Treatment Plan for Xeomin Lip Flip
For a lip flip procedure using Xeomin (incobotulinumtoxinA), inject 4-6 units total into the orbicularis oris muscle, divided between 2-4 injection points along the vermilion border of the upper lip. 1
Injection Technique and Dosing
Specific Injection Protocol:
- Injection sites: Target the orbicularis oris muscle along the vermilion border
- Needle size: Use a 30-gauge needle for precise placement 2
- Dosage: 4-6 units total, typically divided as:
- 1-2 units per injection point
- 2-4 injection points across the upper lip
- Depth: Inject superficially, above the orbicularis oris muscle for vessel safety 2
- Technique: Use a retrograde injection technique for even distribution
Anatomical Considerations:
- Focus injections at the vermilion border where the orbicularis oris muscle functions as a sphincter
- Avoid injecting too deeply or too close to the wet-dry border to prevent complications
- Space injection points approximately 0.5-1 cm apart for optimal effect
Expected Outcomes and Timeline
- Onset of action: 3-5 days after injection
- Peak effect: 10-14 days post-treatment
- Duration: Effects typically last 2-3 months 3
- Expected results:
- Subtle eversion of the upper lip
- Enhanced lip contour without added volume
- Reduction in gummy smile (if present)
Safety Considerations
Potential Side Effects:
- Temporary difficulty with certain oral functions:
- Drinking through straws
- Whistling
- Pronouncing certain consonants (p, b, m)
- Asymmetry (if injection placement is uneven)
- Bruising at injection sites
- Mild discomfort during injection
Risk Mitigation:
- Start with conservative dosing (4 units total) for first-time patients
- Avoid injecting too close to the corners of the mouth to prevent drooling
- Maintain at least 0.5 cm distance from the wet-dry border to prevent functional impairment
- Avoid in patients who rely on precise oral motor control (e.g., professional wind instrument musicians)
Follow-up and Maintenance
- Schedule follow-up assessment 2 weeks after initial treatment
- Assess for desired effect and any adverse events
- For maintenance:
- Repeat treatments every 2-3 months as effects wear off
- Consider adjusting dosage based on individual response
- Document treatment response with standardized photography
Comparison with Alternative Approaches
The lip flip offers several advantages over traditional lip augmentation with fillers:
- Less invasive with minimal downtime
- Lower cost
- More subtle, natural-looking enhancement
- Lower risk of vascular complications
However, it's important to note that:
- The lip flip does not add volume like fillers do
- Effects are temporary (2-3 months)
- Not suitable for patients seeking significant volumization
Clinical Pearls
- Xeomin has demonstrated comparable efficacy to other botulinum toxin formulations with a 1:1 conversion ratio to Botox 4
- Patient education about temporary functional changes is essential for satisfaction
- The procedure works best for patients with adequate lip tissue who desire subtle enhancement
- Consider combining with minimal hyaluronic acid filler for patients seeking both eversion and volume
- Avoid excessive dosing, which can lead to functional impairment and patient dissatisfaction
By following this protocol, you can provide safe and effective lip enhancement using Xeomin for the lip flip procedure, with high patient satisfaction and minimal risk of complications.