What is upper lip botulinum toxin?
Upper lip botulinum toxin, also popularly known as the lip flip, is a procedure based on temporarily reducing the movement of the muscle surrounding the upper lip. Whether any change can occur in the visible part of the lip is assessed at the examination.
The substance used in this procedure, which is popularly known by a brand name, is botulinum toxin. Botulinum toxin is a prescription-only medicinal product for human use (opens in a new tab) that temporarily reduces contraction of the muscle into which it is administered. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
Two things to know first:
- This procedure does not add volume to the lip. No substance is administered into the lip itself; what is assessed is whether or not the change in muscle movement affects the visible part of the lip. The expected change is limited.
- This is one of the botulinum toxin areas that most directly affects daily function. The upper lip muscle is involved in movements such as speaking, drinking and whistling. For this reason the temporary effect of the procedure on speech and drinking is discussed beforehand.
The procedure is performed at the practice (opens in a new tab) by Dr. Suzan Alp, Specialist in Internal Medicine.
Which factors determine whether the procedure is suitable?
The decision on suitability is made at the end of the examination. The following factors determine the assessment in this area:
- The visible height of the upper lip at rest and when smiling
- The distance between the nose and the upper lip
- Whether the patient’s occupation or daily life depends on speaking, blowing or whistling
- Any previous procedures in the area
- Visibility of the gums during smiling
In which patients is the procedure not performed?
- In patients with a disease affecting the neuromuscular junction (myasthenia gravis, Lambert-Eaton syndrome, amyotrophic lateral sclerosis and similar conditions)
- In pregnant and breastfeeding patients
- In patients under 18 years of age
- In patients with a history of allergy to the product to be used or to its components
Situations that require separate assessment
- Muscle disease (an assessment by the relevant specialist physician is required)
- Use of medicines that affect neuromuscular transmission (aminoglycoside antibiotics, muscle relaxants and similar)
- Bleeding or clotting disorder, or use of blood-thinning or anticoagulant medicines
- Active infection or febrile illness (the procedure is postponed)
- A recent procedure in the same area (the timing is adjusted accordingly)
Additional conditions specific to this area
The procedure is not performed if the following are present in the area to be treated:
- Difficulty swallowing
- An active cold sore, infection or open wound around the mouth
In these situations, the procedure is planned subject to the physician’s assessment:
- An occupation that depends on the use of the voice, the breath or blowing (singers, wind instrument players, voice artists, teachers and the like; the procedure may not be considered suitable)
- A speech disorder (the opinion of the relevant specialist is sought)
- Existing asymmetry in upper lip movement (the possibility that it may increase is discussed beforehand)
- A history of facial palsy (the opinion of the relevant specialist is sought)
- Previously applied dermal filler in the area (timing and planning are adjusted accordingly)
- Wearing a dental prosthesis
How is the procedure performed?
- Assessment. The visible height of the upper lip, the distance between the nose and the upper lip and the visibility of the gums during smiling are assessed. You are asked about your occupation, and about whether your daily life requires speaking, blowing or whistling. You are also asked about any history of cold sores, any speech or swallowing complaint, any history of neuromuscular disease, current medication, allergies and previous procedures. Blood pressure and pulse are measured.
- Product check. The authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The procedure, the limit of the expected change, the temporary nature of the effect, the temporary effect on speech, drinking and whistling and the possible side effects are explained in writing and verbally; the form is signed.
- Preparation. There must be no make-up on the area. Antisepsis is ensured.
- Administration. The product is administered to the predetermined points with a fine needle.
- Observation and follow-up. Vital signs and any observed findings are recorded in the file. A follow-up appointment is given at which the outcome will be assessed.
When does the effect begin, and how long does it last?
The time it takes for the effect to appear varies from person to person; the full outcome is assessed between a few days and two weeks. The effect is temporary, and how long it will last cannot be stated in advance. It is discussed beforehand that the duration of the effect in this area may be shorter than in the upper areas of the face. The timing of any repeat is determined at the follow-up.
What should you do before and after the procedure?
