Lip Lifts Before Veneers

By Dr. Sarah Saxon, MD

Board-Certified Facial Plastic Surgeon | Saxon MD Facial Plastic Surgery, Austin, TX

When people come to see me at my office in Austin, they usually have a specific concern in mind. A patient might look in the mirror and notice that their upper lip has lengthened over time, covering their top front teeth even when their mouth is completely relaxed. Another patient might feel that their chin lacks projection, or they might be visiting a cosmetic dentist to discuss porcelain veneers because they want a brighter, straighter, or fuller smile.

What many don’t realize right away is that the lower third of the face functions as a single, complex ecosystem. Your teeth, your upper lip, your jaw structure, and your chin are not isolated components. They interact constantly. If you change one without taking the others into account, the whole balance can fall out of alignment.

One of the most frequent misunderstandings I encounter during consultations involves the sequencing of these treatments. People often think, “I’ll go get my teeth done first to see how much shows, and then I’ll decide if I need a lip lift.” Or they might fill their upper lip with dermal filler for years, trying to force a lift that filler simply cannot achieve.

In reality, the ideal treatment order is actually the exact opposite.

To build a lower face that looks youthful, natural, and structurally sound, we have to address the deep skeletal structure first, adjust the soft-tissue frame second, and fine-tune the surface details, like veneers or subtle lip filler, last.

Let’s walk through the clinical blueprint for lower facial harmony, step by step, so you understand how we plan these procedures to give you the safest, most beautiful, and most lasting result.

Understanding the Foundation: What Determines Your “Tooth Show”?

Before we talk about surgical order, we need to look at what actually dictates how much of your teeth people see when you talk, smile, or rest your face.

In facial plastic surgery, we pay very close attention to resting incisal display, which is simply the amount of your top front teeth visible when your jaw is completely relaxed and your lips are slightly parted. In a balanced, youthful face, about 2 to 4 millimeters of those upper teeth peek through. That tiny sliver of white provides an effortless, refreshed look to the entire lower face.

However, if you don’t have enough tooth show, or if you have too much (often referred to as a “gummy smile”), there are three distinct variables at play:

1. Midface Height (The Skeletal Foundation): The vertical dimension of your upper jaw bone (maxilla).

2. Lip Length (The Soft-Tissue Frame): The distance between the base of your nose and the pink border of your upper lip.

3. Tooth Length (The Surface Detail): The actual height of your natural teeth or porcelain restorations.

Because these three factors work together, trying to fix a structural problem at the bone level by simply changing the length of your teeth with veneers is like building a house on a shifting foundation. You have to address the deepest layer first.

Step 1: Correcting Skeletal Proportions (Midface Height and Chin Projection)

When we evaluate lower facial balance, we always start at the bone level. If the skeletal foundation isn’t positioned correctly, no amount of soft-tissue surgery or cosmetic dentistry can truly resolve the underlying disharmony.

The Role of Midface Height

Your upper jaw bone sets the vertical stage for your entire lower face. If your midface height is too short vertically, your upper teeth will sit higher up under your lip than they normally would. Even if you have a perfectly normal upper lip length, your teeth will stay hidden because the bone holding them sits too high.

Conversely, if your midface height is vertically excessive, your teeth will extend far below your lip line, leading to significant gum exposure when you smile.

When a patient’s midface height is the primary cause of severe tooth display issues, the solution lies in orthognathic surgery (jaw surgery):

• Lengthening a Short Midface: If the upper jaw bone is vertically deficient, orthognathic surgery can lower the maxilla, bringing the dental arch down into a position where the teeth become visible naturally.

• Shortening an Excessive Midface: If the upper jaw bone is too tall, a maxillary impaction procedure can move the jaw upward, reducing excessive tooth and gum exposure.

Any orthognathic surgery must be completed long before you consider a lip lift. Moving the jaw bones changes the position of the soft tissue draped over them. If you were to lift the upper lip before altering the underlying jaw bone, you would be operating on a frame that is about to shift completely out from under you.

The chin forms the lower anchor of the face, defining your profile and supporting the lower lip and neck. A recessed or weak chin alters how the soft tissues of the lower face stretch and drape.

If someone has a weak, set-back chin along with a long upper lip, their overall profile balance is affected. In these cases, chin augmentation, whether using a structural chin implant or a sliding genioplasty, is crucial for setting the true lower border of the face.

As a general rule, chin projection should be corrected before performing a lip lift. Establishing the structural position of the chin ensures that the skin and muscles of the lower face settle into their natural orientation. In certain selective cases, I can perform a chin augmentation at the same exact time as a lip lift during a single surgery, but prioritizing the chin structural baseline first yields the most predictable, harmonized result.

Step 2: Rebalancing the Frame with a Subnasal Lip Lift

Once the underlying bones are in their proper alignment, or if your skeletal proportions are already naturally sound, we move to the second layer: the soft-tissue frame.

As we age, gravity, loss of skin elasticity, and the natural thinning of facial fat take a toll on the upper lip. The distance between the base of the nose (the subnasale) and the pink border of the lip (the vermilion) gradually stretches downward. What used to be a youthful 11 to 14 millimeters can easily stretch to 18, 20, or even 22 millimeters over time. 

