One of the most requested augmentations in the medical aesthetic and plastic surgery industry involves addressing the lips. I say augmentation because addressing concerns about lips can be a multi-faceted approach. It could include addressing pigmentation with cosmetic tattooing, relaxing an inward roll and correcting a gummy smile with Botox, balancing symmetry, smoothing age/smoker lines, and/or adding volume.
What is lip filler?
Lip fillers use (typically) a hyaluronic acid filler product injected by a trained medical professional into the lips. You may have heard of Juvederm or Restylane. These are popular hyaluronic acid products in the U.S. Hyaluronic acid is a hydrophilic (water-loving) compound which our own bodies create to keep us hydrated and plump. The filler creates volume on its own, but also attracts water from its surroundings, creating a hydrated, plump and therefore youthful appearance. Hyaluronic acid comes in all sorts of products including supplements, injections for joints, topical creams and fillers which can be used for facial rejuvenation.
Lips can also be augmented in other ways such as a lip lift which is surgical, or other materials such as fat transferred from your own body and silicone. Silicone has long since fallen out of favor; once touted for its permanence, this is now a major reason for shifting focus away from this technique due to its complications over time. The benefits of hyaluronic acid fillers are that they are a more naturally occurring substance which can be dissolved rather immediately in case of adverse effects or emergent complications. And much like fashion, trends (and even our own anatomy) change over time which may require a different aesthetic approach. Lip fillers have a great bang for their buck and minimal risks in the hands of a talented injector. Done well, augmenting the lips can give a subtle enhancement to the face.
Who is a candidate for lip fillers?
As mentioned above, lip fillers are one of the most requested treatments because lips are so visible, and check the box for so many purposes in patients young and mature.
- More volume. The obvious choice is for someone who wants more volume in their lips. What that means can be different for each person. Some have thin lips and just want a tiny bit to even out the facial profile. Some have great lips and just want an extra plump. The great thing about hyaluronic acid fillers are that there are products designed for the spectrum of looks – soft, slightly bigger with lots of hydration, structured and defined, puffed and pouty.
- Balance. Everyone is asymmetrical. Lip fillers can be artfully placed to balance out asymmetries and camouflage other areas. From the side, they can better align the angle from the tip of the nose to the chin. From the front they can emphasize or detract from features. I’m a great example of this. I was blessed with a large nose right front and center. Larger lips trick the eye so that it doesn’t stand out QUITE as much (it still stands out trust me!) but minimizes the largeness of one feature versus another. I also have asymmetrical lips because I was a sun worshiper and habitual lip picker. Lip fillers helped to provide structure on the one side that is smaller to give me a more even look.
- Anti-aging. I tell my patients our skin is like a balloon. When we are young, it is full of air (collagen, hyaluronic acid, fibrin and elastin) stretched and full and bouncy. When we age, that balloon is still there, but the air is going out. A little bit of air is not noticeable, however over time we start to see the balloon get saggy and deflated. Lips work the same way. As we age we get “smoker lines” (which are expression lines from making a pouty face, or smoking), the crispness of our borders diminishes from loss of volume and pigment loss, and our philtrum (the two columns that make up our Cupid’s bow), elongates. Lip fillers can fill up that lost volume and give a more youthful appearance to the area. Lip fillers in conjunction with a neuromodulator like Botox or Dysport, called a lip flip, can relax the pout to prevent and stop lines from progressing.
Do your research
I cannot stress how important it is to do your research. Although it seems like no big deal these days, it is. Look up reviews, and check Facebook and Instagram just like you would for a hair stylist. Lips are one of the most artful injections in my opinion. Different techniques offer different results. Some are more subtle, others not so. If you find yourself excited over the shapes you’re seeing, book a consult. If you find yourself going ohhhhh nope what is the heck IS THAT. Move along. Keep in mind that there are limitations with your own anatomy. Some things are achievable and others are not. If you have a look you like, bring it and an open mind with you. Rome wasn’t built in a day, and neither are those multi-syringe lips you may be drooling over. It takes time to build, and slow and steady wins the race.
What to expect
Your provider will assess your anatomy, and after consulting on what your desired outcome is, suggest what product is best. Some fillers have more structure, others softness, and other volume. Some are best for building versus defining. Some techniques are best for exactness versus symmetry. They will also be looking at your face at rest, smiling, kissing, and a variety of poses. Our lips change dramatically during these movements, and you’ll be asked to continuously make them throughout your treatment as the filler is placed.
A topical numbing agent is typically used. Most lip fillers also include lidocaine in the syringe. Expect a little bit of a bell curve of discomfort. The first few pokes my feel like a searing pinch but as the lidocaine is laid the lips feel more numb. Then after they’ve been poked a few (or many) times, they may become a little more tender towards the end.
Expect a hilarious amount of bruising and swelling and be pleasantly surprised if this isn’t the case for you. Of course that is never the goal your providers strives to achieve, but multiple pokes, harsh disinfectants and a new product that is going to take that fluid caused by your own swelling and swell even further, it is safe to say that you should invest in a nice plum lip color and hide behind your mask for a few days.
Recommendations to pre-treat 48 hours in advance up to your appointment: Tylenol every 4-6 hour as directed (NOT ibuprofen as this is a blood thinner that will increase bruising). Bromelain (fresh pineapple), vitamin K and arnica topically or by mouth. A good 2-3 days of downtime. You’re not hiding this from anyone.
