Katie Price and Lauren Goodger – two celebrities who have featured in the media over the last few weeks having undergone the latest aesthetic trend: the butterfly lip treatment.1,2 Following the publicity, many patients have been posting on TikTok having undergone the same procedure. The butterfly lip is an emerging technique, where tape is used as part of the procedure to structure the lip after injection, aiming to provide a more prominent cupid’s bow.3 While this may seem like a solution to our patients for getting that round, plump, fuller lip, I believe that the technique presents some major issues for patient safety and alternatives need to be considered by medical aesthetic practitioners.
The technique
The overall idea of the technique is that the steri strip tape holds the filler in the desired place following injection and prevents migration, keeping the lips looking full and round. It has been noted that the tape is typically left on for 24 hours after treatment.3 I believe that this presents an issue for several reasons.
Firstly, placing tape over injection points is a clear risk for infection. After filler treatment, the area should always be kept clean and sterile, to avoid any bacteria spreading into the injection sites.4
Secondly, it can hide obvious signs of other side effects and complications. For example, the tape will cover things such as blisters or skin surface irritation around the mouth. A main concern here is the potential for it to camouflage a vascular occlusion. In this instance, you may see a slight bruise on the lip, but with the surrounding area covered it is unlikely that the patient will notice (or may misdiagnose) discolouration to the skin around it. With the tape recommended to stay on for a 24-hour period, by the time the patient removes the tape and views what’s underneath, severe damage may have already occurred.
The use of tape may also increase the risk of asymmetry. It’s unlikely that the tape will stay in place for 24 hours, as the patient will be needing to eat, talk and breathe. As such, it will probably move slightly on either side, and not symmetrically. Therefore, the filler will probably mould in a slightly different way on the right to the left, providing an undesirable appearance.
Worryingly, it’s also been highlighted in the media that when performing this technique, practitioners have been dissolving previous filler and reinjecting new filler on the same day, to completely reshape the lip. There is currently nothing to indicate how hyaluronidase and hyaluronic acid interact at such short intervals, and so while the lips may look good at the time, there may be risks associated with the long term effects.1 Hyaluronidase can take up to 48 hours to develop properly, so this leaves no time to know what the end result will be or how much original filler will be dissolved.5 After elective treatment with hyaluronidase, the patient can be assessed after 48 hours and the treatment repeated if necessary. It might take longer than 48 hours for the post-procedural swelling to subside, however no enzyme activity remains at this time and cross-linked HA may be administered without risk of being dissolved. However, the Complications in Medical Aesthetics Collaborative recommends waiting a minimum of two weeks until the swelling has settled, longer in the event of significant post-procedural swelling, to ensure a more predictable aesthetic outcome.5
Consider your position
In General Medical Council guidelines, the first rule for practitioners is to ‘do no harm.’6 With this in mind, it is my opinion that the butterfly lip technique should be avoided by all medical aesthetic practitioners, as we have a primary responsibility to ensure patients are cared for and looked after.
However, I also believe it is inevitable that we will get patients coming in and requesting this look, due to the ongoing social media buzz. Therefore, what we need to consider is how to respond to them appropriately. It’s important to remember that as healthcare professionals, we can always say no. Just because a patient is offering us money, doesn’t mean we should agree to whatever they are asking for. In my view, treatments should not be trends-led, but individual-led. So, we should offer an in-depth consultation where we consider the patients’ full-face and individual anatomy, whether a full lip would be appropriate for them, and provide a discussion of solutions.
If a patient does want a full lip look, and it can be provided without compromising their natural facial structure – there are other techniques for the practitioner to employ that do not pose the same risks to health and safety. For example, I recommend using conservative dermal filler in the lip, as well as very careful and precise placement of neurotoxins at the vermillion border which can very subtly, but effectively evert the lip so that the lip appears more volumised.
If the patient isn’t receptive to alternative ideas and is adamant on trying the butterfly lip technique, there is no shame in telling them that you are not the right clinician for them, as again I believe you should not compromise your own ethics in return for financial gain.
Going forward
While the butterfly lip trend is becoming more popular, it is important to remember your responsibilities as a medical aesthetic practitioner. To provide your patients with the correct care, I believe you should not be performing any technique that increases the potential for side effects and complications. In addition, we are currently unaware of how such a technique performs long-term and so you are putting your patient at risk if you perform it. As such, it is my view that practitioners should offer alternatives to provide them with their desired look, or refuse treatment altogether.
