{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T15:43:51Z","timestamp":1782747831001,"version":"3.54.5"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universidade Universus Veritas Guarulhos"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Aesth Plast Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>The lip flip procedure, involving intramuscular injection of botulinum toxin into the orbicularis oris, has gained popularity as a minimally invasive alternative to lip fillers. In this prospective study, 17 women underwent standardized upper lip neuromodulation with 4U of onabotulinumtoxinA. Objective evaluation by stereophotogrammetry demonstrated a modest but significant increase in upper lip height at 15 days (p=0.011), with no change in lip volume. Patient-reported outcomes showed significant improvement in perioral appraisal scores (p&lt;0.001) and high satisfaction (FACE-Q mean = 79.2 \u00b119.9; GAIS median = 1). All adverse events were mild and transient, including temporary numbness and functional limitation, resolving spontaneously within 30 days. These findings confirm that lip flip enhances lip projection through selective neuromodulation, not volumetric augmentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evi\u201edence IV<\/jats:title>\n                    <jats:p>\n                      Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/www.springer.com\/00266\" ext-link-type=\"uri\">www.springer.com\/00266<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00266-026-05727-0","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:59:55Z","timestamp":1774969195000},"page":"4437-4440","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lip Flip Revisited: Clinical Outcomes and Neuromodulatory Basis of Upper Lip Eversion"],"prefix":"10.1007","volume":"50","author":[{"given":"Marcelo","family":"Germani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-8542","authenticated-orcid":false,"given":"Victor R. M.","family":"Munoz-Lora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pietra","family":"Roschel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Cotofana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"5727_CR1","unstructured":"American Society of Plastic Surgeons. 2024 ASPS procedural statistics release. 2025."},{"key":"5727_CR2","doi-asserted-by":"publisher","DOI":"10.1007\/s00403-025-04265-0","volume":"317","author":"CA Pitchford","year":"2025","unstructured":"Pitchford CA, Desrosiers AS, Tolkachjov SN. The lip flip: A systematic review of botulinum toxin lip augmentation. Arch Dermatol Res. 2025;317:765.","journal-title":"Arch Dermatol Res"},{"key":"5727_CR3","doi-asserted-by":"publisher","first-page":"e273","DOI":"10.1097\/SCS.0000000000007128","volume":"32","author":"JC Teixeira","year":"2021","unstructured":"Teixeira JC, Ostrom JY, Hohman MH, Nuara MJ. Botulinum Toxin Type-A for lip augmentation: \u201cLip flip.\u201d J Craniofac Surg. 2021;32:e273\u20135.","journal-title":"J Craniofac Surg"},{"key":"5727_CR4","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1111\/jocd.13731","volume":"20","author":"Y Li","year":"2021","unstructured":"Li Y, Chong Y, Yu N, Dong R, Long X. The use of botulinum toxin A in upper lip augmentation. J Cosmet Dermatol. 2021;20:71\u20134.","journal-title":"J Cosmet Dermatol"},{"key":"5727_CR5","unstructured":"Jain P, Rathee M. Anatomy, head and neck, orbicularis oris muscle. In: StatPearls. Treasure Island, FL: StatPearls Publishing. 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK545169\/."},{"key":"5727_CR6","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000004430","author":"M Germani","year":"2024","unstructured":"Germani M, et al. Unveiling patient expectations: insights from a cross-sectional study on facial aesthetic treatments. Dermatol Surg. 2024. https:\/\/doi.org\/10.1097\/DSS.0000000000004430.","journal-title":"Dermatol Surg"},{"key":"5727_CR7","doi-asserted-by":"publisher","DOI":"10.1007\/s00702-024-02835-6","author":"VRM Munoz-Lora","year":"2024","unstructured":"Munoz-Lora VRM, et al. Understanding clinical meaningfulness when targeting the depressor anguli oris muscle (DAO) with neuromodulators: a clinical prospective interventional study. J Neural Transm. 2024. https:\/\/doi.org\/10.1007\/s00702-024-02835-6.","journal-title":"J Neural Transm"},{"key":"5727_CR8","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.70188","volume":"24","author":"VRM Munoz-Lora","year":"2025","unstructured":"Munoz-Lora VRM, et al. Continuous improvement of frontal rhytids following glabella only treatments with neuromodulators\u2014a clinical prospective pilot study. J of Cosmetic Dermatology. 2025;24:e70188.","journal-title":"J of Cosmetic Dermatology"}],"container-title":["Aesthetic Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05727-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00266-026-05727-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00266-026-05727-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:44:22Z","timestamp":1782744262000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00266-026-05727-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":8,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["5727"],"URL":"https:\/\/doi.org\/10.1007\/s00266-026-05727-0","relation":{},"ISSN":["0364-216X","1432-5241"],"issn-type":[{"value":"0364-216X","type":"print"},{"value":"1432-5241","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"assertion":[{"value":"16 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 March 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflicts of interest to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"This study was approved by the Research Ethics Committee from the UNESP, Ara\u00e7atuba,\u00a0S\u00e3o Paulo  (CAAE: 83475424.1.0000.5420) and conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Written informed consent was obtained from all individual participants included in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}