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The Botox Lip Flip

The lip flip has been a frequent topic of discussion in my office for the past 6 months. I spend more time than I would like explaining what it does, and why I don’t do it.  Before I explain the latter part of that sentence, let’s go into some detail about what it is, and how it (supposedly) works.

What is the Lip Flip?

The lip flip is using an injectable neuromodulator (like Botox, Dysport, Jeuveau, or Xeomin) to raise the position of the lip.  The desired action is to “flip” the lip upward.  The idea of doing this is not that unusual, as these injectables can be used successfully to lift the brow, which is a common treatment that we have relied on for many years.

Using Botox to Lift

How can a medication that temporarily paralyzes muscles “lift” anything?  Doesn’t it just fall once the muscle loses its strength?  This makes perfect sense, and it can be true at times.  What it neglects is that most of the facial features we talk about treating do not have a single muscle responsible for a motion, but rather have a pair of opposing muscles responsible.
For example, the brow has some muscles that elevate the brow, and others that depress the brow.  We can exploit this by treating (relaxing) the brow depressors more than the brow elevators so that the elevators win the game of “tug of war”.  This raises the brow.
If you just take a mirror and make faces at yourself for 30 seconds, you can see that for almost every facial movement you do, you have an “opposite” movement.  You can raise your lower lip, and you can lower it as well.  There are often multiple small muscles that are responsible for each of these movements.

Anatomy of the Lip Flip

The idea behind the lip flip is that the treatment is selectively treating muscles that lower the upper lip.  The muscles that raise upper lip get an edge, giving it a “lip lift”, or “lip flip”.  There are many muscles (with long names) that are responsible for these motions, and a detailed discussion about them is well beyond the scope of this blog post (though for those interested in the word salad, please check out this link.

Lip Flip Limitations

The big anatomic limitation with the lip flip is that there are many muscles of the face that raise the upper lip, but none dedicated to lowering the upper lip.  The muscle that lowers the upper lip is the orbicularis oris muscle, which is the main lip muscle that forms a circle around the upper and lower lips.  It gets help from the muscles that depress the lower lip (try lowering your upper lip without changing the position of the corners of your mouth).  If you were to pick just one muscle that defines the lips, it would be the orbicularis oris muscle.  It puckers the lips when you flex it, and a lot of the facial muscles insert into it so that you can alter the position of the corners of your mouth (e.g. smiling) as well as raise your upper lip and raise and lower your lower lip with great precision.
The big limitation of the lip flip procedure is that the orbicularis oris muscle has to be treated, or selectively relaxed, in order to get this “lip flip”, or a raising of the upper lip.  You cannot get this muscle treated without altering the way your mouth moves when you talk or smile because it is the same muscle!  In other words, treating this muscle in any way with Botox (or one of its relatives) will always change the way the lips move.  The idea is that you treat it just enough to lift the lip without altering the way your mouth moves naturally.  This is how it works in theory.

Lip Flip Results

Personally, I do not think that the results of these “lip flip” treatments look good.  I have seen several patients treated at medical spas that have gotten this treatment, and they have a signature look that I refer to endearingly as “the denture look”.  The reason behind this is that the upper lip loses some of its tone and bulk and stops moving as naturally as it did before.  This (to me) looks similar to people that have worn dentures for several years.  Even if the lip has “flipped” and lifted, the reduced motion of the mouth is something that people will notice from across the room as “irregular”.  This is the same downfall of using Botox to treat the smoker’s lines.
Though some patients are happy with the results, they look “done” to my eyes, meaning that they look like they have had a cosmetic intervention done.  If they had a heavy handed treatment, they may also look like they have had a stroke, Bell’s Palsy, or are still numb from a dental procedure.  This is not why patients come to see me, so despite their requests, I refer them back to a place where they previously had good results to get treated again.

Why I Do Not Perform Lip Flips

Despite the good results that some patients swear by and despite the ability to profit over this “trending” procedure, there is a single very good reason that I cannot do this procedure.  Even if you can get good results once, the ability to reproduce those results is limited because in the mouth, millimeters matter, and there is uncertainty with each treatment of the injectable neuromodulators.
This uncertainty is amplified because we can control how much we inject and precisely where, but we cannot control what happens when it enters the tissues.  If it spreads into a direction that gives worse results or spreads too far, then this is a result my patient would have to live with for months.
I have seen several patients in my practice that had the lip flip done for several treatments by the same person using the same product, but they got really bad results with their last treatment.  This scares me.  Using the injectables in the upper 1/3rd of the face is much more predictable with great results that do not look “done” (when performed with the goal of obtaining a natural look).  Around the mouth, there is less to gain and a lot more to lose.  I do not recommend the lip flip.

Who Performs Lip Flips?

 

When you look at web sites like RealSelf.com for information, one thing you find is that there are a lot of people inquiring about the Lip Flip, and a lot of Facial Plastic Surgeons, Plastic Surgeons, and Dermatologists that don’t have great things to say about this procedure.  Most of the neuromodulator injections done today are done by nurse practitioners, and they are likely the ones performing the majority of Lip Flips.  When patients are less than happy with the results, they probably see the surgeons to discuss what their options are (since there is no “anti-Botox” to reverse it), so we see a disproportionate number of unhappy people that had Lip Flips, and likely have to be the ones to break the news to them that they have no options other than waiting for the Botox to wear off.  Does this bias our opinions?  I suspect it may.  It doesn’t, however, change the results of lips moving oddly after this procedure.  See below for more details.

See Results For Yourself

 

Now it is time for some audience participation.  Please check out videos on youtube (youtube search for “lip flip”) for people that have had this procedure done, keeping in mind that a lot of these are paid or compensated treatments, as the facility or practitioner often reduces the price (or gives it to free) to the influencer (in exchange for publicity).  Though they are far from “unbiased” reviewers, they do provide a lot of footage of how they look before and after the lip flip procedure. Even if they say they love the results, ask yourself if the “after” portion of the video is natural-looking.  Ignore the lighting, makeup, and subject’s own perceptions of their treatment and be critical of what you see.  I see people whose mouths lost some ability to move.  What do you see?  Leave comments below to share your thoughts.