Avoid 48 hours before and after treatment: blood thinners, alcohol, vitamin E, anything that increases circulation (exercise, caffeine, heat), irritating lip products (e.g. lip plumpers or staining lipsticks). Wait for at least a week for any professional massage or large amount of manipulation/pressure to the area.
Contraindications: bleeding disorders, auto immune disorders, cancer of the mouth, pregnant or breast feeding, active cold sores or shingles on the face, dental appointments within the last 2 weeks.
Very important: let your provider know if you have ever had a history of cold sores or shingles on the face as you will need to pre/post treat appropriately.
Risks. Although generally minimal, they are there. Bruising, swelling, pain at the site are all things to expect. There is a risk of vascular occlusion (product injected into a major vessel) which is definitely a bad thing. As I mentioned these products are dissolvable, but they are not without risks. Make sure your provider discusses these with you, how their technique helps to limit the risks and what they will do if something like this happens.
My lip filler experience
You’ve made it this far in my long post (thank you), so let’s get to it.
I didn’t necessarily NEED lip fillers, but because I offer this to my own clients I decided to give it a whirl so that I could better educate on the process and expectations. My face happens to be very asymmetrical and although my lips have decent shape and volume, my smile has always been crooked exacerbated by damage of a muscle and a scar from a mole I had removed on my chin many years ago. I also hardly ever wear lipstick because the shape is hard for me to navigate; one side was more rounded and the other pointed. I have a wide nose which dominates this lovely facial canvas. My lips are also chronically dry and dehydrated. I’ve lost some volume due to age and sun damage.
I don’t look like the ogre I might have just described. But my face could use some balance by addressing my lips.
I went to a friend and expert injector. Not only do I love her work, but I know her technique which she uses to help minimize the chances of complications. After reviewing my photos, addressing my anatomy and what I was looking for, she decided on a product that will give volume to fill out areas that are deficient to balance my asymmetry, but also some rigidity to better define my lip borders. She chose Restylane Kysse for me, which is a newer filler to the market and touts to be both moldable and strong.
She pointed to my areas of concern and what could be done with the appropriate amount of the 1mL syringe I purchased. Most would go in my top, some to balance out my “pillows” would be used in the bottom. More on the right because volume already looked good on the left, and higher “tent poles” on the left for the side that was rounded compared to the other that was more pointed. She said she typically does not inject further towards the ends of the lips, but because I was blessed with large features (ahem I have a big nose) I could handle a bit more of a wider lip.
We started off with a topical numbing agent which was slathered on. I appreciated being numb, and over time I couldn’t feel the inside of my mouth or my tongue. Unintended drooling may have also been a factor. This brings up an important piece to aftercare. Since you may be numb for a bit, be careful of chewing, spicy or hot foods, holding a cold pack on your lips for too long, and generally anything that may zing your lips or mouth afterwards. Be kind. They will have been through enough.
Time to poke
We discussed my areas of concern and that I would be treated with what was appropriate of the 1ml syringe I purchased. My provider tilted me back and away she went. I felt slight pinches in some areas, but that quickly dissipated once the product (which contains lidocaine) was injected. There was a lot of stopping and asking me to pout, smile, smile some more, BIG SMILE (was I even smiling? I’m not sure), look straight ahead… I loved this because all angles were being considered.
Much like taking a toddler to the grocery store, you have a finite amount of time to mess with them until the swelling takes over and skews the results. Your provider should work diligently, but also efficiently. There is also a fine line between extra pokes to get the job done perfectly, and too many pokes. All of this comes into play when addressing the lips.
I’m well versed in this and have seen it hundreds of times. Experiencing it is another level. There is a HUGE curve to lip treatments and recovery. And let me tell you, when I looked initially in the handheld mirror my lips were also huge. I also made a rookie mistake of forgetting that I was using ibuprofen for a few days which increased my recovery time. Do as I say, not as I do.
I looked like a doll. As I mentioned before, the swelling was hilarious. I looked like me, but a sort of animated, exaggerated version of me. And you know what? I didn’t care one bit because that’s the way it goes. But you need to mentally prepare yourself. Almost every single person says, “Oh wow they look huge! I wanted subtle, I look ducky.” This is totally normal lip behavior and chances are if you like your subtle, plump look immediately afterwards, your results will be unremarkeable once the two weeks of settling has occurred. You can expect your results to be 30-50% from your baseline with one syringe depending on the product used.
The next day I looked even more hilarious. My lips were red. They were spotted from little bruises like a speckled egg. One side was puffier than the other. They were tender. I had little lumps that I massaged with a wince. But again, I knew what to expect so I wasn’t phased. Trust the process, but also know this is not something you head right back to your Zoom meeting and no one notices.
It took about seven days for everything to settle down a bit. I did experience a few bumps that only I could feel, and I massaged them out.
Here’s my before and after 1ml of Restylane Kysse. I was still swollen, but you can see how my symmetry was restored.
Here is an example of 6 different types of lips I treated with 1ml each of different products. The left is each one previous to treatment. The right is the same person immediately after treatment which includes redness and swelling. You’ll see how the anatomy is different as are outcomes even while using the same amount of product. None of these models had a lip filler treatment previously. Generally first timers will need another syringe a month a part. The first one is building the foundation, the second is providing the perfect result.
I hope you learned a little bit of what lip fillers can do and what to expect. It’s not for everyone, but also isn’t as big of a deal or taboo as some may think. I tend to think, “To each their own,” and if a little plump here or there makes you feel confident, I’m here to help. Just know, too, that I will tell you when enough is enough. Enjoy, Readhead readers!
Have you thought about lip augmentation? Drop us a line in the comments.