuvers aimed at correcting this problem intentionally lengthen it, which is a planned and favorable outcome. Such structural changes can occasionally influence columella support and the perceived philtrum length after rhinoplasty.

Visual (optical) increase. This happens much more often. When rhinoplasty lifts a previously drooping nasal tip, the person simply begins to see more of the upper lip. Physically the distance does not change, so a complaint of a long upper lip after nose job is usually an optical illusion rather than a true change.

Read more in the PMC study on open rhinoplasty and upper lip position

Is lip correction needed? Bullhorn?

If the issue remains after swelling subsides and is truly physical rather than visual, a bullhorn lip lift can be considered. However, it should be performed no sooner than 6–12 months after tip surgery or related procedures, especially if any upper lip scar tissue needs time to soften.

If a person initially has a long upper lip and clear indications for a bullhorn, this must be discussed at the primary consultation, because after tip surgery lip change or rhinoplasty this feature can become even more noticeable.