You’re staring in the mirror, pulling your upper lip taut, wondering if a little piece of surgical steel would actually look good or if you’re just bored. It’s a vibe. The lip piercing on top—whether you call it a Medusa, a Monroe, or a Jestrum—has this weird way of completely re-centering your face. It's symmetrical. It’s bold. Honestly, it’s also a bit of a commitment compared to a standard lobe piercing.
People usually dive into this because they want that specific aesthetic punch. But there is a lot of noise online about what actually happens when a needle goes through your philtrum. You’ve probably heard horror stories about receding gums or teeth chipping. Some of that is real; some of it is just bad luck from going to a "scratch shop" instead of a professional studio.
Getting a lip piercing on top isn't just about the five seconds of sharp pain. It’s about the next six months of your life. It’s about how you eat a burrito without snagging the jewelry. It’s about the specific anatomy of your frenulum. Let's get into the weeds of what this actually looks like, from the chair to the long-term heal.
The Different Flavors of the Lip Piercing on Top
Most people just say "top lip piercing," but your piercer is going to want specifics. The most common is the Medusa, technically known as a philtrum piercing. It sits right in that little dip above your Cupid’s bow. It’s meant to be centered. If it’s off by even a millimeter, you’ll notice every time you look in the mirror.
Then you have the Monroe and the Madonna. These are the off-center ones. The Monroe is on the left (inspired by Marilyn’s beauty mark), and the Madonna is on the right. They’ve fallen out of fashion a bit lately, replaced by the more modern, symmetrical look of the Medusa.
Then there’s the Jestrum. This one is different. It’s a vertical piercing. It goes through the philtrum and exits out the bottom of the upper lip itself. The cool thing here? The metal never actually touches your teeth or gums. If you’re terrified of dental erosion, the Jestrum is basically your best friend.
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Anatomy and Why Your Piercer Might Say No
Not everyone has the face for a lip piercing on top. That sounds mean, but it's purely anatomical. Professional piercers, like those certified by the Association of Professional Piercers (APP), will check your "webbing"—the superior labial frenulum. That’s the little flap of skin connecting your lip to your gums.
If your frenulum is too low or too thick, a centered piercing might constantly rub against it. That leads to irritation bumps that never go away. Also, if you have a very short philtrum, there might not be enough "real estate" to house a labret stud comfortably.
Don't get mad if a pro turns you down. A good piercer would rather lose $60 than give you a piercing that’s going to migrate out of your face in three weeks. They’re looking at the thickness of your lip tissue, too. Thicker lips need longer initial bars to accommodate the inevitable "sausage lip" phase that happens about two hours after the needle pops through.
The Pain Scale and the "Pop"
Let’s be real. It hurts. It’s a needle going through a very sensitive, nerve-dense part of your face. Most people describe a lip piercing on top as a 5 or 6 out of 10. It’s a sharp, localized sting followed by a weird pressure. You’ll probably tear up. Not because you’re crying, but because it’s a natural cranial nerve reflex.
The sound is what gets people. Sometimes you hear a tiny "pop" or "crunch" as the needle passes through the tougher connective tissue of the philtrum. It’s quick.
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Once the needle is through, the jewelry follows. This is the crucial part: the initial jewelry must be long. Like, awkwardly long. You will feel like you have a tiny antenna sticking out of your face. This is to allow for swelling. If the bar is too short, your lip will literally swallow the metal, and you’ll end up in the ER getting it cut out. Not fun.
The Dental Dilemma: Gums vs. Metal
The biggest risk with any lip piercing on top (excluding the Jestrum) is oral health. Your mouth is a wet, bacteria-filled cave. The back of a labret stud is a flat disc. Over time, that disc can rub against your gingival tissue.
- Gum Recession: Once gums move, they don't grow back.
- Enamel Wear: Constant clicking against your front teeth can wear down the enamel.
- Nesting: This is actually a good thing. It’s when the inside of your lip forms a little pocket for the disc to sit in. It keeps the metal away from your teeth.
To minimize damage, most high-end piercers use titanium (ASTM F-136) or 14k gold. Avoid "surgical steel" if you have sensitive skin, as it often contains nickel. Also, once the swelling goes down (usually after 4–8 weeks), you must go back and get a shorter bar. This is called "downsizing." Most dental damage happens because people are lazy and keep the long "starter" bar in for a year. That extra length allows the jewelry to flop around and smack your teeth.
The Boring (But Vital) Healing Process
Healing a lip piercing on top takes anywhere from 3 to 6 months. Some people take a full year. You aren't "healed" just because it stops hurting. The internal tissue—the fistula—takes a long time to toughen up.
Stop touching it. Seriously. Your hands are gross. Every time you twist the jewelry, you’re tearing the tiny new skin cells trying to form inside the hole. Use a sterile saline spray (like NeilMed) twice a day. Spray it on, let it sit, pat it dry.
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Inside the mouth, just rinse with bottled water after you eat. Avoid harsh mouthwashes with alcohol; they’ll burn like crazy and dry out the wound. And maybe skip the spicy wings for a week. Getting habanero sauce inside a fresh piercing channel is a level of hell you don't want to experience.
Real Talk: The Scars
Eventually, you might want to take it out. Maybe for a job, or maybe you just grew out of the look. You will have a "pockmark." It’s a tiny, permanent indentation. On a lip piercing on top, it usually looks like an enlarged pore.
If you’re prone to keloids or hypertrophic scarring, think twice. While most "bumps" are just irritation from bad jewelry or sleeping on your face, some people develop actual scar tissue that requires dermatological intervention.
Practical Steps Before You Book
- Check the APP Database: Go to the Association of Professional Piercers website and find a member near you. Don't go to a mall kiosk.
- Eat a Meal: Your blood sugar needs to be stable so you don't pass out when the adrenaline hits.
- Buy the Saline Now: Don't wait until 9 PM when the shops are closed and you're panicking because your lip feels like a hot coal.
- Check Your Calendar: Don't get this done two days before your sister's wedding or a big photoshoot. You will look like you got punched in the mouth for at least 72 hours.
- Downsize or Die: Mark your calendar for 6 weeks post-piercing to go back for a shorter post. This is the single most important thing you can do for your dental health.
Managing a lip piercing on top is mostly about patience and resisting the urge to fiddle with it. If you can handle the first two weeks of swelling and the commitment to cleaning, it’s one of the most rewarding piercings for changing your facial symmetry. Just respect the anatomy and the metal quality, and your gums will thank you later.