Before the procedure, report:
- A list of all the medicines and supplements you use (in particular blood thinners, painkillers and antibiotics)
- Your known allergies
- Any history of nerve or muscle disease
- Your pregnancy and breastfeeding status
If you have a history of cold sores, and if your occupation depends on the use of the voice or the breath, please state this at the consultation.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- Drinking through a straw, blowing movements and whistling should be avoided for the period specified
- In the first few days there may be difficulty in producing certain sounds when speaking; care is advised when drinking hot drinks
- Bending forward, remaining head-down for long periods and lying face down should be avoided for the period specified
- Avoid hot environments, saunas, sunbeds and intense exercise for a while
- Temporary raised bumps, redness and slight bruising may occur at the points of administration
Advice and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
In this area the side effects relate to function rather than to appearance.
Risks specific to this area
- A temporary change in speech (in particular in sounds produced using the lips)
- Difficulty with drinking through a straw and with blowing movements
- Inability to whistle
- Liquid leaking from the mouth
- Asymmetry of the smile and an irregular appearance of the upper lip
- A feeling of heaviness or numbness in the upper lip
- Difficulty controlling the lip while eating
- The expected change not being seen (the outcome in the upper lip area is limited)
- Triggering of a cold sore in the area
General risks that may occur with any minor procedure
- Pain, redness, swelling and bruising
- Infection at the site of the procedure
- Headache
- Allergic reaction
- Flu-like symptoms
- Vasovagal syncope (fainting)
These side effects are temporary; however, the time they take to resolve varies from person to person and may take weeks. It is not possible to reverse the effect of the botulinum toxin.
Results vary from person to person.
When should you see a physician without delay?
If you experience these symptoms during treatment, contact your physician without delay:
- Continuous leakage of liquid from the mouth
- Increasing redness, increased warmth, swelling or discharge at the site of the procedure
- A high fever
- Widespread rash, itching
In the event of difficulty swallowing, disturbance of speech, double vision, shortness of breath, widespread muscle weakness, or swelling of the lips or eyelids, go directly to the emergency department.
Frequently asked questions
Does upper lip botulinum toxin make my lip bigger?
No. This procedure does not add volume to the lip, and no substance is administered into the lip itself. What is assessed is whether or not the change in muscle movement affects the visible part of the lip; the expected change is limited.
Will my speech be affected after upper lip botulinum toxin?
A temporary change in speech is among the side effects reported in this area; in particular, there may be difficulty in the first few days with sounds produced using the lips. This possibility is discussed before the procedure.
Can I drink through a straw, and can I whistle?
Difficulty with drinking through a straw, with blowing movements and with whistling is among the side effects reported in this area. After the procedure these should be avoided for the period specified.
My occupation requires me to use my voice; can I have this procedure?
In people whose occupation depends on the use of the voice, the breath or blowing, the procedure is assessed separately and may not be considered suitable. Please state your occupation, and whether your daily life requires these movements, at the beginning of the consultation.
Will my tendency to get cold sores be a problem with upper lip botulinum toxin?
Triggering of a cold sore in the area is among the situations that have been reported. If there is an active cold sore around the mouth, the procedure is not carried out. Please state your history of cold sores at the consultation.
How long does the effect of upper lip botulinum toxin last?
The effect is temporary and its duration cannot be stated in advance. It is discussed before the procedure that the duration of the effect in this area may be shorter than in the upper areas of the face. The timing of any repeat is determined at the follow-up consultation.
Are upper lip botulinum toxin and upper lip line botulinum toxin the same thing?
No. Upper lip botulinum toxin concerns the visible part of the upper lip. The vertical lines that run upwards above the lip are described on the Upper Lip Line Botulinum Toxin page.
Is upper lip botulinum toxin carried out during pregnancy?
No. The procedure is not carried out during pregnancy or breastfeeding.
Sources
- Ministry of Health of the Republic of Türkiye, Turkish Medicines and Medical Devices Agency, Beşeri Tıbbi Ürünler Ruhsatlandırma Yönetmeliği, Official Gazette 11 December 2021 / 31686. https://www.resmigazete.gov.tr/eskiler/2021/12/20211211-5.htm (opens in a new tab)
- Ministry of Health of the Republic of Türkiye, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelikte Değişiklik Yapılmasına Dair Yönetmelik, Official Gazette 7 January 2025 / 32775. https://www.resmigazete.gov.tr/eskiler/2025/01/20250107-3.htm (opens in a new tab)
