Lip Lift

In masculine facial anatomy, the distance between the base of the nose and the top of the upper lip—the philtrum length—tends to be longer. The upper lip itself may also appear flatter and less full. In contrast, a feminine lip aesthetic is typically characterized by a shorter philtrum, greater dental show (the visibility of the upper teeth at rest), and a more pronounced Cupid’s bow. These elements contribute to a youthful, soft, and characteristically feminine expression.

A feminizing lip lift reduces the distance between the nose and the upper lip, creating a more balanced and proportionate lower face. This not only increases upper tooth visibility at rest but also enhances the curvature and volume of the upper lip without the need for fillers. While subtle, these changes can significantly contribute to facial feminization and alleviate gender dysphoria related to facial appearance.

Dr. Marano and Dr. Keith can perform lip augmentation in a variety of ways, tailoring their techniques to your comfort levels, goals, and unique vision for improvement. They offer the following treatment options:

Lip Fillers

Lip fillers can enhance the volume and shape of the lips, creating a more feminine appearance. They can also smooth away vertical lip lines, improve symmetry, sharpen the Cupid’s bow, and enhance lip border definition. Fillers come with no discomfort or downtime, allowing patients to resume their normal activities the same day quickly. Results typically last from 6 to 18 months.

Facial Fat Transfer

Our team can use fat grafting to give the lips a fuller shape without fillers or implants. Fat cells are extracted from an area of excess fat, such as the belly, thighs, or flanks, and then injected into the lips to create a more sultry, feminine pout.

Lip Lift

A lip lift is minor surgery to raise the upper lip so it appears fuller and more feminine without the use of fillers, transferred fat, or implants. The procedure shortens the distance from the nose to the upper lip while improving tooth show and revealing more of the feminine pink portion of the upper lip.

A subnasal (bullhorn) lip lift is the most common technique used. During this procedure, a strip of skin is removed from just beneath the nose in a shape that follows the natural contours of the nostrils. The upper lip is then elevated and secured in its new, shortened position. This lifts the vermilion (the pink part of the lip), creates more tooth show, and enhances lip curvature.
The incision is carefully placed in the crease at the base of the nose to help conceal the scar. Over time, with proper scar care, the incision typically fades to a fine line that is barely visible.
This procedure is often performed under local anesthesia with sedation, though general anesthesia is more commonly used as it is typically part of a larger facial feminization surgery.

Ideal candidates for a feminizing lip lift are transfeminine or nonbinary individuals seeking to enhance the femininity of their facial features—specifically the mouth and perioral region. You may be a good candidate if you:
Feel that your upper lip is too long or lacks curvature

• Have minimal upper tooth show at rest
• Are seeking more permanent results than those achieved with injectable fillers
• Are in good overall health and a nonsmoker (or willing to stop)
• Have realistic expectations and are pursuing surgery as part of gender-affirming care

It’s also important that you have completed any necessary mental health evaluations and have support in place before undergoing surgery.

The first step is to meet with Dr. Marano or Dr. Keith for a private consultation at GAMMA in New York City or New Jersey. During this time, you will discuss your goals and medical history with our team, who will then create a customized treatment plan according to your unique anatomy, comfort levels, and goals. Prior to consultation, you should ensure the following:

• Provide Mental Health Letter – Many insurance providers and surgical guidelines require a letter from a qualified mental health professional confirming a diagnosis of gender dysphoria and the patient’s readiness for surgery. This letter should follow WPATH (World Professional Association for Transgender Health) standards and address the patient’s understanding of the procedure and its implications. Our team will assist in ensuring the proper language is used and the provider is appropriately credentialed
• Quit Smoking – Nicotine constricts blood vessels and significantly increases the risk of complications, including poor wound healing and tissue loss. Patients must stop using all nicotine products—including cigarettes, vapes, nicotine patches, and gum—at least 4-6 weeks before and after surgery.
• Manage Medications – You may be asked to discontinue certain medications that increase surgical risks.
• Well-Controlled Medical or Mental Health Issues / Medical Clearance – To ensure safe surgery and recovery, patients with underlying medical conditions such as diabetes, high blood pressure, or psychiatric conditions should have them well-managed. Medical clearance from a primary care provider or specialist is required.
• BMI Cutoff – There is no strict BMI cutoff for FFS at GAMMA. Every patient is evaluated individually, considering overall health and surgical goals rather than BMI alone.
• Insurance Coverage – GAMMA works with various insurance providers to help patients access gender-affirming surgery. Our team assists with insurance verification, prior authorization, and necessary documentation. Patients should check with their insurance carrier regarding coverage criteria, including mental health letters and medical clearance requirements.
• Complete Your Consultation – You will undergo a detailed consultation with Dr. Marano or Dr. Keith to ensure your expectations are realistic and your health supports the treatment process. Our team will discuss the risks and benefits, recovery and results, of FFS.

