What You Need to Know Before Getting Lip Filler

While lip filler injections can be a beneficial tool to add or restore volume, improve facial symmetry, and enhance the size and shape of the lips, their pervasiveness is a sensitive topic. From the rise of overfilled pouts to the danger of botched jobs, there’s plenty of reason to exercise caution and have reservations around lip augmentation—especially in the age of social media, where unrealistic aesthetic standards abound. As New York City-based dermatologist Shereene Idriss, M.D., stresses, “Your lips and your face are not a trend.” In the spirit of making informed and measured decisions around tweakments, three experts who are known for their light hand with injectables break down everything you need to know about lip filler.

Lip Fillers Are An Injectable Treatment

“Lip fillers are a gel-like substance that’s injected to add volume to the lips, correct asymmetries, and/or create a desired shape or fullness,” explains New York dermatologist Dendy Engelman. “They work by binding water molecules within the lips to create a plumper look. Many of my patients are looking to plump naturally thin, flat lips or want to add volume to lips that have lost definition with age.” The most common type of filler is a hyaluronic acid-based filler, such as Juvéderm or Restylane. As Engelman highlights, studies have shown that in addition to stimulating collagen production, hyaluronic acid-based fillers hold up to 1000 times their molecular weight in water, and in turn, boost hydration, contributing to a smoother, plumper look.

Not All Lip Fillers Are the Same

“Lip fillers, or fillers in general, are like different paint brushes,” explains Idriss. “They all come in different weights and are structurally different.” For example, Juvéderm tends to diffuse a little bit more, while Restylane can hold its shape, she says. How does that impact the length of time that lip fillers last? “It depends on how much is injected and how the person is trying to achieve a fuller look,” says Idriss. “If over-injected right away, it might last a little bit longer, but you will look over-injected. If your goal is to achieve a natural looking, but still fuller lip, then less is more, but injecting more regularly over time will help you achieve that look.” Overall, you can expect lip filler to last, on average, anywhere from 6-18 months, with results differing depending on the type of filler used, how much is injected, and a patient’s individual metabolism.

Lip Filler Is a Non-Invasive Procedure, But There’s Moderate Swelling

According to Engelman, an average lip filler treatment will proceed something like this: First, the injector will apply an anesthetic in the form of a topical cream on your lips so they’re numb during the procedure. Once the lips are numb, the actual injecting, which consists of the provider using a small, thin needle to inject the filler into various parts of the lips, usually lasts about 5-10 minutes. “The needle usually goes about 2.5 mm into the skin, which can cause some irritation, a pinching sensation, or your eyes to water,” says Engelman. In the days following the injections, your lips can become swollen, painful or bruised. Depending on the person, these side effects can subside within 24-72 hours or take up to a week to lessen after the procedure. “To help your lips heal, it’s important to apply cold compresses to your lips to reduce inflammation,” she stresses.

Lip Filler Only Enhances Lips If Used Safely and Sensibly

Needless to say, seeking out a qualified and experienced injector is essential because if lip filler injections aren’t administered correctly, the results can be undesirable in more ways than one. “In minor cases, the area on and around the lips appears asymmetrical, bruised, bumpy and/or swollen,” cautions Engelman. “Overfilling can also cause the common ‘duck lips’ look—protruding lips brought about when too much filler is injected and makes the lip area push out and stiffen.” The good news? These effects are temporary and should begin to improve after a few months. However, in more serious cases, long-term damage can occur when lip filler is injected incorrectly or in the wrong area. One of the worst-case scenarios is a vascular occlusion, which occurs if filler has caused the blood flow through an important artery to stop. “This very minute risk is present for any injector despite board certification and experience,” explains Dara Liotta, a New York City-based plastic and cosmetic surgeon. “The difference is that someone experienced will know how to recognize this immediately and to treat it appropriately to avoid devastating complications.”

Finding the right practitioner is not only paramount for safe and effective results, but also to ensure that your aesthetic goals are being assessed carefully. “Realistic expectations are key to be set at the very beginning of every encounter,” explains Idriss. “I try to understand what it is the patient is looking to achieve from fuller lips while also explaining my personal aesthetic when it comes to lips and a face overall.” When meeting with a patient, Liotta breaks down the conversation into three pillars: volume (assessing the amount of filler), shape (“the best and most natural-looking results come from respecting and enhancing the lip shape that you were born with”), and assessing overall aesthetic goals. “You may notice that on social media, post-lip injection photos are often taken right after the procedure—needle marks are usually even still visible!” says Liotta. “This bears little or no resemblance to what your lips will look like two weeks after injections. This is important to understand. These immediately post-injection photos are not ‘real‘ results.”

If You Hear “No,” Listen

“I say ‘no’ more than I say ‘yes,’ especially in patients who have already been overfilled and are not willing to scale back by erasing the canvas, which consists of breaking up the filler and starting from scratch,” explains Idriss. “If I don’t think my aesthetic is going to vibe well with the patient, I will not inject them.” Idriss also acknowledges the psychological effect of overdone lip fillers, which she believes is a major pitfall that isn’t talked about enough. “A person can know that their lips look artificial and fake, but once they get used to those proportions on their face, psychologically, it is very hard for them to scale back and get rid of them. They feel like they have no lips when their lips actually look naturally full and beautiful.”

Botox Can Help Yield More Natural Results

While most people associate lip augmentation with filler, Botox (also known as botulinum toxin type A) can also be beneficial. “Botox can also be used either alone or in combination with fillers for a subtle pout-magnification by flipping out the lip line (where you would apply lip liner), rolling the lip gently outward, and giving the appearance of a fuller lip,” says Liotta, who has developed a custom non-surgical “couture lips” treatment using one to three different types of filler, often in tandem with Botox for the ultimate bespoke results. “Filler adds volume and makes the lip larger by literally making it bigger. Botox works differently; it relaxes muscles, and by relaxing the muscle around the mouth, it rolls the lip outward—or ‘flips’ the lip—giving the illusion that the lip is bigger without actually adding any volume.” This is known as a “lip flip,” and it’s a subtle enhancement that continues to gain popularity for a more natural look.