Lip augmentation with hyaluronic acid (HA) fillers has quickly become one of the most commonly performed cosmetic medical procedures, and for good reason. Hyaluronic acid fillers have revolutionized aesthetic medicine since its FDA approval in 2003 by providing providers a way to add volume to the face in a safe and natural manner. Hyaluronic acid occurs naturally in the skin and joints, but native HA degrades rapidly in the body, with a half-life of 24-48 hours. Cross-linking agents allow for increased stability of the polymer and thereby increase the duration from 1-2 days up to 6-18 months.
Hyaluronic acids have hydrophilic properties, meaning HA fillers will tend to attract and retain water, creating a plump and hydrated appearance to the lips. A wide spectrum of HA filler products exist, with differential cross-linking to confer different degrees of elasticity or firmness, cohesivity and longevity. When it comes to the lips, the ideal product needs to be silky and smooth while looking and feeling completely natural. Options such as Restylane Kysse and Juvederm Volbella have excellent characteristics for use as lip augmentation injections.
Filler-based lip augmentation offers several distinct advantages relative to surgical lip augmentation in that it is non-invasive, customizable, requires minimal downtime and is completely reversible. The only downside remains the temporary nature of the filler product. The easy reversibility of the augmentation with another simple injection likely makes this only a relative downside.
The experienced provider will have a solid understanding of the perioral anatomy in order to provide the safest and most beautiful lip injections. Bruising can be minimized by avoiding unnecessary trauma to the labial artery and its branches, and the orbicularis oris muscle. Aesthetically, each injector should maintain an eye for symmetry and balance with a patient’s facial features while simultaneously looking to enhance elements of each individual’s lips such as Cupid’s bow, the vermillion border, and the ratio of the upper and lower lip. Injections should be placed in a retrograde linear or micro-droplet fashion in the sub-mucosal glide plane above the orbicularis muscle. This is an avascular anatomic plane, and therefore the safest depth for injections.
As with other facial filler injections the most common risks include bruising and swelling, which can be minimized with meticulous injection technique but also with a few patient precautions. Blood-thinning medications should be avoided prior to treatment, including aspirin and ibuprofen, as should blood-thinning foods such as alcohol. Applying cold compresses to the treated area post-treatment will reduce bruising and swelling in the area, as will limiting salt-intake for ~24-48 hours post.
Once any swelling and mild bruising resolves with a few days, the lips should appear naturally plump and full. Initially the lips may feel a big more firm or tight than pre-treatment, but this resolves as the swelling dissipates and the filler material diffuses slightly. The HA filler will naturally be broken down and absorbed by your body over the next 6-12 months, and if you like then you can repeat it again at that point. If you don’t repeat it, then your lips will return to their natural pre-augmented state.
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