A lip lift can be performed under local anesthesia with or without sedation. If it is performed in combination with other facial feminization treatments, Dr. Marano and Dr. Keith may choose to use general anesthesia. The lip lift procedure itself takes about 45 minutes to an hour when performed on its own. Once the incision is closed, a small dressing may be placed beneath the nose. You’ll be monitored during recovery and then discharged home the same day with detailed postoperative instructions.

Recovery time varies for each patient and depends on several factors, including the individual’s healing ability, the specific techniques utilized, and whether lip lift is combined with other treatments or procedures.

• Hospital Stay: Most patients will spend 1-2 nights in the hospital after surgery, as additional FFS procedures are typically performed.
• Swelling & Bruising: Expect swelling and bruising which will peak within 2-3 days and gradually improve over 2-3 weeks. Final swelling may take several months to resolve.
• Stitches are typically removed at the 5–7 day follow-up visit.
• Activity Restrictions: You will need to avoid strenuous physical activity for 2-4 weeks, especially lifting and bending, which could increase swelling or put stress on the healing tissues. It is important to sleep with the head elevated, either in a recliner or with multiple pillows, to limit facial swelling.
• Return to Work: Most patients can return to work 4 weeks after surgery, depending on the nature of their job and comfort level.
• Final Results: The final aesthetic results of FFS may take up to 12-18 months to fully manifest, as swelling continues to subside and tissues heal.

Insurance carriers will typically cover gender affirmation surgery, including facial feminization surgery, when it is performed to treat gender dysphoria, a condition in which the patient’s outer traits do not reflect their authentic gender identity. You’ll need a letter from a mental health provider detailing your decision to undergo FFS. Our team can go over the insurance requirements in greater detail during your consultation.

• Resources – For patients traveling to NYC for surgery, GAMMA provides recommendations for LGBTQ+ friendly accommodations, post-op caregivers, and recovery services. Our team can also assist with logistics such as medical transport and aftercare arrangements.
• Requirements – Out-of-town patients must plan to stay in NYC for at least two weeks after surgery to ensure proper healing and attend necessary post-operative appointments. We encourage having a trusted friend, family member, or professional caregiver for the first few days post-surgery.

Our team at Gender Affirming Medical and Microsurgical Associates (GAMMA) in New York City and New Jersey is known for providing the highest-level care in an affirming environment. We utilize today’s most progressive and cutting-edge techniques to provide the highest level of service possible. Our goal is to help transgender, nonbinary, and gender nonconforming individuals achieve their unique appearance goals and thrive with confidence, security, and peace of mind.

Dr. Drew Marano

Dr. Drew Marano is an accomplished, board- certified, and fellowship-trained plastic and reconstructive surgeon who has devoted his career to the art of gender affirmation surgery. He graduated from Rutgers New Jersey Medical School at the top of his class, receiving AOA honors before embarking on a competitive six-year Integrated Plastic and Reconstructive Surgery Residency at Columbia University/Cornell University in New York City. Following his residency, Dr. Marano was selected as the first-ever Harvard University Complex Gender and Microsurgery Fellow, during which time he underwent advanced training in groundbreaking and innovative surgical techniques. He is a prolific author, researcher, and lecturer who has contributed to over 40 publications and presentations at regional and national meetings. Dr. Marano offers ongoing support for transgender patients as they navigate their unique and rewarding journey of transitioning.

Dr. Jonathan Keith

Dr. Jonathan Keith is a renowned, fellowship-trained, board-certified plastic surgeon known for his progressive approach to microvascular surgery. He is an active member of the World Professional Association for Transgender Health and the founder of the Rutgers Center for Transgender Health. In 2018, Dr. Keith created the first multidisciplinary clinical program for transgender patients in New Jersey and was the first surgeon in the state to perform a female-to-male phalloplasty for gender affirmation. Regarding his extensive educational background, Dr. Keith completed a demanding seven-year residency at the University of Pittsburgh, one of the nation’s most elite and well-regarded plastic surgery training programs. As a testament to his skill and artistry, in 2012, he received the Stephen S. Kroll Fellowship in microsurgery at the University Hospital of Gent, Belgium. Today, Dr. Ketih performs a range of complex and delicate procedures to assist transgender and nonbinary individuals in achieving their ideal appearance, including DIEP flaps for breast reconstruction, vaginoplasty, and phalloplasty.

As with all surgical procedures, a lip lift carries some risks, although complications are uncommon in experienced hands. Potential risks include:
Bleeding or hematoma

• Infection
• Poor scar healing or scar visibility
• Asymmetry
• Numbness or changes in sensation
• Over- or under-correction

Your surgeon will discuss all potential risks during your consultation and guide you through proper scar care and healing strategies to minimize them.