Lip flip with botulinum toxin: what it is and its limits

The lip flip became a well-known name on social media: a "filler-free" technique that promises more prominent upper lips when smiling. To the patient, it seems simple. To the professional, it is a procedure on a small, functional area that is very sensitive to errors, with a subtle aesthetic benefit and clear limits.

This page presents the concept, the reasoning behind the indication, the effects on function and the pitfalls, at a review level. It gives no dose, injection point or technique. Management is the decision of the qualified professional, following the product label and the rules of their professional council in Brazil.

What is a lip flip?

It is the use of botulinum toxin to reduce the activity of the orbicularis oris, in its upper portion, so that the lip retracts less over the teeth during a smile. The expected effect is a discreet eversion of the vermilion, which shows a little more.

Two characteristics define the procedure:

1. It does not add volume. The lip gains no tissue. The impression of a "fuller" lip comes from more visible vermilion.
2. It depends on movement. The effect shows mainly when smiling and speaking, and can be almost imperceptible at rest.

That is why it is an option for people who want discretion, and a poor option for people who want to enlarge the lip.

Who it may make sense for

In general, the lip flip conversation makes sense for patients with some of these characteristics:

• A thin upper lip that retracts when smiling and almost disappears.
• Little visible vermilion in a smile, despite reasonable volume at rest.
• A preference for a discreet and reversible approach.
• Little or no excessive gum show when smiling.
• No intense functional demand on the lips.

On the other hand, other situations call for caution or a different route:

• Lips lacking volume at rest: lip filler is the topic.
• Gummy smile: when the orbicularis action is reduced, the lip may rise less or more, and the result depends on the whole picture. See botulinum toxin for gummy smile.
• Marked vertical lines: the approach is broader, as in botulinum toxin for vertical lip lines.
• Voice professionals, wind instrument players and patients with prior speech difficulties.

Comparison with other approaches

The decision should not come from the popularity of the procedure, but from the patient's concern and anatomy.

Functional and aesthetic risks

The upper lip is a structure of function. The orbicularis takes part in speech, whistling, blowing, holding liquids and expressions. When its activity is reduced, even partially, the following may appear:

• Difficulty pronouncing some sounds, such as "p," "b," "m," "f" and "v."
• Difficulty using a straw and drinking without leakage.
• Changes in whistling and in wind instruments.
• A "floppy" lip or a feeling of heaviness.
• Asymmetry, if the response is uneven.
• Altered smile, from diffusion to the lip elevators. See toxin diffusion and frozen smile after toxin.
• Insufficient result: in some patients the effect is almost imperceptible.
• Bruising and local pain, as with any injectable.

Functional effects are usually temporary, following the duration of the toxin, but the discomfort during that period can be significant.

How to assess

An organized assessment brings together function and aesthetics.

1. Spontaneous and posed smile, front and three-quarter view, with photo and video.
2. Visible vermilion at rest and in a smile, comparing the two.
3. Incisor display at rest and in a smile, as in incisor display.
4. Proportion and symmetry of the upper and lower lip, as in asymmetric lips: assessment and thin lip: assessment.
5. Function: speech, lip sounds, whistling, straw use, habits and profession.
6. Dental and bone structure, with attention to gummy smile and tooth protrusion.
7. The patient's expectations, stated explicitly.

Standardized photos, in the format of standardized clinical photography, are essential to compare the before and after of such a subtle effect.

How to talk to the patient

Communication is critical, because the expectation is usually bigger than the effect.

Avoid social media images as a promise. Before-and-after photos of other patients are not a reference for an individual result, and advertising must follow what can be advertised.

Combining a lip flip with other options

Some patients combine a lip flip with filler, others with toxin in other areas. Each combination brings decisions about order, interval and risk. In general, it is worth reassessing between stages and avoiding stacking small changes that the patient cannot attribute to each option.

When filler is part of the plan, remembering the availability of hyaluronidase and knowing the vascular anatomy of the lip, covered in lip vascular occlusion, is part of the preparation.

How Harmy relates to this

Harmy has the Lips area, which simulates volume with hyaluronic acid. The app does not simulate a lip flip, because the projection does not represent smile movement and because the effect of a lip flip is not one of volume.

For patients torn between "just a little more" and "enlarge," showing the volume simulation can clarify the preference: if the person likes the result with 0.5 ml and Subtle intensity, perhaps what they want is light volume, not a lip flip.

Timeline

Quick review

The lip flip is a procedure with a subtle effect, in an area of high functional demand. Those who recommend it with judgment, explain honestly what it delivers and respect the patient's routine reduce the risk of frustration and preserve trust.