Expert Doctor

Lip Fillers

Lip fillers have been in existence for about a hundred years. One of the first lip fillers used was a type of wax called paraffin, but it did not do very well. Science moved on in the 1950’s to liquid silicone. Then in the 1980’s collagen came out, and that became the gold standard. Technology has gotten better since then. Many of the products used now are hyaluronic acid based products. Hyaluronic acid increases volume in the lips and is a natural substance found in the body. Its main purpose is to enhance the volume and/or shape of the lips. Some doctors also use fat injections and even some implants to add volume to the lips.



If a doctor is using injectable fillers, like the hyaluronic acid products, it involves a simple injection to reshape.

If the doctor decides to use fat from the patient’s body, they first have to remove the fat from the body. Some people will process the fat with centrifuging. Others will use microcannulas (a thin hollow tube), which will make a tiny opening to try and avoid traumatizing the tissue.

Collagen is rarely used anymore. What doctors call collagen was protein from cows, and skin testing was necessary prior to using it on the patient to make sure they did not have an allergy to Bovine collagen. The patient would have to come in and get tested and then come back to get tested a second time. It would take over a month before the actual injection, and that led to its popularity going down. Plus, a lot of people did not like using an animal product.

The main choices today are between hyaluronic acid and fat transfer.



The basic types of hyaluronic acids are Juverderm and Restylane. There are other ones now such as Perlane, as well as products from overseas that mix hyaluronic acid with little microspheres that are permanent like Artecoll and ArteFill.



Hyaluronic acid is clear and moldable. For the first day or so, the patient can actually feel a little lump or bump. If the patient does not like it or it is too lumped there is an antidote, hyaluronidase, which is an enzyme that can be injected to dissolve it.

The problem with permanent implants or permanent injections is that removing them is not possible without actual surgical intervention.



The two things that doctors look at are size and shape. Lip fillers can be used simply to plump up the center of the bottom lip. The typical perfect aesthetic in the upper lip is when it looks like a cupid’s bow (like the bow from a bow and arrow) where it points to the top. Some patients do not have a good contour so the edges of the lip can be injected to recreate that and change the shape of the lip. The proportion of how thick the upper lip is versus the lower lip can be changed.

Patients who have pencil thin lips can be given injections to achieve the appearance of normal lips. The injections can be really helpful to look just normal, and not everyone is looking for a dramatic change.



Botox works quite differently because it is not a filler. Botox blocks the transmission of nerve impulses to a muscle so it works well for what are called lines of facial expression, or lines caused by movements. The only thing in the lips Botox is really used for is smoker’s lines. When people smoke for a long period of time, sucking on the cigarette causes small vertical lines to appear above the upper lip. Botox can be used to smooth those out, but not within the lip itself because it can cause partial paralysis of the lip. Doing things like drinking through a straw or moving the mouth normally could become impaired, and it does not add any volume to the lip. It is not permanent and it is not a filler. It is a wrinkle reducer by relaxing muscles.



There is a limit to the amount of the product that can be used. Putting too much product in can actually impede blood flow in the lip. Injecting it into blood vessels can cause circulation to be lost to an area.

There are certain types of patients you want to be careful with these types of products. If patients have a history of herpes or cold sores on their lips, whether they are active infections or sores, they should not be injected. If they have a history of it, they can be placed on medication prior to any treatment so it will not provoke a breakout. Patients with diabetes or lupus take a little longer to heal so doctors need to be more cautious with patients who have serious medical conditions.



A product like hyaluronic acid can be dissolved. However, if it is injected into a blood vessel, occludes that blood vessel, and loses circulation to the area, that is an immediate hazard for the patient.

There is a product called Radiesse and it is a calcium-based paste which is like toothpaste. The problem is sometimes it forms nodules on the inside of the lip that needed to be surgically removed. Radiesse is rarely used in the lip anymore.

There are also lip implants made of Gore-Tex that can be surgically placed in the lip. The problem with this is they can become infected or cause contour irregularities of the lip.



Lip implants had their moment but they are not particularly popular. They are far less commonly used than lip fillers and injections. Even if the lip implant is done perfectly and there are no nodules, infections, or issues with it, the lips change as a person gets older and the permanent material does not go away. It looks odd as the years go by. Even though it might be a hassle to have to come back often to have the lips done via filler injections, it gives a patient more flexibility.



In terms of the ability to do normal activities, patients can walk right out and do normal things. However, they should not go to the gym and exercise for the first 24 to 48 hours because it raises the blood pressure and can increase swelling. There is a possibility of some bruising. Some pain and swelling can also occur. The majority of people can receive fillers on their lunch break and go right back to work without much hassle. Patients should avoid using a straw because that can contract the lips and move the product around.



The results from lip fillers are immediate. There is a little swelling so there will be a little bit more of a result initially. The results from hyaluronic acid based products can last for about 3 to 6 months.

Some patients come back for follow-up treatments on a regular basis because they want to be perfect all the time. There is no hazard in multiple injections if they are done properly.



Hyaluronic acid is the safest way to go as opposed to the semi-permanent or permanent injections that are available. A patient needs to use caution if they are considering using their own body fat in the lips. It is more expensive and involves more down time and swelling. The results can also be somewhat unpredictable.

Patients should not get silicone injections in their lips. It is a permanent product. If they get an infection or a problem it is a major difficulty to remove, and sometimes it cannot ever be removed adequately.

The lips are a very delicate and prominent part of the body. Stick with what is reversible and do some homework before choosing a doctor. Select a board certified provider who can share a lot of good pictures of the procedure so the patient can choose the results they want to achieve. 


Written by Cosmetic Town Editorial Team- MA

Based on an exclusive interview with Jeffrey Yager, MD in New York, NY