Dr. Elizabeth Roche of the Elizabeth Roche M.D. MedSpa talks about the key differences between lip filler and a lip flip. Dr. Roche explains that hyaluronic-acid dermal fillers add volume, define the lip border, soften fine lines, and can show immediate results that typically last 6–12 months (or longer depending on product and amount), and can be reversed with hyaluronidase if needed. A lip flip uses a small dose of neuromodulator (e.g., Botox/Dysport) to relax the upper lip muscle so more “pink/red” shows, with results appearing in about 3–7 days and lasting around two months, and it cannot be reversed—only time resolves it. She also discusses gummy smiles and why injector anatomy expertise matters, plus how treatment choice often differs by age, with younger patients frequently preferring a subtle flip and older patients sometimes benefiting from a combination approach.
John Maher: Hi, I’m John Maher. I’m here today with Dr. Elizabeth Roche, founder of the Elizabeth Roche M.D. MedSpa in Bergen County, New Jersey. A medical aesthetics center committed to providing people with the most advanced procedures available to restore youth, while preserving the beauty and functional health of your skin. Today, our topic is lip filler vs. lip flip. Welcome, Dr. Roche.
Dr. Elizabeth Roche: Thank you, John.
What is the Difference Between a Lip Filler and a Lip Flip?
John: So, Dr. Roche, tell me what the difference is between a lip filler and lip flip.
Dr. Roche: Absolutely. A lot of people come in asking that exact question. So, what a lip filler is, is an injection of a gel-based dermal filler that is injected to restore volume or to create volume that was never there for patients who have thin lips. It can help define borders, it can help camouflage little fine lines and it can hydrate the lips as well.
How Fast Are The Results From A Lip Filler?
John: And how soon does a patient see results with a lip filler injection and how long does it last?
Dr. Roche: So, a lip filler injection is immediate results. As soon as we finish injecting, we hand the patient a mirror and they see the beautiful results that have occurred. There might be a slight swelling for 24 to 48 hours.
And then from there on, they can get a longevity between 6 to 12 months and sometimes even more. That all depends on how much filler we’re putting in and the type of filler we’re putting in. Some patients just want a small enhancement, so we use less filler. The less filler we put in, the less likely it’ll last. And sometimes depending on the type of filler we use, there’s different cross-linking of the product. And some may last longer because it’s harder for the body to break down that filler.
What is a Lip Flip?
John: And so, then what is a lip flip?
Dr. Roche: A lip flip is the injection of a small amount of neuromodulator such as Botox, Dysport or Jeuveau, which is injected into the upper lip muscle called the orbicularis oris muscle. This muscle is the muscle that helps us speak. We eat with it, we kiss with it. And when we inject a small amount of neuromodulator in that muscle, it relaxes it. So, the upper lip everts, showing more of the red. So, it’s not a volumization type of injection. It’s more to show the pink or the red of the lip.
Lip Flip Results
John: And do you get the same immediate results with a lip flip like you do with the dermal fillers? And does it last just as long as a lip filler?
Dr. Roche: So, the lip flip takes a few days to come on. It takes about three to five days, maybe seven days to start to see the results of the lip flip. Just the same thing as when we inject Botox or neuromodulators in between the brows, it takes a few days for that muscle to absorb it and for the action to occur.
The duration of the lip flip is shorter than what would last in the Botox or Dysport being injected in the forehead or around the eyes because we need to use such a small amount. If we use too much, then it’s going to inhibit our ability to move that muscle, and it’ll inhibit speaking and eating. So, it’s a smaller dose, and because it’s a smaller dose, it doesn’t last as long as other areas, and it definitely does not last as long as dermal fillers.
So, a patient will get probably two months out of the lip flip injection. It’s great for patients who are looking to just show a little more of the redness, or if they smile and their lip thins out, it helps prevent that thinning of the upper lip when injected in there as well.
Can Lip Flip or Lip Filler Procedures Be Reversed?
John: Tell me a little bit about whether or not the lip flip and the lip filler procedures can be reversed.
Dr. Roche: So, dermal fillers injected anywhere can be reversed. They are made of a substance called hyaluronic acid, and when we put an enzyme in called hyaluronidase, it breaks down the hyaluronic acid and it can either reduce the amount of filler or depending on how much of that hyaluronidase, we can completely remove the filler from a patient.
Sometimes I get patients from other places who’ve had their lips over-injected, so much so that they ended up having migration of the filler outside of their natural lip border, and we have to correct that. And how we correct that is to inject this enzyme to break down the filler. So, the dermal fillers can be reversed.
A lip flip, which is created by Botox or a neuromodulator being injected, cannot be reversed. The only thing that can make that go away is time, really. So, there’s no reversal agent for a lip flip.
John: All right. So, to summarize, lip fillers add volume while the lip flip relaxes the upper lip muscles so that it makes the upper lip evert up to show more of the existing lip. Is that correct?
Dr. Roche: Yes, that is correct. Lip fillers add volume and lip flip shows more red and gives it a flip.
What is a Gummy Smile?
John: Some people have mentioned something called a “gummy smile”. What is that, exactly?
Dr. Roche: So, a gummy smile is when someone has a very strong levator muscle. The levator [labi superioris] is a muscle up here [shows a muscle above the upper lip], and when they smile, their gums show. And there is an injection that can be done in that muscle to relax it so that they’re not pulling so strongly up and showing their gums. Now, it’s very important for the injector to know the difference and know where to inject because if someone is coming in for a lip flip and you hit that levator muscle, just the opposite is going to happen. They’re going to have too much relaxation of their upper lip and they’re going to be upset because they didn’t get the flip. They actually got just the opposite of what they wanted.
John: So, then they try to smile and then you can’t even see their teeth or something like that?
Dr. Roche: Exactly. Yeah, because their muscle in the beginning wasn’t as strong and now we’re putting that relaxation agent in there and now they don’t have the ability to lift their lip up at all. So, you need to go to somebody who has experience in knowing the anatomy of which muscles need to be injected for the correct effect.
Choosing a Lip Treatment
John: So, how do you decide what treatment a patient should have between the lip filler and the lip flip?
Dr. Roche: It’s very interesting. Over the years of my injection experience, lately, a lot of the younger patients in their 20s are coming in and just asking for lip flip. They know what it is, they know what they want. I guess that’s social media that’s helping to educate them. So, a lot of the young patients who have youthful, young lips, they don’t want volume, they just want that little extra show of the red or little pouty look, they’re asking for the lip flip.
Patients in their 40s to 80s usually need a little combination of both. We usually can put a small amount of dermal filler to re-volumize what their lips once looked like, and then putting a small amount of the neuromodulator in just to create a little bit more of a show of the red. And that’s a beautiful combination doing the two of them. But knowing it comes from years of experience, it comes from listening to the patient, it comes from knowing your anatomy, and just experience really.
John: All right. Do you have any final thoughts on lip fillers versus lip flips?
Dr. Roche: I think if you’re interested in having something like that, I invite you to come in and we can assess what your goals are, and we can come up with a treatment plan that would work for you.
John: All right, well, that’s really great information, Dr. Roche. Thanks again for speaking with me today.
Dr. Roche: Thanks for having me, John.
John: And for more information about lip fillers, lip flips, and any of the other types of procedures that are performed at the Elizabeth Roche M.D. MedSpa, visit the website at elizabethrochmedspa.com or