Two different lip treatments work on the same small muscle. A lip flip uses a tiny dose of Botox to let the upper lip roll very slightly outward, so a little more of it shows. Botox for vertical lip lines, often called smoker’s lines, softens the fine creases that form around the lips when you pucker. At Shield Dental Care in Burke, VA, Dr. Ghorbani offers both as part of our Botox service.
The muscle around your mouth
The orbicularis oris is the ring of muscle that circles the mouth. It closes and puckers the lips when you talk, eat, drink and kiss. Years of that movement fold the skin along the lip border into fine vertical lines. The lines are common in smokers, which is where the nickname comes from, but plenty of people who have never smoked get them too.
What a lip flip is, and what it is not
For a lip flip, a few units are placed along the border of the upper lip, into the edge of the muscle. With that part of the muscle slightly relaxed, the upper lip can turn a little outward and look fuller, especially when you smile. A 2025 review of the published studies found the typical total dose was about 4 to 6 units.
A lip flip does not add volume. It changes how the lip sits, not how much lip there is, so the change is subtle and it will not look like lip filler. If you want a noticeably bigger mouth, a lip flip is not the right treatment.
Botox for vertical lip lines
For lip lines, very small doses are spread across a few points along the lip border. The aim is to soften the lines that deepen when you purse your lips. Lines that stay etched into the skin when your mouth is relaxed usually soften only partly, because Botox reduces movement; it does not repair the skin itself. We keep doses around the mouth low on purpose, because too much makes the lips feel weak.
An off-label use
No botulinum toxin product is FDA-approved for the lips. BOTOX® Cosmetic is approved for frown lines, forehead lines, crow’s feet and neck bands, and Dysport and Daxxify for frown lines only. Using any of them in the lips is off-label. That is legal and common, and we go through it with you as part of consent before treatment.
What to expect
- Consultation. We look at your lips at rest, smiling and puckering, and review your medical history and medicines.
- Treatment. A few tiny injections along the lip border with a very fine needle. The lips are sensitive, so expect a sharp pinch, and a small bruise or some swelling is possible. It takes a few minutes.
- Afterwards. You can go straight back to your day. We give you written aftercare, which includes not rubbing or massaging your lips.
The change starts to show within a few days and settles by about two weeks. Lip results can be shorter-lived than the three to four months typical for frown lines. Cleveland Clinic puts a lip flip at about two to five months, and in a small 2026 study the measured change in upper lip height had largely faded by one month. Treatment should not be repeated more often than every three months.
Side effects specific to the lips
In the published studies, the most common complaints were difficulty drinking through a straw and whistling, which settled within weeks. If the dose is too high or the product spreads, people can have trouble keeping liquid in the mouth, drooling, or less clear speech. These also wear off, but they are why we dose cautiously. If you sing, play a wind instrument or speak for a living, tell us before treatment.
All botulinum toxin products carry an FDA boxed warning: rarely, the effect can spread away from the injection site, causing trouble swallowing, speaking or breathing, vision problems or general muscle weakness, hours to weeks after treatment. These are medical emergencies. If they happen, get help immediately.
Who should wait
- Anyone pregnant or breastfeeding. Cosmetic botulinum toxin has not been adequately studied in pregnancy, so we recommend waiting.
- Anyone with a cold sore, mouth sore or other infection where the injections would go, or an allergy to any botulinum toxin product.
- Anyone with a nerve-and-muscle condition such as myasthenia gravis, Lambert-Eaton syndrome or ALS.
- Tell us if you take blood thinners, have recently taken aminoglycoside antibiotics, or have had any botulinum toxin treatment in the last four months.
If what bothers you is how much gum shows when you smile, see Botox for a gummy smile. For a wider change to how your smile looks, our smile makeover page covers the dental options.
Frequently Asked Questions
Will a lip flip make my lips bigger?+
Only slightly, and only in appearance. A lip flip lets the upper lip turn a little outward so more of it shows. It does not add any volume, so the change is subtle.
Will I be able to drink and talk normally?+
For most people, yes. For the first weeks you may find it harder to drink through a straw or whistle. We keep the dose low to limit this, and it wears off.
How long does a lip flip last?+
Often less time than Botox in the upper face. Estimates run from about one to five months, and it varies from person to person. You can be treated again after three months at the earliest.
Is Botox for the lips FDA-approved?+
No. Using Botox, Dysport or Daxxify in the lips is off-label. That is legal and common, and we explain it before treatment as part of consent.