Permanent fillers have been used for many years and require a small operation, often under local anaesthetic. They are not quite as effective as an injectable in reproducing the subtle shape of the lip particularly the cupids bow but they can be suitable for some individuals.

The vermilion of the lip can be increased in size by excising some skin along the margin of the vermilion and advancing the lip. This procedure carries the risk of scarring and has never really been very popular.

Females tend to have a shorter and fuller lip than males, and also show more of their teeth at rest. The lip can be made shorter and the lip everted by excising a strip of skin from the upper lip placing the incision just under the nose to hide any scar.