What is upper lip line botulinum toxin?
Upper lip line botulinum toxin is a procedure directed at the appearance of the vertical lines running upwards above the upper lip, popularly known as barcode lines. Whether any change in appearance is possible 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 the contraction of the muscle to which it is applied. The procedure is carried out with an authorised product, within the terms of use in its authorisation, and by a physician.
The functional aspect of this area is described on the Upper Lip Botulinum Toxin page; the two pages address different aims in the same anatomical area.
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 are decisive in the assessment of this area:
- Whether the lines appear only with movement, or whether they also remain when the face is at rest
- The depth and extent of the lines
- The movement of the upper lip and the distance between the nose and the upper lip
- Whether the patient smokes or has a habit of pursing the lips
- Any previous procedures in the area
If smoking and the habit of pursing the lips continue, the result and the duration of the procedure may be affected; this is discussed at the consultation.
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 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. Whether the lines appear with movement is determined; their depth and extent are assessed. You are asked about the movement of the upper lip, the distance between the nose and the upper lip, smoking and the habit of pursing the lips. You will be asked whether your occupation requires the use of the voice, breath or blowing. Any history of cold sores or neuromuscular disease, current medication, allergies and previous procedures are recorded. Blood pressure and pulse are measured.
- Product check. The marketing authorisation status of the product to be used and its compliance with storage conditions are checked.
- Information and consent. The procedure, the limited contribution expected in deep, established lines, the temporary nature of the effect, the temporary effect on speech and blowing 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.
- Application. The product is applied 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 result 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 result 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 in advance 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
Please state if you have a history of cold sores and if your occupation depends on the use of the voice or breath.
Come with no make-up on the area.
After:
- The area must not be massaged or rubbed on the day of the procedure
- You will be asked to avoid drinking through a straw, blowing movements and whistling for the period specified
- In the first few days there may be difficulty in producing certain sounds when speaking
- You will be asked to avoid bending forward, staying head-down for long periods and lying face down for the period specified
- Avoid hot environments, saunas, sunbeds and vigorous exercise for a time
- Temporary raised bumps, redness and mild bruising may occur at the injection sites
Recommendations and time periods specific to you are given in writing at the end of the procedure.
Risks and side effects
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
- Leakage of liquid from the mouth
- Smile asymmetry and an uneven appearance of the upper lip
- A feeling of heaviness or numbness in the upper lip
- The expected change not being seen in deep lines (in this presentation the result 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
- A change in facial expression
- 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
My upper lip lines are deep; will this procedure be enough?
Lines that appear only when the lips are pursed and deep, established lines that remain even when the face is at rest are not assessed in the same way. In the second situation, the contribution expected from this procedure is limited. Which of the two is present is determined at the examination.
Why do barcode lines form?
The lines in this area are related to the repeated movement of the upper lip muscle. Smoking and the habit of pursing the lips are among the behaviours that affect their formation, and they are asked about at the consultation.
Are upper lip line botulinum toxin and upper lip botulinum toxin the same thing?
No. Upper lip line botulinum toxin concerns the vertical lines above the lip. The assessment relating to the visible part of the upper lip is described on the Upper Lip Botulinum Toxin page. The two procedures address different aims in the same anatomical area.
Will my speech be affected after the procedure?
A temporary change in speech is among the side effects reported for this area; in particular, there may be difficulty in the first few days with sounds produced using the lips. In those whose occupation depends on the use of the voice or breath, the procedure is assessed separately.
I smoke; will the result be affected?
If smoking and the habit of pursing the lips continue, the result and the duration of the procedure may be affected. This is one of the issues discussed at the consultation.
How long does the effect of upper lip line 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.
Is upper lip line 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)
