Forty-five to ninety minutes under local anaesthesia — but the result is decided in the design minutes and the closure craft. What actually happens.
With you upright and animated, the excision is drawn along the nasal sills and columella base: the classic 'bullhorn' shape, following your nose's exact curves. Your philtrum length, tooth show and smile photos set the millimetres — typically 3–6 mm, around 25–33% of the philtrum, calibrated conservative because this step cannot be undone.
Fine local infiltration — the same class of comfort as detailed dental work. You're awake, comfortable and able to cooperate (a quiet advantage: lip position can be checked live). No general anaesthetic, no hospital night.
The drawn strip of skin — and only skin, in the standard technique — is removed with the design's exact geometry. Where anatomy indicates, the muscle layer is conservatively addressed; where it doesn't, it's respected and left — restraint at this layer protects natural animation.
Deep layers are set first to carry every gram of tension, so the skin edge meets unstretched; the surface is closed with fine sutures in the shadow line. Alar base symmetry is protected throughout — nostril distortion is the amateur signature this stage exists to prevent.
A small dressing, aftercare kit and instructions — you walk out within the hour. Sutures come out day 5–7 in clinic, before you fly. The week-by-week calendar covers the rest.
An under-lifted lip can be refined with a small secondary touch. An over-lifted lip — too short a philtrum, a toothy stare, nostril distortion — is among facial surgery's hardest problems, because the removed skin no longer exists. Every design decision here runs through that asymmetry: when in doubt, take less. Patients occasionally wish for one more millimetre at month three; nobody has ever wished for one less — and that's the record this practice intends to keep.
Photos in — your millimetres, your incision map and your written quote out.
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