The prominence of our faces in the era of Zoom, coupled with the use of face masks — which visually block would-be downtime due to swelling or bruising — has the popularity of in-office cosmetic treatments skyrocketing. Among top requests are treatments promising plumper lips, the face's seat of sensuality. Basically, if you've been thinking about getting lip fillers, you are not alone.
"There has definitely been a rise in lip filler treatments," says American and European board-certified plastic surgeon Yannis Alexandrides, founder of 111 Harley Street and 111 Skin. "Lips have become a focus that goes beyond aesthetic and almost hinders on a cultural movement," he adds, attributing their emphasis on the ability to balance the face, the symmetry and proportions of which are integral to aesthetics.
New York-based, board-certified plastic surgeon Lara Devgan, founder of Dr. Devgan Scientific Beauty, has her own theory as to why COVID lockdown prompted interest in lip augmentation. "The 'lipstick index' is a term originally made famous by Leonard Lauder of Estée Lauder [who] hypothesized that lipstick sales increase during economic recessions and times of financial instability," she begins. "I postulate that this is today's version of what Lauder alluded to back in the early 2000's. The 'Lip Filler Index': a small way to achieve beauty, femininity, and confidence during a destabilizing time."
Still, pouty, kissable lips have always been a top goal among the aesthetically minded, and pop culture has long normalized aesthetic "adjustments," so to speak. (Simply look to the daily use of social media filters and popular TV shows like the Netflix Series, Skin Decision: Before and After, making in-office cosmetic treatments more popular than ever.) "Lip fillers have always been the number one request," Atlanta-based, board-certified physician injector Thuy Doan confirms to TZR.
If you are considering getting injectable filler for your lips, the research it takes can feel like a daunting process — unless you know who and what to ask. Below, expert injectors provide their insights in this no-nonsense guide to getting lip fillers.
Lip Filler: What is it?
"Lip fillers are predominantly made of hyaluronic acid," says Alexandrides, who explains that the water-binding substance — which is naturally present in the skin's extracellular matrix — provides a plumping effect at the surface of the skin. "Because it is already a biocompatible chemical, one that the skin recognizes and knows, there is [a minimal] chance of reacting badly to hyaluronic acid fillers."
There are several different brands and varieties of filler — like Juvederm or Restylane, to name a couple well-known brands — and Alexandrides explains that their primary differences come down to viscosity, texture, and thickness. Devgan shares that medium density and viscosity gel fillers are the ideal consistency for injecting lips. "Fillers in this category allow for enough structure to restore the shape of the Cupid's bow, the harmony of upper to lower lip ratio, and an improvement in lip volume, but also softness to make the lips appear plush and natural," she says.
Every injector has a preferred arsenal of fillers for the lips, which they draw from to meet different lip anatomies, needs, and patient histories. Aesthetic nurse Melissa Berg, AKA The Beauty Nurse and the founder of Crafted Beauty in Spokane, WA, has a cult-following for her lip enhancement technique — and her methods of selecting filler is as meticulous as her work. Her role as an elite National Allergan and Galderma trainer has yielded an extensive familiarity with the intricacies of fillers as she travels the country conducting trainings for physician assistants, nurses, nurse practitioners, and doctors in safe injection techniques and product knowledge.
For the virgin lip that has never been injected, Berg turns to Juvederm Ultra XC for a hydrated, pouty appearance, whereas Juvederm Volbella is her choice for treating those with lines running around and onto the lips. The challenging-to-inject "M-shape" lip calls for the use of Restylane-L, which provides structural support that serves as the foundation for modified lip shapes. The newest filler on the market, Restylane Kysse, provides volume and a kissable texture that she finds ideal for a second appointment, after your initial filler has been integrated into the tissue and formed a foundation.
Fillers typically last anywhere from six months up to a year; for instance, Versa, a filler Doan likes for its less hydrophilic properties that make it less likely to migrate, falls in the six-to-nine month range. Unofficially, lip fillers have been known to go without touch-ups for up to three years.
Lip Filler: How to Choose Your Injector
"Finding [an injector or plastic surgeon] is like commissioning an artist to make a very beautiful and very high-stakes painting for you," explains Devgan, who recommends that you select an injector who errs on the side of patience and slow progress — a repeated theme among our experts. "You need to make sure that you have a similar aesthetic and are communicating well about your anatomy goals."
The importance of patient-injector rapport makes the consultation appointment paramount. "The most important part [of the process] is actually the consultation, finding out the patient's objectives with treatment, desired look, and getting a sense of their expectations," Alexandrides reveals. In your initial appointment, your injector will also give you honest feedback on how to achieve your desired look, whether this is possible or advisable, including the expected time frame. Berg insists that a great injector should be able to tell you no when necessary. Often, patients come in requesting lips similar to some of Hollywood's most famous — like Angelina Jolie or Kerry Washington — and the onus falls on their injector to re-frame their objectives in the best interest of their unique facial proportions, bone structure, and overall harmony.
