Patient-Reported Dissatisfaction After Lip Lift: Insights From a Thematic Analysis of RealSelf Reviews

Lip lift surgery has grown in popularity because of changing aesthetic ideals and social media influence. Despite high reported satisfaction rates, patient dissatisfaction, especially regarding aesthetic outcomes and emotional impact, remains underexplored in the literature. The authors of this study aim to identify common causes of patient dissatisfaction after lip lift surgery and evaluate the psychosocial impact of these experiences using publicly available online reviews. Twenty-five publicly available patient narratives from RealSelf (New York, NY) describing dissatisfaction following lip lift surgery were analyzed in this qualitative descriptive study. No exclusions were made based on geography or demographics. A hybrid thematic analysis was conducted using Braun and Clarke's 6-phase framework, coded with NVivo 15 (Lumivero, Denver, CO). Coding combined inductive (data-driven) and deductive (theory-driven) approaches, referencing the FACE-Q and PHQ-9 validated domains. Emotional distress was scored from 0 to 3 based on language intensity. Among 25 patient reviews following lip lift surgery, most procedures were performed in the United States (n = 21). Scar-related concerns were the most common (n = 15, 60%). Other common sources of dissatisfaction were nasal/alar distortion (n = 6) and lip asymmetry (n = 5). PHQ-9 scoring revealed high emotional impact, with 59.3% in severe and 25.9% in moderate distress. Based on FACE-Q domains, 54.8% experienced appearance-related distress, 35.7% psychological, and 9.5% social distress. Although lip lift surgery is generally well tolerated with favorable outcomes, a notable minority report aesthetic dissatisfaction and psychological distress. Recognizing these concerns aids counseling, whereas future studies should integrate dissatisfaction rates with quantitive assessments of aesthetic improvement. Level of Evidence: 4 (Therapeutic).