As that skin elongates, two things happen:

1. The upper lip rolls inward, making the pink portion look flat and thin.

2. The lengthened lip acts like a heavy drawn curtain, completely covering your upper teeth at rest.

A subnasal bullhorn lip lift directly addresses this soft-tissue issue, and it is the most common of the different types of lip lifts. During this procedure, I carefully remove a small, custom-tailored strip of skin right beneath the nostrils, where the incision can heal discreetly in the natural shadow beneath the nose. By gently lifting the skin and securing the deep tissues, we achieve three things:

• Shortened Philtral Distance: Brings the lip back into ideal vertical proportion with the rest of your face.

• Natural Vermilion Eversion: Softly rolls the hidden pink lip tissue outward, creating a fuller, more youthful lip shape without relying on filler.

• Restored Resting Tooth Show: Lifts the “curtain” back up, revealing the natural edges of your teeth once again.

By completing the lip lift at this stage, we place the upper lip into its final, ideal anatomical position. We now know exactly where the frame sits relative to your natural teeth.

Step 3: Refining the Teeth with Porcelain Veneers (If Still Needed)

This brings us to the final step in our lower facial blueprint: cosmetic dental work.

Once your jaw structure is aligned and your upper lip has been repositioned with a lip lift, you can finally assess your teeth accurately. Now that the lip curtain has been raised to the proper height, you and your cosmetic dentist can see exactly how much natural enamel shows when you talk and relax.

In many cases, once the lip lift is complete and healed, patients realize their natural teeth look great! Simply exposing those hidden edges was all they needed to revive their smile.

However, if your teeth are worn down, chipped, discolored, slightly crooked, or unevenly shaped, this is the exact moment to get porcelain veneers.

Why Veneers Must Come Last

If you were to get porcelain veneers before a lip lift, your dentist would be working blindly against a sagging upper lip. To make your teeth visible beneath a long lip, they might feel forced to make the veneers unnaturally long or push them forward.

Then, if you were to get a lip lift later, that newly elevated lip would expose those extra-long veneers, leaving you with an unnatural, overly “toothy” look or making it difficult to close your lips comfortably (a condition known as lip incompetence).

When you wait to do veneers after your lip lift has fully healed:

• Your cosmetic dentist crafts your veneers to fit the new, stable position of your upper lip.

• Tooth length can be kept completely natural and proportional.

• The dentist can focus purely on aesthetics, like straightening, whitening, and shaping, without trying to compensate for a long lip.

Already Have Veneers?

Please don’t let that stop you. For most people, it’s perfectly fine to adjust the teeth after a lip lift. I recommend waiting at least three months, because the cheek or lip retractors dentists use can stretch a fresh incision, and I want the scar as mature as possible. Rarely, the teeth are long enough that shortening the lip could keep you from closing your mouth comfortably. In those cases, I won’t do a lip lift until the teeth are shortened a bit.

What About Dermal Fillers? Managing Lip Augmentation Around Surgery

Lip filler is one of the most popular non-surgical treatments available today, but it is frequently misused when someone actually needs a structural lip lift.

If an upper lip is elongated, adding volume with hyaluronic acid fillers will not lift it. In fact, injecting heavy filler into a long, thin lip often weighs the tissue down further, making it look bulkier or causing it to project outward like a “duck bill” while still hiding your teeth.

If you currently have lip filler and are considering a surgical lip lift, here is how we handle it:

1. Dissolve Existing Filler Before Surgery: I often recommend dissolving old lip filler with hyaluronidase prior to performing a lip lift. We want to operate on your natural tissue anatomy, not on tissue stretched out or distorted by gel. Dissolving filler resets the lip to its true baseline, allowing me to take precise millimeter measurements during surgery.

2. Fine-Tune with Filler After Surgery: Once your lip lift has fully healed (usually 3 to 6 months post-op), you can absolutely use a small amount of dermal filler if you want extra volume, body, or border definition. Using filler after a lip lift is wonderful because we are simply fine-tuning a frame that is already in the correct structural position. You need far less product, and the results look significantly more natural.

The Master Sequence for Lower Facial Rejuvenation

To wrap everything up, here is the clear, step-by-step master sequence we use to guide our patients toward lower facial balance:

1. Skeleton and foundation: orthognathic (jaw) surgery if needed to adjust midface height, and chin augmentation or genioplasty to establish the lower facial profile.

2. Soft-tissue framework: dissolve old lip filler to reset the tissue to its natural baseline, then a subnasal bullhorn lip lift to shorten the philtrum and restore resting tooth show.

3. Surface detail and aesthetics: cosmetic dentistry or porcelain veneers crafted to match the new lip position, plus optional subtle lip filler to fine-tune volume and shape.

Achieving a result that looks authentic, elegant, and balanced requires stepping back and looking at the big picture. Your face isn’t a collection of separate parts. It’s a continuous, interconnected canvas.

When you plan your care in the right structural order, addressing bone structure first, soft tissue second, and surface cosmetics last, you avoid unnecessary revision procedures, protect your investments, and achieve a result that looks effortlessly natural.

If you are considering a lip lift, evaluating past facial work, or trying to coordinate your surgical plans with a cosmetic dentist, my team and I would love to help you map out a personalized plan. Sitting down together, measuring your proportions, and building a logical, comfortable roadmap is where every great outcome begins.

• Explore Real Results: Take a look through our Lip Lift Before & After Gallery to see how restoring lip proportions transforms the entire lower face.

• Connect with Us: When you’re ready to take the next step, reach out to our team at Saxon MD to Schedule Your Consultation. We look forward to welcoming you!