Updated: Jan 6, 2021
So you're not ready to fill your lips but you'd like a little more lip show? Or you have smoker's lines, the lines surrounding the mouth, whether you smoke or not. Continue reading to learn everything you need to know about the lip flip and smoker's lines with Botulinum Toxin.
What is Botulinum Toxin?
Botulinum toxin is a neurotoxin that has been prepared to relax or fully paralyze specific muscles they are injected into. How does the paralysis happen? The muscle contracting transmitters can't get out of their uber to get to the muscle, so they go back home. This causes no damage to any structures of the nervous or musculoskeletal system.
Botox, Dysport, Xeomin, and Jeuveau, are Botulinum Toxin Type A brands for cosmetic indication to treat the glabellar complex. Just like Kleenex, we often refer to the treatment as the brand name, Botox. "I'm going to get Botox." "Pass me the Kleenex." What we mean to say is, "Pass me the tissue," or, "I'm going to get Botulinum Toxin type A injected in certain muscles to relax them."
How Does Tox Flip My Lip?
Botox relaxes muscles. The muscle around the mouth is the orbicularis oris muscle. We can pucker this muscle tightly, and we can also tuck our upper lip in.
Botox does not remove lines directly or make the lips bigger. Tox relaxes the muscle so it cannot pucker as tightly, or tuck in as much.
Go to a mirror and say a few sentences, smile big, or try to tuck in your upper lip. If when you are talking or smiling and your lip tucks inward and seems to get smaller, this means your muscle tucks your lip in, making your lip look smaller. If your lip does tuck in, you will benefit from a lip flip. If your lip does not tuck in, you are less likely to see a difference from lip flip.
My lip does not tuck in much, but it does tighten a little when I talk and smile. My lip flip results are subtle, but I do enjoy the results. For some, this may not be enough to be satisfied.
If you truly want a visible difference in the lip, one syringe of filler injected by the right provider creates a very subtle enhancement once fully healed.
How Does Tox Treat Smoker's Lines?
These lines are not always caused by smoking, but can also be caused by holding a puckering expression or drinking out of a straw. These lines have often been created as a result of tightening the muscle, and as a result of collagen loss. Tox will likely not remove the lines, but may soften them. For example, if I crease a bedsheet every day for years, a tight crease will form. If I iron the sheet, but I don't stop creasing the sheet, the crease will not go away because the sheet keeps getting creased. We need to stop creasing the sheet. This is what Botox does.
Will My Line(s)/Wrinkles Go Away?
If your skin only creases when you contract the muscles, Botox will relax the muscles, stopping the creases made by those muscles. Lines only visible by contracting the muscles are called dynamic lines. Lines visible at all times when the muscles are fully relaxed are called static lines. Static lines will soften with time depending on a variety of factors.
If your skin has static lines, your sheet (or skin) will need some ironing treatments (skin resurfacing ie. retinol, chemical peels, lasers, microneedling), in addition to stopping the creasing (Botox). The quality of your skin (younger, older, sun-damaged, sun protected), and how long the crease has been present will determine how long it will take for the line to go away. Some wrinkles or deep creases may never go away. This is why preventative Botox, or Baby Botox, is on the rise. It stops the creasing before it happens. If the line is present at rest, the treatment is no longer preventative.
A very thin filler placed in small droplets can replace the lost collagen contributing to lip lines. Adding a subtle volume to the lips also prevents lip lines. Filling lip lines with a dermal filler also significantly helps reduce lip lines, but may not fully eradicate them.
What Are The Risks of Botox In The Lip?
Injection Site Reactions
Injection site reactions are the most common risk. This includes bruising, swelling, minor pain, and sensitivity. Bruising is common in the lips. Swelling does not commonly happen. A needle poke in the lip is one of the most painful areas of the face to treat. Fortunately for my patients, the pain is limited due to my injection technique. Ice and numbing also make a significant difference for pain.
Most patients will be started at one unit per side of the upper lip for a total of two units. The lower lip is not commonly treated but can be. If you happen to be very sensitive to tox, it can feel a little strong. Those who are very sensitive may find it difficult to perform normal talks like drinking water. In my experience, less than one out of ten patients will experience this. It is more common that the sensation of a slightly relaxed lip is not enjoyable, but function is preserved. Most patients end up eventually using more units, such as 4-6 units in the upper lip.
Lower Face Asymmetry
This risk is only possible with tox in the lower lip. If tox in the lower lip is injected too low or spreads lower, it may affect the DLI (depressor labii inferioris). This will result in a significantly asymmetric lower face effect in the lip. The lower lip will make a nike swoop shape, instead of a normal smile.
Google-able Scary Side Effects
If you google "Botulinum Toxin Side Effects" or Adverse Effects, you may read some scary reactions like difficulty swallowing, breathing, or talking, severe muscle weakness, or loss of bladder control. These are systemic results that can occur when upwards of 300-400 units of tox are used. Botulinum toxin is also used for hypertonic muscle conditions, like dystonias. Full limbs are treated with multiple hundred units of tox. The likelihood of a scary adverse event happening is extremely unlikely with cosmetic dosages of tox.
With this said, most patients will never experience any of the above adverse effects.
How Much Will Lip Flip or Lip Line Botox Cost?
Some clinics charge by unit, while some clinics charge by area.
Most places charge by unit, and the price per unit or per area will vary based on the specialty, location, and many other factors.
In the lips, 1-8 units may be used. 2-4 units is the most common. Start with 2 units for your first time. If you do not feel any different after two weeks, you may get a total of 4 units.
Most men and some women with strong muscles will need more units. Above 6 units in the upper lip alone is somewhat uncommon.
Since the amount of units required for the lip is so low, there will likely be a minimum charge by the clinic.
What Should I Do Before My Lip Botox Appointment (Pre Care)?
It is possible to bruise with tox in the lip, so avoiding blood thinners to prevent the risk of bruising is a good idea. Common blood thinners are alcohol, aspirin (and NSAIDs), fish oil, gingko biloba, ginseng, and garlic. If you are on a prescription blood thinner, it is possible to have injections as long as your primary care physician gives the okay and you are not in critical health.
If you have high anxiety or are really nervous, you may have a history of fainting with injectables, like getting needle pokes or giving blood. This is called vasovagal syncope. To avoid fainting, make sure you have eaten before the appointment, avoid coffee, and be hydrated. Communicate your fainting history to your provider. It helps to talk during the treatment, or be distracted. To avoid fainting, make sure you do not hold your breath. Relax your upper body. If you feel yourself about to faint, squeeze your abdominal muscles, and tell your provider so they can lay you down.
If you love to workout, plan your workout before your appointment. Sweating profusely is discouraged for the rest of the day, or 24 hours after tox.
What Are Lip Flip + Smoker's Line Botox Appointments Like?
First your provider will assess your concern. They will estimate the amount of units and check your medical history. You should disclose any medical conditions, allergies, medications, and current pregnancy or breastfeeding information. The only people who should not get Botox are those who are pregnant, breastfeeding, severely or acutely ill, or who have some muscular weakness disorders.
You may request numbing for tox in the lip. Topic numbing cream takes 30 minutes to fully kick in, so arrive early if desired. It really is quick so if your injector is gentle or you have a great pain tolerance, numbing is not necessary. Injectable numbing is not necessary for lip Botox.
They should take baseline pictures in consistent lighting of your muscles relaxed and contracted to store in your chart. They should educate you on the risks of the procedure. They should assess the characteristics of your muscles.
Your lip will be cleaned, and the product will be injected in 2-4 injection sites.
What Do Botox Injections Feel Like In The Lips?
The injection feels like a tiny pinch, maybe equivalent to plucking a thick hair in the area or extracting a pimple on the border of the lip. You may or may not feel the fluid being injected. It has the consistency of water. It may or may not be cold. You may or may not feel a little bit of blood from this area after the injection. It is common and normal for blood to come out of an injection site, though the injection site may also not bleed.
