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Where to Inject Botox® for Lip Flip
Last updated: September 2026
Knowing exactly where to inject Botox® for a lip flip is what separates a clean result from a patient who cannot drink through a straw for six weeks. The target is the superficial fibers of the orbicularis oris in the upper lip — a shallow, deliberately under-dosed placement that sits above the vermilion border, never in the body of the lip. Everything that goes wrong with this treatment goes wrong because units drifted too deep, too medial, or too far toward the corner of the mouth, which makes a working knowledge of facial injection-site anatomy non-negotiable before you pick up a syringe.
It is also worth correcting the most widespread misunderstanding about this procedure up front, because it drives a lot of disappointed patients. A lip flip does not add volume. A 2025 systematic review in Archives of Dermatological Research concluded that the technique improves lip contour and fullness without adding volume, and a 2026 prospective study measured exactly that: upper lip height increased, lip volume did not change at all.
Think of a rolled shirt cuff. Nothing has been added to the sleeve — you are simply seeing more of the fabric that was already folded under. That is the lip flip. Managing that expectation during consultation prevents most of the dissatisfaction associated with the treatment.
Key Takeaways
Placement: superficial orbicularis oris, roughly 5 mm above the vermilion border and 10 mm lateral to the philtral column — two points per side, four in total.
Dose:4–6 units total across the published literature; a 2026 prospective study produced a measurable result with just 4 units. Ten units is not supported.
Mechanism: eversion, not augmentation. Measured upper lip height rose from 8.31 mm to 8.74 mm with no significant change in lip volume.
Duration: peaks around day 15 and returns toward baseline between 30 and 90 days — considerably shorter than a glabellar treatment.
Signature risks: difficulty whistling and difficulty drinking through a straw. Both are dose and placement problems, and both resolve within weeks.
Regulatory status: the lip flip is an off-label use of BOTOX® Cosmetic and should be consented as such.
Botox® Lip Flip Injection Location: Where the Units Actually Go
The orbicularis oris is a sphincter that encircles the mouth. Relaxing its upper, superficial fibers releases the inward pull on the upper lip, allowing the vermilion to roll outward and show more of itself. To do that without compromising the muscle's job — sealing the mouth — the injection must stay shallow and stay away from the functional centre of the sphincter.
A 2026 prospective study published in Aesthetic Plastic Surgery is currently the most precise published description of placement. Seventeen patients received two injection points per side, each positioned approximately 5 mm above the vermilion border and 10 mm lateral to the philtral column, delivering 2 units per side.
Parameter
Where it goes
Why
Muscle
Superficial fibers of orbicularis oris, upper lip
Deep placement weakens the sphincter and causes oral incompetence
Height
~5 mm above the vermilion border
Close enough to evert the lip, far enough to avoid injecting the lip body
Width
~10 mm lateral to each philtral column
Preserves the philtral columns and the definition of the Cupid’s bow
Points
2 per side, 4 total
Spreads a small dose evenly; single-point dosing concentrates the effect
Avoid
Philtral columns, oral commissures, lip body
Flattens the Cupid’s bow, drops the corner of the mouth, or causes a lumpy, weak lip
The two errors that cause almost every complication
Too medial — units placed at or across the philtral columns flatten the Cupid’s bow and produce a smooth, featureless upper lip. Too lateral or too deep — diffusion toward the oral commissure weakens the corner of the mouth, which is what patients describe as a crooked smile or trouble forming p and b sounds. Both are placement failures, not inherent risks of the treatment. The same principle governs every perioral and periocular treatment; see how a few millimetres of drift produces ptosis after a glabellar treatment for the clearest illustration of it.
What About a Bottom Lip Flip?
The lower lip can be treated with the same logic — one or two shallow points per side in the lower orbicularis oris, above the vermilion border — but it is a more conservative undertaking and is not what the published lip flip literature studied. The lower lip carries more of the burden of oral seal and speech, so the margin for error is smaller and the dose should be smaller again. Most injectors treat the upper lip alone, or treat the lower lip only after the patient has had a predictable upper-lip result. Where both lips and the surrounding perioral region are being considered together, it belongs in a full-face treatment plan rather than being handled as an isolated request.
