Cheek augmentation & subnasal bullhorn lip lift.

In biological males, the distance between the base of the nose and the top of the red lip (the philtrum) is structurally 3 to 6 millimeters longer than in females. When hyaluronic acid filler is injected into a long, heavy upper lip, it cannot lift the lip vertically against gravity; instead, the added weight pushes the lip outward (creating an unnatural "duck lip" in profile) and downward, covering your upper teeth even more. A subnasal bullhorn lip lift physically removes the excess vertical skin and suspends the deep muscle fascia upward, permanently shortening the philtrum to a feminine 11–13 mm and revealing a youthful 2–4 mm of upper tooth show.

Visible lip lift scars and distorted nostrils occur when a surgeon performs an outdated "skin-only" excision, hanging the entire weight of the upper lip on the delicate skin stitches under the nose. At Sissy Clinic, we perform a deep-plane sub-SMAS lip lift: we release the upper lip in the deep plane over the orbicularis muscle and anchor the deep fibrous tissue directly to the immobile bone periosteum of the pyriform aperture (nasal base). Because the deep anchor holds 100% of the weight, the outer skin edges come together with zero tension, allowing the incision to heal as an imperceptible line hidden inside the natural shadow crease beneath your nostrils.

Both techniques serve complementary roles in facial feminization. Subperiosteal cheek implants provide crisp, guaranteed, 100% permanent skeletal projection right on the cheekbone without any resorption—ideal for patients with flat midface bone structure. Autologous micro-fat grafting provides soft, diffuse subcutaneous fullness across the apples of the cheeks, hollow temples, and under-eye tear troughs, while stem cells improve skin luminosity. Many of our patients choose our hybrid protocol: a low-profile anatomical malar implant for permanent high-cheekbone architecture, feathered with micro-fat grafting for seamless, pillowy softness.

Cheek implants are inserted through a tiny 1.5 cm intraoral incision hidden high inside the upper gumline above the premolars, leaving zero external scars on your face. Our surgeons place the implant strictly beneath the periosteum (directly on the zygomatic bone under all muscle and fat layers) and lock each implant securely to the bone using a titanium micro-screw. Because it is fixed to the skeleton beneath your natural cheek pad, it can never shift or migrate, and to the touch it feels indistinguishable from your own natural cheekbone.

Yes. When feminizing rhinoplasty rotates the nasal tip upward, the distance between the nose and upper lip can visually appear even longer unless a lip lift is performed concurrently. Our craniofacial team routinely combines open ultrasonic rhinoplasty and a subnasal bullhorn lip lift in the same surgical session by unifying the columellar design with the subnasal bullhorn curve and preserving the lateral nasal blood supply—delivering a harmonious middle and lower facial third in one recovery.