The Lip Flip for Beautification and Rejuvenation of the Lips

January 2022 | Volume 21 | Issue 1 | 71 | Copyright © January 2022

Published online December 30, 2021

Sahar Ghannam MD PhDa,b, Fotini Bageorgou MDc

aSahar Polyclinic, Salmiya, Kuwait
bAlexandria University, Alexandria, Egypt
cAndreas Sygros Hospital, University of Athens, Athens, Greece

Background: The lower third of the face, especially the lips, offer a pivotal contribution to the overall facial appearance. Hyaluronic acid fillers are widely used for lower face support and beautification.
Objective: This study presents a novel perioral rejuvenation technique. 
Methods: 70 females were enrolled in the study. The injection technique utilized cannula with bilateral single-entry points. Two different evaluation systems were used.
Results: In the upper white lip area, the distances exhibited significant shortening difference before and after treatment in both age groups (P<0.001 for all measurements). Improvement was generally higher among patients injected more than one session. In the lower white lip and chin, the agreement level by physician and patients was fair (P<0.001) while by observers and patients was moderate (P<0.001).
Conclusions: The lip flip technique is a novel, safe and effective additive for perioral rejuvenation.

J Drugs Dermatol. 2022;21(1):71-76. doi:10.36849/JDD.6344R1


The lower third of the face is a barometer of both the biologic and physical aging, also reflecting the person’s emotional status. Facial expressions and communication are linked and involve muscle and soft tissue dynamics, which are prominent in the lower face.1 A combination of extrinsic and intrinsic factors contribute to a gradual and progressive deterioration of this area’s clinical appearance. Aging impacts expressiveness due to the creasing of the skin, the slackening and drooping of the soft tissues, the muscle hyperactivity and the bony loss over time.2 Among other age stigmata, this loss of structural support, results in the elongation of the upper white lip and flattening of the vermillion border, forming the depressed lip triangle. Additionally, it accentuates the appearance of the chin shadowing, creating the nasolabial and labiomandibular folds.3,4

Nowadays, injectable hyaluronic acid (HA) soft-tissue fillers have gained ground and became popular and widely used treatments for ameliorating aging changes.5 Injectable fillers replace the structural support and volume loss, trigger collagen stimulation, reshape the facial contour and reduce perioral lines, offering a youthful and beautiful appearance.6 Lip fillers are a big demand from patients. Some of them do need big voluminous lips, yet there are a good percentage of patients who still require a natural lip enhancement without the necessity of a big volume. Candidates for this innovative approach we propose in this article, other than mature patients with evident aging stigmata, are patients with abnormalities such as gummy smile or asymmetries and individuals who desire mild lip volume enhancement or even a smooth improvement of the area in terms of beautification.


Patient Selection
The injection procedures were performed between June 2019 and January 2021, 70 female patients from Middle East (Kuwait) and Central Europe (Athens, Greece) were enrolled in the study. Exclusion criteria were pregnancy, use of anticoagulant drugs, hematological diseases and history of allergy or hypersensitivity to injectable hyaluronic acid, and/or lidocaine anesthetics. All patients were photographed prior to the procedure; follow up photos were taken one month post procedure. All participants signed an informed consent. Based on their age, and in order to assist the statistical analysis, patients were divided into two groups, young females and mature females using as cut-off criterion the age of 40 (≤40 or >40 of age).

Injection Technique
A topical antiseptic octenidine based agent was applied to disinfect the skin prior to the injection. The cannula entry point was determined by measuring 1 cm laterally to the lip commissure on the lower edge of the nasolabial fold and a 25-gauge needle is inserted perpendicular to the skin and withdrawn. A 25 G/40 mm cannula is then being introduced into