How Many Units of Botox® for a Lip Flip
Four to six units in total. That is the range reported consistently across the published literature, and the more recent the study, the lower the number tends to be.
Source
Total dose
Distribution
Systematic review, Arch Dermatol Res (2025) — 7 included studies
The practical rule is to start at four units and treat the follow-up visit as part of the protocol rather than an inconvenience. A lip flip that is slightly too subtle can be topped up in two weeks. A lip flip that is too strong leaves the patient unable to whistle, sip through a straw, or pronounce certain consonants cleanly for a month or more, and there is nothing to be done but wait it out. In a region this functional, under-dosing is always the safer error.
What the Lip Flip Actually Does — and What It Doesn’t
The 2026 study measured the outcome rather than describing it, which settles a question the marketing around this procedure has muddied for years.
4 UTotal dose used
+0.43 mmUpper lip height gained
0Significant volume change
79.2Mean FACE-Q satisfaction
Upper lip height moved from 8.31 mm to 8.74 mm at day 15 — statistically significant, but under half a millimetre. Lip volume did not change measurably. Patient satisfaction was nonetheless high, which tells you the effect is real and worthwhile when the patient wanted definition, and a guaranteed disappointment when the patient wanted fullness.
This distinction matters commercially as well as clinically. The American Society of Plastic Surgeons’ 2025 statistics report, released in September 2026, found that neuromodulators and hyaluronic acid fillers together account for roughly 80% of all minimally invasive procedures, with ASPS President C. Bob Basu noting that patients are “increasingly seeking authentic restoration rather than transformation.” A treatment that changes shape by less than a millimetre fits that brief precisely — provided it is sold as what it is.
How Long a Botox® Lip Flip Lasts
Less time than patients expect, and less time than most sources claim. In the 2026 prospective study the effect peaked at approximately day 15 and had returned toward baseline somewhere between day 30 and day 90. Six to twelve weeks is the honest answer to give in consultation.
Typical duration by treatment area
Lip flip (4–6 U)6–12 weeks
Glabellar lines12–16 weeks
Masseter16–24 weeks
Two things shorten the lip flip: the dose is a fraction of a standard treatment, and the orbicularis oris is in near-constant use for speech, eating and expression.
Onset follows the same compressed curve. Patients typically notice something at three to five days and see the full effect at around two weeks, which is why the follow-up and any top-up belongs at day 14, not day 7.
Candidate Selection and Contraindications
The lip flip suits a specific patient: someone with reasonable existing lip tissue who wants more visible upper lip and more definition, who prefers a reversible, low-commitment option, or who wants to test the idea of fuller lips before committing to filler. It does not suit a patient with genuinely thin lips who wants volume — that patient needs hyaluronic acid.
A common misclassification
A gummy smile is not a lip flip indication, despite being listed as one on a great many websites. Excessive gingival display is corrected by relaxing the lip elevators — principally the levator labii superioris alaeque nasi, at what is commonly called the Yonsei point — which is a different muscle group, a different injection site, and a different dose. Treating a gummy smile by injecting the orbicularis oris will not work, and combining the two treatments requires deliberate planning rather than one set of injections doing both jobs.
Absolute and relative contraindications follow the product labelling rather than anything lip-specific:
Known hypersensitivity to any botulinum toxin preparation or to human albumin
Infection or active inflammation at the proposed injection site
Neuromuscular disorders including myasthenia gravis, Lambert-Eaton syndrome and amyotrophic lateral sclerosis, in which toxin effects may be exaggerated
Concurrent aminoglycoside antibiotics or other agents that interfere with neuromuscular transmission
Pregnancy and breastfeeding
Occupational dependence on fine perioral control — wind instrument players, vocalists, and professional voice users should be counselled carefully or declined
That last point is rarely listed and frequently regretted. A trumpet player with a weakened embouchure has a professional problem, not a cosmetic one.
