Thin and sausage looking lip when smiling - what treatment would help me achieve my goal? (photo)

Question

Hi there. I am looking to enhance my lips. When I smile my upper lip gets thin and sausage looking. I would like it lay flat and be wider. Would Botox, a lip flip, or filler help me achieve this goal? I also have migrated filler from a previous lip filler from 3 years ago that I will get dissolved before getting any more filler. Thanks!

Nima Shemirani, MD · Answer

Hi @Straightforward571500! Thank you for sending your photos. I would recommend dissolving your lips and starting with a fresh canvas. A lip flip will not add volume. Thus, I recommenced 1 syringe of Restylane Kysse. Best Wishes, Dr. Nima!

Jonathan Kulbersh, MD · Answer

If volume is your primary concern, you are likely to see the most satisfying results from a bit of well-placed filler. I would recommend dissolving the former filler first to ensure the most precise results. Make sure your injector is both qualified and experienced in administering lip filler to ensure the best possible result.

Nelson Castillo, MD · Answer

Thank you for sharing your question. I would likely recommend a combination of thin dermal HA filler with conservative botox placement as part of a lip flip.  Hope this helps.

Jason Emer, MD · Answer

you will need a lip lift to give your lip more show and improve the border. fillers will give you shaping and volume but at this anatomy there isnt much improvement you can get with the lip you have. consult us.

lip fillers and lift will not help the corners of your mouth, that needs botox, threads or a lip corner lift.  sometimes an early face/neck lift helps. accutite can be a non invasive alternative. I would use daily hydration and plumping (see emeragecosmetics lip essentials kit).  everyone can do a little filler when done well really gives nice hydration and plumping.  Best, Dr. Emer.

Daniel Barrett, MD · Answer

Dear Straightforward571500,
I perform a lot of lip injections with fillers such as juvederm and it works great. Many times I need to put more in one side than the other to attempt to even out the vermillion border (The red line of the lip). This helps provide more symmetry at times.For patients looking for a more long lasting result, I recommend fat grafting. That is, using your own bodies fat to make your lips naturally look more shapely. The bonus is that the results last many many years.
In general, I avoid using permanent prosthesis because I find that the lips are such dynamic and sensitive structures, the end result is not natural.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Andrew M. Ress, MD · Answer

You can use Botox for a lip flip which will make your top lip appear slightly wider when smiling or the best option would be a lip filler. You can even do a combination of both.

Joel L. Cohen, MD · Answer

I would use Restylane Kysse specifically, and place it very carefully in the lip quadrants with attenuated volumes going laterally. I teach courses in this regularly, and you need to see a skilled CORE aesthetic doctor (board certified derm or facial/oculo-plastics) for these injections. Don’t focus on doing it all in one day, as volume is best done in stages to make sure you like how it looks and at the same time folks close to you verify that it looks “natural”. 
But if there is something you don’t like right now like for-existing nodules &mdash; I would try to dissolve first. But if really 3 years old, not all of this may dissolve (as there is neo- collagenesis from old filler that can’t be dissolved). Sometimes this is actual fibroplasia. 
Take it from me (and I wrote the current largest book on Botox and other Neuromodulators) the “lip flip” isn’t a reliable and predictable procedure &mdash; it only flips a small number of patients, and flattens or makes others feel weird trying to engage oral competence (like pursing).

Ian Lehrer, DDS · Answer

I would consider returning directly to your injector and see if the filler is dissolvable. After that, bring in pictures to show your injector what you have in mind. Botox would allow your lip to lay flatter, but will not add any volume to your upper lip. For that reason, I'd suggest a filler.

Vibha Gambhir, MD · Answer

Hi! Thank you for your question. Botox ''lip flip'' is a good choice to relax the muscle above the lip if you are looking for more pink show and yes, to prevent the lip from "curling" under when smiling..giving the appearance of a fuller lip. The amount of units used is a very small amount (4-6 units to start) because the muscle above the lip is used all day and therefore we cannot weaken those muscles the same as we would the upper face. That being said, it typically does not last as long as the areas that are able to take full doses of botox, but is most definitely worth talking to your provider about and can be done in conjunction with filler to achieve the results you are looking for.  As for the migrated filler, hyaluronidaise would most definitely be a good option to dissolve or smooth out the product above your lip and could also be the cause of your lip looking "sausage like" or flat. Hope this helps!

Thin and sausage looking lip when smiling - what treatment would help me achieve my goal? (photo)

Answers (9)

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