When it comes to changing lip shape or achieving a plumper pout, the go-to request that may immediately roll off most patients’ tongue is filler. According to data from the American Society for Aesthetic Plastic Surgery, injections of hyaluronic acid fillers (in the lips and elsewhere) ranked as the second most popular nonsurgical procedure of 2017. But, there’s another under-the-radar option for patients looking to achieve the look of a more voluminous lip, and the technique and product may surprise you: micro-injections of neurotoxin in a treatment doctors call the “lip flip.”
“There are many different techniques for the lip flip, but it’s most commonly done with Botox,” says Fort Lauderdale, FL dermatologist Matthew Elias, MD. During the procedure, a very small amount of neurotoxin (Botox Cosmetic, Dysport, Xeomin) is placed into the muscles around the upper lip. “The procedure weakens the muscle around the mouth that causes lips to turn inward over time,” explains Augusta, GA dermatologist Lauren Ploch, MD. “It’s fairly low-risk but there is the potential of minor bruising or swelling that resolves quickly as with other injections. It’s a great low-cost and low-downtime alternative to fillers.”
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“It works really well for folks who still have an upper lip that's turned inward toward the gum. It evens the upper lip so you get more lip show without any filler. It's very subtle but needs to be done by a very experienced injector,” adds Brookline, MA dermatologist Papri Sarkar, MD.
The lip flip technique, although unanimously loved by dermatologists we surveyed, has mostly stayed out of consumer awareness. But recently, a variation of the procedure has gained popularity on Instagram, where trending videos of the treatment have garnered hundreds of thousands of views and more than a few enthused responses. As with most medical advice found on social media, however, the learning is the same: 15-second looping videos may be transfixing to watch, but rarely tells the full—or safe—story.
The Instagram version of the lip flip shows a practitioner creating a pattern of controlled injury to the area of the upper lip using a tool called the Plasma IQ pen. This intentional wounding mechanism creates two outcomes: stimulate collagen production to lift the upper border of the lips and shorten the distance between the nose and the lips. Dermatologists, however, are wary about risks of undergoing the treatment, especially when a much safer alternatives—including Botox Cosmetic—can achieve similar results. “The Plasma IQ pen uses ionized gas to shrink tissue by damaging it through thermal energy,” says Dr. Sarkar. “I can see why this works and it should work well on lighter skin, but in darker skin types it is likely to cause hypo or hyperpigmentation (light or dark spots) and if done too aggressively, can cause scarring.”
In addition to the heightened risk of scarring and post-procedure discoloration, Jericho, NY dermatologist Sarika Banker, MD adds that the treatment also takes a while for the effects to show. “Botox would work more quickly than trying to achieve lift via collagen stimulation,” she says.
In addition to Botox Cosmetic, doctors say that there are other proven technologies that can achieve the look of the lip flip. According to Germantown, TN dermatologist Purvisha Patel, MD, the procedure can also be done using CO2 laser and Ultherapy. “A CO2 treatment can create scar tissue to lift the vermilion border. Ultherapy uses heat to thicken the collagen to help lift the vermilion border. Botox, as others have said, also can temporarily cause the vermilion border to flip.”
Bottom line? Consult your board-certified dermatologist or plastic surgeon, not just your Instagram feed, before making any kind of cosmetic medical decision. And don't be surprised if your doctor suggests Botox, instead of filler, to achieve your perfect lip look.