Aim: To compare two different techniques for lip augmentation: A surgical technique (V-Y in V-Y) and a filler technique (autogenous micro-fat injections), with a focus on comparing the patients’ satisfaction using the Visual analog scale (VAS). Materials and methods: This randomized controlled trial was conducted on 40 female patients, aged 18–45, who were outpatients at the Oral and Maxillofacial Surgery Department. The patients were randomly assigned with a 1:1 allocation ratio into two groups. The first group (n = 20) underwent the surgical procedure using the V-Y in the V-Y Technique. The second group (n = 20) received autogenous micro-fat injections using an abdomen fat extraction technique that was subsequently centrifuged. The VAS assessed the patient's satisfaction after 1 and 6 months. Results: There was a statistically significant difference in the evaluation of patient satisfaction with treatment 1-month post-procedure when comparing the surgical procedure group and the fat injection (p < 0.001), favoring the fat injection group. Moreover, there was a statistically significant difference in the evaluation of patient satisfaction with treatment 6 months post-procedure when comparing both groups (p < 0.001), favoring the surgical group. Conclusion: The micro-fat injection technique had higher VAS scores reported by patients in the first month of treatment. In contrast, the surgical technique using the V-Y method was more favorably received by patients in the sixth month of treatment. Clinical significance: The V-Y in V-Y technique may yield more favorable long-term outcomes for upper lip augmentation, while micro-fat injection is initially well-received by patients, but satisfaction tends to diminish over time.