The Ultimate Guide to Lip Fillers

Lip fillers are a popular cosmetic procedure used to improve the appearance of the lips by adding fullness, shape, and structure. Filling can decrease lip asymmetry and thicken thin lips for a stronger lip profile. The most common means of using this procedure is injecting filler beneath the surface, or around the edges of the lips.

There are a variety of different substances used to make lip fillers, but the two most common include collagen and polyacrylamide. These have historically been a popular choice for first time lip filler users. However, most modern procedures tend to use hyaluronic acid-based fillers. Hyaluronic acid-based fillers are preferable due to their excellent results, safety, reversibility, and for a lack of any serious detrimental side effects. Hyaluronic acid is also a superb choice because it already naturally occurs in the body as a component of skin and cartilage. Hyaluronic acid’s purpose is to bind water and swell, and as a result it can provide hydration where applied. [Ref. 1] In a study completed by Allergan for Juvéderm Volbella, hyaluronic acid was shown to present improvements that could last up to one year for the lips. [Ref. 12] Hyaluronic acid is created by fibroblasts in a system of cytoplasmic proteins existing on the plasma membrane that are called hyaluronan synthases. Hyaluronic acid is a component of the extracellular matrix and it is what allows the lips to form a gel-like consistency which can withstand compression and significant movement. [Ref.13]

Different fillers also have different lifetimes. Hyaluronic acid lasts from a half year to about a year. Calcium hydroxyapatites last up to 18 months. Poly0L-lactic acid can last up to two years. However, polymethylmethacrylate beads cannot be absorbed by the body and so these fillers are completely permanent. [Ref. 14]

The first hyaluronic acid medical serum for sale, named Healon, was originally created as an eye-surgery aid to use in segment procedures after retinal detachment surgery. It has also been used in the past to treat osteoarthritis of the knee as a joint fluid supplement and is usually applied by injection to the knee joint. Hyaluronic acid fillers have been available in European countries since 1996 and the FDA approved it for this purpose in the US in 2003. [Ref. 13]

It is also possible to get permanent lip enlargement by using the patient’s own tissue, but this is slightly more dangerous than injections or subcutaneous fat insertion. This tissue is generally harvested from other procedures like abdominal reduction, facelift, or breast reduction. The outer skin of the lip is taken off and the newly shaped skin is grafted to your lip area to achieve the desired effect. Additionally, one can also do a fascia graft to move muscle covering to the lip area, however, this also carries significant risks as well. This procedure uses skin grafting to shift the shape and size of the lips. [Ref. 7] The orbicularis oris muscle is what makes up the lip and is divided into a superficial and deep part. The anchoring feature of this muscle is what allows it to work so well a connector and maintain tension in the face. [Ref. 12] Other procedures include Dermalogen, Autologen, and HylaForm. Dermalogen is composed of human tissue matrix that is obtained from donor tissue, and it is injectable. Autologen is composed of material derived from patient skin. HylaForm is made of molecular components of the body and is considered a donor tissue that can be injected. [Ref. 16]

There are also several strategies and methods for enlarging lips. If injections are used, they are typically promoted under the white hair line that outlines the vermillion of one’s lips. This method creates a pouting lip look. However, when collagen or fat injections are used, these can improve the bulk of the lip overall by injections placed throughout the lip. [Ref. 7] There several different injecting techniques that will allow your dermatologist doctor to augment your tissue. These techniques include depot technique, tunnel injection, and stamp injection. Depot goes to the center of your tissue, tunnel outlines your lip structure linearly, and stamp technique injects deep tissue first and slowly raises it to create a vertical deposit of injection serum. [Ref. 12]

If you want to complete a lip filling procedure, it is important to think about the potential appearance you want for your lips. Providing a clear set of expectations will allow your doctor to choose the right brand and procedure that will help you reach an optimal outcome. You should also inform your physician if you use nonsteroidal anti-inflammatory drugs or if you have a history of cold sores prior to undertaking this procedure. [Ref. 2] Another way in which your doctor can minimize the potential of thrombosis is through the location of injected serum post-procedure using ultra-sonography. [Ref. 12] Lip fillers are considered some of the most popular cosmetic procedures available, and they have only risen in popularity since 2015. Google searches for this procedure have risen by over ten times since 2015. [Ref. 6]

Injectable lip fillers were first created at the beginning of the 19th century and were made of fat. However, at the time this was not used for cosmetic purposes and was part of a reconstructive surgery for tuberculosis patients. Later, however, doctors became to experiment with the possibility of using it as a cosmetic procedure and it then came into vogue. However, in 2015, lip filler sales skyrocketed due the admission of reality television star Kylie Jenner that she had used lip fillers extensively. [Ref. 6] Jenner, who owns the company Kylie Cosmetics, also sells a variety of lip products and due to the popularity of her lip kits, her choice to get fillers has also been popularized in tandem with her products. [Ref. 10]

