Injectable cosmetic dermatology treatments have become extremely popular over the past few years. Dermatologists, medical researchers, and pharmaceutical companies have refined formulas for improved results and a greater variety of possible applications. While there are numerous different name brands and types of injectables, two of the main options are neuromodulator injections and dermal fillers. According to Dr. Mahsa Karavan of U.S. Dermatology Partners in Plano, Texas, “In the past, neuromodulator injections, like Botox, and dermal fillers haven’t been in direct competition. They are designed to perform two separate functions. Neuromodulators are typically created to smooth and firm skin while dermal fillers plump and add volume. With the introduction of the “Botox lip flip,” these two injectable options are essentially offering two paths to a similar end result – plumper, fuller lips. As a dermatologist, I would love to give my patients an easy answer about which is better, but it truly depends on their individual needs and the results they’re looking to achieve.” In this blog, Dr. Karavan will talk through some of the factors involved in choosing between the lip flip procedure and dermal fillers for plumping lips.

What Is a Lip Flip?
In the past, increasing lip fullness meant relying on cosmetic dermatology procedures like lip lifts and implants. While these options may deliver beautiful results, they aren’t the ideal solutions for every patient. According to Dr. Karavan, “If you’re looking for a subtle option to improve lip fullness, a lip flip may be a great option. Unlike other treatment options, the lip flip is a conservative treatment that creates the appearance of increased fulness, especially when smiling, speaking, and making other facial expressions. Unlike other cosmetic dermatology solutions that significantly increase fullness, the lip flip simply provides a small increase in lip plumpness, so for those who feel self-conscious about thin lips or lips that appear thinner during facial movements, the lip flip may be the right option.”

The lip flip procedure uses neuromodulator injections (such as Botox, Xeomin, Dysport, or Jeuveau) that are typically placed into the orbicularis oris muscle, which is above the lip. Following the injection, neuromodulators inhibit the release of acetylcholine from presynaptic motor neurons. Acetylcholine is a neurotransmitter that causes muscles to contract. By preventing the release of acetylcholine, the muscle relaxes. This allows the lip to flip upwards, showing more of the pink portion of the lip and giving the lip a fuller and plumper appearance without adding volume to the natural lip. To raise the corners of the lips giving a smiling appearance, neurotoxins can also be injected into the corners of the mouth. The lip flip procedure usually takes a few minutes to perform. After treatment, patients could start to see improvement right away, and the final results are visible a week or two after treatment. To sustain the lip flip, patients usually need to schedule retreatment every 2-3 months, as results of lip flip last slightly shorter than typical indications for neuromodulators. It is important to keep in mind that side effects of this treatment could include difficulty with whistling, drinking, or eating for 2-3 weeks as the muscle can be a bit weaker temporarily.

What Are Lip Fillers?
Dermal fillers are used, as the name implies, to fill up areas that are sagging or generally lack fullness. There are many different types of dermal fillers that contain a variety of ingredients geared to achieve different results, including plumping lips. While dermal fillers can be made from a variety of ingredients, hyaluronic acid fillers are typically used for the lips. Other types of dermal fillers may be utilized in combination with hyaluronic acid lip fillers to improve the appearance of lines and wrinkles around the mouth. A naturally occurring substance, hyaluronic acid is a staple ingredient in many moisturizers because it helps the skin to attract and retain water. This leads to an immediate boost in moisture followed by lasting hydration as the hyaluronic acid continues to attract moisture to the skin. Similarly, when hyaluronic acid fillers are used, patients see the area become immediately smoother with increased fullness. Over time, the hyaluronic acid continues to attract and retain moisture, sustaining the results for several months. Lip filler treatment involves injecting the hyaluronic acid solution into the lips. Then, the dermatologist will smooth and shape the filler into place, creating the desired look.

Specifically, in the United States, there are few lines of filler (Juvederm, Restylane, RHA, Belotero, and others) that can be used to increase lip volume. Most of these products have a longevity of six to twelve months, though this depends heavily on the patient’s metabolism. These fillers are also dissolvable in case of a complication or undesired appearance. Each of these hyaluronic acid fillers offers a variety of formulas specifically for plumping lips, including:

• Restylane – The original formula with a versatile range of uses, including improvement of lip fullness
• Restylane Kysse – A filler designed specifically for lips
• Juvederm Volbella XC and Juvederm Ultra XC – Both fillers are designed to address fine lines and wrinkles around the mouth as well as plumping lips
• Juvederm Ultra Plus SC – Another formula that can be used off-label for deeper lines, wrinkles, and adding more structured volume to the lips as compared to the more subtle appearance of finer fillers
• RHA fillers – This filler can be used off-label to treat lips, however, it is more commonly used for lines and wrinkles around the mouth and for adding volume to cheeks
• Belotero – A very soft filler that provides a subtle and natural appearance to the lip

Which Is the Right Option for Me?
When it’s time to choose between the two options, Dr. Karavan says, “Take your time to talk through the decision with your dermatologist. While it’s simple to approach the subject of lip flips and dermal fillers as an either-or situation, I’ve seen more than one patient who benefitted from a combination of the two treatments rather than one or the other. Discuss all of your treatment options with your dermatologist and consider the final look you want to achieve. Listen to your dermatologist’s recommendations and explanations of the procedure, but make sure that you are clearly voicing your priorities. Do you mostly care about having a fuller lip when you smile, speak, or make other expressions but think your lips have adequate volume otherwise? A lip flip might be your best option in this scenario. Just want to see a little bit more fullness and volume in general? Fillers may be better suited to deliver that result. Want to see both? Consider a combination of the two treatments. The decision is more nuanced and patient-specific than that, but it’s a good starting point toward a final decision.”