You may feel like the treatment is working immediately, but that is just the presence of the fluid in the tissue. It takes a minimum of hours, usually a few days to begin seeing effects.
It is likely to feel sensitive after the injection. The lips are very sensitive. You may ice after the treatment.
What Should I Avoid After My Treatment?
There were general rules created when tox was developed for cosmetic use. These are "do not sweat, workout, or use a sauna for 24 hours after, do not lay down for 6 hours after, and do not touch the area treated for an hour." You can also contract the muscles treated more after the treatment to help the tox kick in faster.
What Does Botox Feel Like Kicked In In The Lips?
Squeeze your hand tight. This is what your muscles do without Botox. Move your hand a little bit, but don't squeeze it tight. This is what Botox feels like. You won't be able to squeeze the muscles of the area tightly. You may be able to move them, but they will not squeeze tightly.
All toxin products take ten days to fully kick in. The strength is the greatest in the beginning, and will wear off with each passing week. For some people, you may feel a little funny in the beginning. This will soften with the passing weeks.
The lip does feel very different your first time getting lip tox. I like to describe it as numb, though if you touch it, you still have full sensation. When you go to the dentist and they inject numbing, the muscles relax a bit. It feels like this, but not as strong, and with full sensation to touch. The second and third time you get tox in the lip will not feel as dramatic.
What To Expect From My Treatment
If you express your goals and expectations to your provider, your provider should be able to educate you on if those goals and expectations are realistic or not, and what they recommend.
This will last 4-6 weeks on average. If 20 units are used between the brows, and this is FDA approved to last 3-4 months, 1-4 units will last significantly shorter in comparison. It is not realistic to have the lip relaxed for more than three months. Lip lines will often not fully eradicate with tox and even filler. They often require a series of skin resurfacing (or ironing) treatments.
Which Tox Product or Brand Should I Pick?
I could make a whole blog post on this topic alone. Early in my injectable career, I set out to compare every single publication on all types of toxin for cosmetic use for efficacy. I spent over half a year trying to compare all of the studies, and learned that it was impossible to compare. The indicators of efficacy such as onset, duration, or improvement in lines are defined differently in every study. Most studies are funded by pharmaceutical companies that profit off the product and have bias. There can be flaws found in every single study, or findings can be disputed. The points used in-vitro to support a product as 'the best' are also not necessarily indicative of product efficiency. I could ramble on end about this topic.
Here's my advice. I feel every patient should at some point try every product type. All of the products are so incredibly similar. Every patient has a different goal and different opinions on what they feel is the best outcome for them. Keep in mind placement of injection is greatly responsible for patient satisfaction. Placement is directly influenced by the patient's communicated expectations and feedback. Providers are also heavily influenced by the price they get the product for and politics associated with the companies. If you feel too pressured by a provider to pick a specific product, they are not the right provider for you.
Try whichever product makes you feel the most secure. Try the product the injector recommends for you. Try a different product if you weren't happy with the previous treatment (and communicate your concerns to the provider to alter their injection placement if not previously satisfied).
Am I A Good Candidate for Botox In My Lip?
You are not a candidate if you have some rare muscular disorders, expect tox to remove all of your lines, or do not accept the risks that come with the injection. Your first treatment is a learning experience for both you and your provider. You need to learn if it feels tolerable and if you see worthy results. Your provider needs your feedback to tailor the treatment. It is also very possible to not enjoy what lip tox feels like, and will take trying it with the right provider to learn if this is the right treatment for you. It is also very possible to not see significant results. If you are not okay with this, you are not a good candidate.
A good candidate is someone who is looking to soften the lines on the upper or lower lip or try a lip flip to see how they like it. They may have static or dynamic lines. They understand and consent the risks of the injection. They understand they may or may not see significant results. They do not expect lines to fully eradicate immediately after tox kicks in. They are able to be local to the clinic ten days to two weeks later in case they need a touch up.
If you live in Southern California, specifically Los Angeles, Orange County, or San Diego, schedule to see Jasmin in Costa Mesa, California for Botulinum Toxin Lip. Consultations are free.