Alexandrides recommends MD's (i.e., plastic surgeons, internists, or dermatologists) and aesthetic nurses as injectors, emphasizing that they use only FDA-approved fillers. Another great quality to look for is a vested interest in continuing education — whether as a lecturer, trainer, or trainee — that indicates their passion for the field. "There may be a lot of good injectors out there, but not everyone is willing to put in the time to educate themselves and seek quality trainings in order to become a great injector," Berg points out.
Word of mouth is also a powerful means of referral in the ever-less-discreet world of cosmetic dermatology and injectables. "If you know people who look natural post-injection, that is a good indicator that they saw a good injector," Berg says. Just as we each have particular interests, so do injectors; some injectors might be renowned for their technique in placing tear trough filler to reduce under-eye hollows, while others specialize in perfecting the lips. To do your research, take a look at their past work; before and after photos on their websites and social media are especially telling because they can provide clues as to their aesthetic style. "Funnily enough, Instagram is a great tool for discovering talented injectors near you," Alexandrides confirms.
Lip Filler: Red Flags
As for caveats, our experts warn against rushing the process in search of a good deal, or worse, buying a discounted package on Groupon. As gratifying as it might be to have a stunning one-and-done experience, patience really is key when injecting filler into the face. "I tell them that filler is a marathon and not a race," Berg says. "I will lay down the foundation filler first and then tell them that I want them back in two to four months [when], if it's appropriate, we will do another round of filler."
This is also important for preventing the "ducky" look we've all seen and know. Oftentimes, patients come in requesting vertical height to help mask the length of the philtrum, or the space between the nose and upper lip. "To get the 'vertical height' you have to do multiple sessions," Doan confirms. "Lips can only take so much in one sitting. If you force more fillers than it can take, it has nowhere to go but forward. This is what creates a 'ducky' look from the profile." It is also important to note that filler placement should not be confused with a lip lift (i.e., a surgical procedure to shorten the philtrum), or a lip flip (i.e., the use or neuromodulators like Botox used to lessen a gummy smile).
How much of a transformation to expect in a single appointment depends on your unique pout. "It really depends on the anatomy of the lip," says Los Angeles-based, board-certified plastic surgeon Sheila Nazarian. "You want to make sure that your injector is trained in lip anatomy and has [years of experience.]" Experienced injectors know that too much filler can cause migration, or even disfigure the shape of the lip. She also notes that on certain patients — namely, those with long philtrums — moderation is key for ensuring natural results, stating, "There is no lip flip or filler that will result in a natural look." In these instances, filler might be placed near the sides of the nose to subtly "lift" and shorten the upper lip, or a surgical lip lift might be recommended.
Nazarian also warns against the injection of the most hydrophilic fillers around the border of the lip. "When a [very hydrophilic filler] is injected in the border of the lip, it expands and makes it look like the filler was injected way higher. Sometimes it even looks like a mustache," she says, noting that she has to dissolve poorly injected, cheaper fillers "all the time." As noted, botched filler placement can be dissolved — but you will have to start all over again from scratch.
Lip Filler: What to Expect At Your Appointment
"A typical lip filler appointment starts with me asking a patient what brought them into the office to ask about having their lips treated," says board-certified dermatologist Dr. Corey L. Hartman, founder of Skin Wellness Dermatology in Birmingham, AL, who notes that he gains valuable information about patient needs and desires while assessing their skin and facial anatomy. They then review before and after photos, as he explains the amount of product used and the number of sessions required for respective results — including anticipated maintenance appointments. "Since filler is broken down more rapidly in the lips, it may be necessary to do small touch ups more frequently," he says.
If you do decide to move forward with researching an injector, booking a consultation, and going under the "needle," it's normal to experience some nerves — usually about whether or not the injections will be painful. "We prep them by cleansing the face and applying a topical numbing cream," Hartman continues. "The procedure is made more comfortable by breathing techniques, a vibrating distractor tool, and ice."
As one final tip, Nazarian shares not to drink red wine or green tea within two weeks of your appointment in order to avoid bruising.
Lip Filler: What are People Asking For?
"Angelina Jolie, Kerry Washington, and Rihanna still top the list of most-requested celebrities, as more and more people request not to look like Kylie Jenner," Hartman explains. "But that is really irrelevant to what is attainable for each patient and what will ultimately look best. I'm honest with patients who have unrealistic expectations."
For the most part, the over-arching theme from all of our experts indicates a more minimalist approach with a "less is more" mentality to facial filler, a look that Hartman refers to as 'hydration of the well-contoured lip.' "In 2021, I predict a continued swing of the pendulum away from the over-filled, oversized lips," Hartman adds, noting that "subtle is the new flashy."
"Patient interest in lip augmentation has increased, although the desired end point is more subtle than in previous times… The most beautiful work is subtle and undetectable," Devgan reiterates. While the stunning Kylie Jenner certainly brought pillowy lips onto our radar, our experts indicate that the trends are shying away from obvious aesthetics that look "done."
As Berg puts it, "Remember, less is more. We want to create natural-looking results that enhance the already beautiful person you are, and looking great for your age."