Side Effects, Off-Label Status and Consent
BOTOX® Cosmetic is FDA-approved for glabellar lines, lateral canthal lines, forehead lines and platysma bands. The lip flip is not among those indications, which makes it an off-label use. Off-label prescribing is lawful and routine in aesthetic medicine, but it should be stated plainly during consent, alongside the product’s boxed warning regarding distant spread of toxin effect.
The side effects the literature names specifically are functional:
Difficulty whistling and difficulty drinking through a straw — the two effects reported across the systematic review, resolving within weeks
Transient numbness, discomfort, mild bruising or swelling at the injection site — reported in the 2026 study, all resolved within 30 days
Asymmetric smile or speech changes — placement and dose dependent; the 2026 study reported none at 4 units with symmetric placement
Flattened Cupid’s bow — the signature result of injecting too close to the philtral columns
Post-treatment instruction is straightforward: no rubbing or massaging the area, no makeup over the injection sites for the rest of the day, and a realistic warning that hot drinks and straws may be awkward for the first fortnight.
Lip Flip or Lip Filler?
The two are often presented as alternatives when they solve different problems. This table is worth having in front of you during consultation.
Botox® lip flip
Hyaluronic acid lip filler
What it changes
Lip position — everts and exposes existing vermilion
Lip volume — physically adds product
Measured effect
+0.43 mm upper lip height, no volume change
Volume increase proportional to product placed
Typical duration
6–12 weeks
6–12 months, product dependent
Reversible
Not reversible, but short-lived
Reversible with hyaluronidase
Best for
Definition, a slightly longer-looking upper lip, testing the idea
Genuine volume, structural reshaping
Main risk
Oral incompetence from over-dosing
Vascular occlusion, nodules, migration
They combine well. Filler builds the volume, a small lip flip refines how the upper lip sits over it. Staging them — filler first, lip flip at the review — makes it far easier to attribute a result to the right treatment.
What a Lip Flip Costs
Because a lip flip uses only four to six units, it is priced from the practice’s per-unit neuromodulator rate rather than as a standalone procedure, which makes it one of the least expensive treatments on most menus. Some practices apply a minimum charge or a consultation fee that raises the effective price, and pricing varies widely by region and injector credentials.
Worth flagging in consultation: a conspicuously cheap lip flip is a supply-chain question, not a bargain. Four units of authentic product costs what it costs.
Product Sourcing: The Risk Behind a Cheap Lip Flip
The lip flip’s low unit count and low price point have made it a common entry treatment in non-medical settings, and that has drawn regulatory attention.
In April 2024 the FDA issued an alert on counterfeit BOTOX® found in multiple states, identifying fake product bearing lot number C3709C3, labelled “Botulinum Toxin Type A” rather than “OnabotulinumtoxinA,” supplied in 150-unit vials that the genuine manufacturer does not produce, with packaging in a language other than English. It had been administered by both licensed and unlicensed people, including in non-medical settings, and led to hospitalisations with blurred or double vision, difficulty swallowing, dry mouth and breathing difficulty.
On 5 November 2025 the FDA followed up with warning letters to 18 companies illegally marketing botulinum toxin products online, citing adverse events including botulism symptoms. FDA Commissioner Marty Makary framed it bluntly: “Unapproved and misbranded Botox products carry serious health risks.” Product obtained outside authorised channels may be unapproved, counterfeit, adulterated, contaminated, or improperly stored and transported.
For practices
Federal law requires that providers who dispense or administer prescription drugs purchase them only from authorised sources. Documenting your supply chain is no longer just good practice — it is the thing that distinguishes your clinic from the operators the FDA is currently writing to.
Who Should Perform a Botox® Lip Flip
A lip flip is a small treatment in a high-consequence area. Four units placed correctly produce a subtle, satisfying result; the same four units placed a few millimetres off produce a functional deficit the patient lives with for six weeks. It should be performed by a licensed clinician — physician, nurse practitioner, physician assistant, registered nurse or dentist — who has trained specifically in perioral neuromodulator placement and is working within their state’s scope of practice.
Scope and supervision rules differ meaningfully by profession and by state, and they change. Nurses in particular should confirm the current position for their licence before adding perioral work: the RN Botox® injection training and scope guide sets out where RNs stand state by state, and nurse practitioner Botox® scope of practice covers the equivalent picture for NPs.