Social media has played a meaningful role in the boom for lip fillers, with many celebrities and influencers advocating to make these treatments more normalized and mainstream. Statistics for use are limited in the United Kingdom due to the lack of regulation for non-surgical procedures, but in 2015, at least 27,000 Americans completed a lip filler treatment. However, a downside of this boom is that young people are attempting to get these fillers cheaply and as a result are undergoing botched procedures. [Ref. 9]

A huge factor in the dramatic rise of the use of lip fillers is the ability to be completely transparent and present yourself through social media. Additionally, videos of cosmetic procedures can now be shown in full online, and this lessens the fear factor of going in to get a procedure completed yourself. However, despite added awareness of the procedure, most information online does not point young people as to how to discern the best practitioner they can work with and how to distinguish between genuine vs. bargain fillers. [Ref. 21]

However, there have been some disturbing variants of lip fillers over the course of the 1900s. In 1906, doctors attempted to inject liquid paraffin in the lips unsuccessfully. In the 1960s, liquid silicone was used, but concerns about the safety of silicone eventually cause the abandonment of this practice. Later, bovine collagen began to come into use, but allergy tests were required prior to treatment and this made administering the collagen difficult. [Ref. 9] The most significant problem with fillers of the past is that were completely synthetic, and this typically doubled risks of infection, rejection, and need for removal. [Ref. 17]

Prior to any procedure completed, your doctor will anesthetize the lip area, or will perform the procedure with a hyaluronic filler with anesthetic premixed, to minimize and mitigate any potential risk of pain. It is common after completing this procedure to have some swelling, discoloration, or bruising. While serious complications are rare, complications can include nodules below the point of injection. [Ref. 1] It’s important to abstain from ingesting aspirin, fish oil, Motrin, Vitamin E, or multivitamins prior to getting your lips filled, because these supplements can act as blood thinners and cause bruising. [Ref. 5] There is also a mild rick of getting vascular occlusion, which is technically blood vessel blockage, and can potentially cause tissue death. [Ref. 8]

Lip fillers should be re-completed periodically to maintain or increase the impact of a procedure. The most effective lip fillers can last for up to three months; however, this can vary from brand to brand. [Ref. 3] You can choose to have either injected or surgical lip fillers. Injection fillers are composed of hyaluronic acid, and so the body will naturally metabolize it over time, and it will fade away slowly on its own. However, surgical fillers are somewhat more permanent, and they are accomplished through repositioning one’s own fat or through surgical realignment of lip margins. [Ref. 4] However, if you’re unhappy with the look of a lip filler, and it is injected rather than surgical, it is possible to have it dissolved quickly. Your aesthetic doctor will inject hyaluronidase, an enzyme that melts away hyaluronic acid if you choose to reverse the filler. [Ref. 5] However, research exists that has shown that injecting your lips improves natural stimulation of collage production. [Ref. 8]

There are a variety of lip filler brands to choose from if you decide to get a less invasive treatment. These brands include Restylane, Volbella, Restylane Silk, and Juvéderm. Typically, Restylane is a good option for older patients who are looking to slightly reshape and redefine their lips. However, for plumping younger people’s lips, she recommends Juvéderm Volbella. [Ref. 8]

There is research that suggests it is best not to get lip fillers or any type of facial fillers at a young age. It is possible if you get too much, too soon, you can end up looking much older than you are. However, it is possible if one has a deformity or imbalance to use lip fillers for corrective purposes rather than overuse fillers for cosmetic purposes. Additionally, starting earlier is problematic because it can set you on a repetitive course of continuing to need and use these injections for life. It is not desirable to use fillers for such an extended period, as fillers were not designed for such repetitive and extreme use. It can also have the impact of unnecessarily aging a young face before its time. The need for constant maintenance can also add to feelings of heightened social expectations and does not act as a substitute for good lip care. [Ref. 20]

There are potential risks to repeated use of injectable lip fillers. The filler can act to expand tissue, and over time, it could stretch the skin permanently. This can cause your lips to sag and deflate at an alarming rate after the filler eventually dissolves entirely. [Ref. 11] The potential for this to happen occurs because doctors typically feel the lip for an ideal injection site but cannot determine the exact position the injected filler ultimately takes. [Ref. 12] Additionally, if any bumps appear below the surface of your lips, this means that the filler may have been placed a bit too close to the surface and you may want to work with your doctor to resolve this problem. It is also helpful to avoid using numbing cream after this procedure, because the numbing cream can cause your lips to swell significantly and will make it difficult to ascertain the true outcome of the procedure. Although it is technically considered a cosmetic procedure, it is important to remember that they are a prescription-level treatment and should not be taken lightly. [Ref. 20]

References: