Lip fillers: keeping it natural

Key takeaways

• The goal is your lips, slightly refreshed, not a new shape.
• Effect usually lasts around six months or more, varying between people.
• Swelling peaks over the first couple of days; judge the result at about two weeks.
• Cold sores can flare after lip filler in people prone to them; tell your doctor.
• Hyaluronic acid can be dissolved with an enzyme, which makes small steps safer.

What can lip filler do, and what can it not?

Normally, lips change with age in a few ways. They can thin, lose definition at the border, develop vertical lines above the upper lip and turn down slightly at the corners.

Lip filler can: - Define the border, the edge between the lip and the skin, which softens with age - Add hydration and smoothness to dry, finely lined lips - Restore modest volume where it has been lost - Balance a small asymmetry

It should not: - Change the basic shape of your lips into someone else's - Make the upper lip overpower the lower lip - Replace treatment for lines caused by sun damage or smoking, which also need skin treatment

What does "natural" actually mean?

See, what happens is, everyone has a picture in their head. But someone else's lips rarely suit your face. What most people actually miss is their own lip, a few years younger.

A 2023 review on lip augmentation stresses preserving and accentuating the natural landmarks of the lip: - The white roll, the thin raised line at the lip border - The Cupid's bow, the double curve at the centre of the upper lip - The philtral columns, the two ridges running up to the nose - The tubercles, the small natural fullnesses in the lip body

When these are kept, lips look like yours. When they are blurred by too much product, lips look filled. That is very important to understand. The other key point is proportion: in most faces, the lower lip is fuller than the upper. An upper lip pushed beyond the lower is one of the quickest signs of overdone filler.

How long does lip filler last?

The lips move constantly, so filler here generally lasts a shorter time than in deeper, stiller areas.

A 2021 meta-analysis in Frontiers in Surgery pooled studies of hyaluronic acid lip filler. The proportion of people with a meaningful increase in fullness was:

The authors concluded it is effective for at least six months, but rated the certainty of the evidence as very low, so take these as a guide. Results vary between people and products.

What are the side effects?

The same meta-analysis reported these as the most common effects, mostly mild and resolving within weeks: - Tenderness, in most people - Swelling, in about three-quarters - Bruising, in a large minority

Rarer effects included small inflammatory lumps (granulomas, about 0.6%), cold sore flares (about 0.6%) and a sudden allergic-type swelling called angioedema (about 0.3%). One trial reported cold sores in 17% of people, so if you get cold sores, tell your doctor, as an antiviral medicine may be suggested.

The lips also have important arteries running through them, so the general rare risk of filler entering a blood vessel applies. My article on filler safety explains the warning signs.

What to expect on the day and after

1. Assessment. I look at your lips at rest and when you smile and talk, and at their relation to your nose, chin and teeth.
2. Plan in writing. Product, amount and price before treatment. For a first treatment, I usually suggest a small amount.
3. Numbing. Many fillers contain a local anaesthetic, and numbing cream may be used.
4. Injection. Small amounts, placed carefully.
5. The next few days. Expect swelling, often more on day two. Lips may feel firm or uneven at first. Avoid judging the result in the mirror on day one.
6. Review at about two weeks. That is when the result has settled. If we want a little more, we add it then.

Basically, two small sessions look more natural than one big one.

When should you wait?

• If you have an active cold sore
• If you are pregnant or breastfeeding
• If you have dental work planned in the next couple of weeks
• If you have an important event within the next two weeks
• If you are unsure what you want. That is a reason to wait, not to try.

Questions to ask before lip filler

• Which product will you use, and how much, written down?
• Will you keep my natural lip border and Cupid's bow?
• How will you keep my upper and lower lip in proportion?
• When will you review, and what if one side settles differently?
• What should I do if I get a cold sore or unusual pain afterwards?

A careful doctor will be happy to answer all of these before picking up a syringe.

How we approach this at Dr Tvacha

At our centres in Thane, Andheri, Bandra and Dahisar, lip filler follows a Rs 499 face assessment. We look at your whole face, because lips are only natural in proportion to everything around them. The product, amount and price are written down before treatment, we start small, and I review at two weeks. If I think your lips do not need filler, I will say so. Read about the Long Game Anti-ageing Plan, or why some faces look overdone.

Written by

Dr Amit KarkhanisAesthetic Physician · MBBS, Dip. Dermatology (UK) · Reg. No. 2001/02/1124

Founder of Dr Tvacha, practising in Thane since 2005. Leads the weight loss and hair programmes.