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Frequently Asked Questions
Where exactly do you inject Botox® for a lip flip?
Into the superficial fibers of the orbicularis oris of the upper lip, above the vermilion border — not into the lip body itself. A 2026 prospective study placed two points per side, each about 5 mm above the vermilion border and 10 mm lateral to the philtral column, giving four points in total. The philtral columns and the oral commissures are deliberately avoided, because units placed there flatten the Cupid’s bow or weaken the corner of the mouth.
How many units of Botox® are needed for a lip flip?
Four to six units in total is the range reported across the published literature, and a 2026 prospective study produced a measurable result with just 4 units — 2 per side. Doses toward 10 units are not supported by the evidence and raise the risk of oral incompetence, meaning difficulty whistling, drinking through a straw, or forming certain sounds. Start at the low end and titrate at the follow-up visit.
How long does a Botox® lip flip last?
Shorter than most Botox® treatments. In the 2026 prospective study the effect peaked at about day 15 and had returned toward baseline between 30 and 90 days. Roughly six to twelve weeks is a realistic expectation. The dose is tiny and the orbicularis oris is one of the most continuously active muscles in the face, so the effect fades faster than a glabellar treatment.
Does a Botox® lip flip make lips bigger?
No. This is the most common misunderstanding about the procedure. A 2025 systematic review concluded that the lip flip improves lip contour and fullness without adding volume, and a 2026 study measured no significant change in lip volume. What changes is exposure: relaxing the upper orbicularis oris lets the lip roll outward, increasing visible upper lip height by less than a millimetre. If a patient wants genuine volume, they want hyaluronic acid filler, not a lip flip.
Is the Botox® lip flip FDA-approved?
No. BOTOX® Cosmetic is FDA-approved for glabellar lines, lateral canthal lines, forehead lines and platysma bands. The lip flip is an off-label use, which is legal and common in aesthetic practice but should be disclosed during consent along with the product’s boxed warning about distant spread of toxin effect.
What are the most common side effects of a lip flip?
The characteristic ones are functional rather than cosmetic: difficulty whistling and difficulty drinking through a straw, both named specifically in the published literature and both resolving within weeks. Mild bruising, swelling, temporary numbness and discomfort at the injection site are also reported. Asymmetry and speech changes are placement-and-dose problems rather than inevitable ones — the 2026 study reported none at 4 units with symmetric placement.
Training That Covers Perioral Placement Properly
The lip flip is a good illustration of why injection training has to be hands-on. The dose is trivial, the anatomy is shallow and unforgiving, and the difference between a satisfied patient and a functional complaint is a few millimetres that no textbook diagram can teach you to feel. IAPAM’s hands-on Botox® training is taught by board-certified physician instructors on live models in a clinical setting in Scottsdale, Arizona, with perioral and full-face placement covered as part of the core curriculum.
Pitchford CA, Desrosiers AS, Tolkachjov SN. The lip flip: a systematic review of botulinum toxin lip augmentation. Arch Dermatol Res. 2025;317(1):765. doi:10.1007/s00403-025-04265-0
Germani M, Munoz-Lora VRM, Roschel P, Cotofana S. Lip Flip Revisited: Clinical Outcomes and Neuromodulatory Basis of Upper Lip Eversion. Aesthetic Plast Surg. 2026;50(11). doi:10.1007/s00266-026-05727-0
U.S. Food and Drug Administration. Counterfeit Version of Botox Found in Multiple States. April 2024.
U.S. Food and Drug Administration. FDA warns companies over illegal marketing of Botox and related products. November 5, 2025.
American Society of Plastic Surgeons. 2025 Plastic Surgery Statistics Report. Released September 1, 2026.
BOTOX® Cosmetic Full Prescribing Information, including boxed warning on distant spread of toxin effect.
Disclaimer: This guide is for informational and educational purposes only and does not constitute medical advice. The lip flip is an off-label use of botulinum toxin. Treatment plans, injection techniques, and dosing must be tailored to each patient by a qualified, licensed provider. Always follow product labeling, your scope of practice, and your state medical and nursing board regulations.
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