Can a Botox lip flip affect cheeks when smiling?

Question

Hi Doctors. I’ve had both lip filler and Botox “lip flip” at different times in the past. In deciding what to do in the future, I’m wondering: can Botox for a lip flip affect how the lower cheeks look/move when smiling? I only had 4 units and it had a great effect on making my top lip not disappear when smiling, but my lower cheeks, around the nasolabial area, looked weird when I smiled. Is this a thing? Also: how long does 4 units typically last for this? Thanks!

Amelia Damse, DO · Answer

When botox is injected into a muscle, it causes that muscle to relax. Since muscles in our face move together to make facial expressions, paralyzing/relaxing one of the muscles may lead you to use other muscles more than before injections to compensate for the lack of muscle movement in other areas. Typically botox injections last around 3 months, but this can be different for different patients depending on their body's metabolism.

Christine Bokman, MD · Answer

I love the Botox lip flip and it is a great option for patients who feel their upper lip disappears when they smile. Botox can diffuse or move to other muscles that are involved in smiling. When I inject the muscle around the lips for a lip flip, I inject the product very superficially so it does not affect the other muscles that are involved in smiling. If the product is injected too deeply or too much product is injected, it can move and affect other muscles. Luckily this is an effect that lasts only 3-4 months. Next time, I would recommend letting your injector know what you are experiencing so that they are extra precise and careful with their injection and in staying in the correct zone for the beautiful Botox lip flip.

Dean P. Kane, MD, FACS · Answer

Dear Ginger_Snap123, 
This is a very intuitive observation! 
Yes. If the botox is injected too far laterally on the lip, it will affect unintended muscles causing the lateral lip corner to drop; ie, frown. 
The complex functional and expressive muscles (spokes) around the corner of the lip (hub or modiolus) will be rebalanced by the botox. If the zygomaticus muscles are weakened, the modiolus will descend and create a deeper marionette fold and “frown-like” expression. 
This is not unlike the desired effect of softening the DAO (depressor anguli oris) muscle spoke to allow the modiolus to elevate the lateral lip, ie. smile lift. 
I hope this is helpful. It will reverse in 3 to 4 months. Be patient and keep smiling! All the best!

Rita Rakus, MBBS - Account Suspended · Answer

Hello and thank you for your question. It is always best to see you face to face for a consult and examination however in this case yes it is possible for botox around the mouth to affect other areas close by. 4 units is a relatively low dose so after 6 weeks or so the result will begin to fade. I hope that helps answer your question. Always seek an experienced and qualified medical professional for these treatments. Very best wishes

Can a Botox lip flip affect cheeks when smiling?

Answers (4)