Lip Fillers for Young and Old Patients

Lip fillers, also known as soft tissue fillers, are an injectable material used to gain fuller, shapelier lips. There are many different types of fillers and each one is comprised of a natural, biocompatible or synthetic material. Furthermore, each type of filler has a slight variation in density and longevity. Lip fillers can restore or enhance the natural curves of the visible portion of the lips called the vermilion. They can also be injected along the Cupid’s Bow or the central curve and the philtrum (which is the vertical area that extends from the upper lip to the nose). Each of these regions can be augmented to increase the volume, or the lip pout, for a more sensual lip appearance.

Am I a Good Candidate for Lip Fillers?

GOOD CANDIDATES for lip fillers include:

• Patients who desire plumper or more shapely lips
• Patients who have naturally thin lips
• People whose lips have become thin due to age
• Patients whose lips have pulled outward or the upper lip has developed a straight look
• People with wrinkles around the mouth

Lip augmentation with fillers does not have an age limit but older patients should consider the fact that very plump lips may not look as appropriate on them as they would on a patient who is in their 20s. Patients should be over the age of 18 and be mentally and physically healthy.

Who is NOT A GOOD CANDIDATE?

• Patients who smoke
• Patients with medical conditions such as diabetes, blood-clotting disorders, lupus or connective tissue disorders
• Patients with oral herpes or the herpes simplex virus type 1, commonly known as chronic cold sores, may not be able to undergo lip fillers due to the possibility of an outbreak
• Patients who desire a permanent solution for fuller lips may be better suited for lip implants

How are Lip Fillers Performed?

During the consultation, the doctor will review the patient’s medical history and current medications. The patient’s goals, such as subtle definition or major volume increase, will be discussed in detail and the doctor should be able to supply “before and after photos” of his or her previous patients. Since there are several different types of fillers to choose from, the doctor will determine which filler is best to meet the patient’s needs.

Fillers are categorized as temporary, semi-permanent (lasting more than a year) and permanent and they include:

• Collagen-Based Lip Fillers: Temporary filler that is the most frequently injected filler around the world. This filler comes in two forms:
  • Human-derived collagen is harvested from excess skin removed during surgeries or from cadavers. This type of filler is biocompatible which eliminates the need for pre-treatment allergy tests. Dermalogen is a brand of human-derived fillers.
  • Bovine-derived collagen is extracted from cow tissue. The cattle are closely monitored and disease-free but, due to the possibility of an adverse reaction, an allergy test is required prior to lip injections. Zyderm is a brand of bovine-derived fillers. Artefill is bovine-derived filler that includes synthetic microspheres that help the body produce new collagen.
• Fat Transfer: This type of filler involves removing the fat from one area of the body and transferring it to the lips. The fat is generally taken from an area of the body such as the abdomen or the butt. Since the process involves removing the fat from the patient’s own body, there is little risk of rejection so pre-allergy tests are not needed. The fat is removed via liposuction, purified and then injected into the lips. Fat transfer is considered a permanent filler since the injected fat behaves like the residing fat.
• Hyaluronic Acid: This lip filler contains hyaluronic acid and is considered temporary. Hyaluronic acid naturally occurs in the body’s joints and skin so pre-treatment allergy testing is not needed. Hyaluronic acid is known to bind with water molecules upon injection into the lips and provides long lasting results. Restylane, Radiesse, Juvederm and Restylane Lyft are examples of this type of filler. Hyaluronic acid is considered a safe means to add shape, volume, symmetry and/or structure to the lips.

It is common for a doctor to suggest a mix of hyaluronic acid fillers to achieve the best results since these fillers fall into two categories:

• Thin fillers are used to address fine lines, wrinkles around the mouth and to plump up the lips. Thin fillers include name brands such as Restylane and Restylane Silk.
• Shaping fillers are placed in the fatty layers around the mouth. Shaping fillers include Voluma, Radiesse and Restylane Lyft.

Lip filler injections may be done in an office setting and the entire procedure can usually be done in 30-60 minutes. Lip fillers can be injected all at once or can be injected gradually, over several sessions, to ensure symmetry and balance. Anesthesia is generally not needed since most temporary fillers already include lidocaine to ease the discomfort. The injection can feel like a bee sting while the filler is described as an uncomfortable pressure due to the filler moving throughout the lips. Some doctors offer nerve block injections to completely numb the lips. If the patient is having additional areas treated with a fat transfer, the procedure will take longer and general anesthesia will be necessary. Patients who opt for general anesthesia will need to arrange for a ride home since they will not be permitted to drive.

Lip Implants:

An alternative procedure for gaining fuller lips involves a surgical procedure known as lip implants. Implants are permanent but have more recovery and downtime than lip fillers. Due to the passing of time or weight fluctuations, the implants can begin to show or shift out of place. Further surgeries may be necessary to correct implant issues. Furthermore, the size of the implant is limited by a patient with a thin lip due to the amount of lip tissue available to cover it. However, a person with a thin lip is not as limited by plumping up a thin lip with filler.

What is the Cost of Lip Fillers?

Since lip fillers are a cosmetic procedure, medical insurance will not cover the cost. The cost can vary depending on several factors including the individual rates charged by the doctor and the type of filler being used. Depending on the area where the injections are performed, they can cost from $300 to $750 to $1200 per syringe. Semi-permanent and permanent lip procedures are generally more involved and might have a greater cost. Fat injections can cost anywhere from $5000 to $11,000 while lip implants can cost $3000-$6000 for both lips.

Downtime and Recovery

After a lip filler treatment, the doctor will usually start the RECOVERY process by applying some ice to the lips to ease discomfort and to minimize swelling. The use of ice packs should be continued during the first 24 to 48 hours. The use of lipstick or other products for the lips should be avoided immediately after filler injections. The doctor will instruct the patient on when it is safe to use these products. The patient can expect to feel some numbness and tenderness of the lips just after the injections. Redness and minimal pain at the injection site is also common but pain medications are generally not needed.

Patients should avoid taking aspirin and nonsteroidal anti-inflammatory medications such as Advil or ibuprofen for one week after the procedure since these medications can increase bleeding. Swelling and bruising can also be expected but should subside within two weeks. Patients should not touch their lips and extra pillows should be used to elevate the head.

Any patient who smokes should avoid smoking for at least a few weeks since smoking can interfere with the healing process. Heavy exercise is not permitted the day of the procedure since this can cause increased blood flow to the treated area. There is generally no DOWNTIME unless the patient feels the appearance of bruising and redness is an issue for them. Therefore, most patients can return to work immediately after lip fillers or take a day off to rest. All normal activities can resume the day after lip augmentation with fillers. Swelling and redness after a fat transfer to the lips can last 6-12 weeks.  

Results

Patients can see immediate volume with lip fillers. However, the improvements will be more prominent once the swelling has gone down.

The duration of lip enhancements with fillers varies depending on how quickly the patient’s body breaks the filler components down. The duration has nothing to do with the patient’s age since the results are the same whether a patient is 20 or 60.

• Collagen lasts 4-6 months
• Fat transfer to the lips can last anywhere from 6 months to a year
• Hyaluronic acid generally last 6-18 months

These fillers can gain a longer lasting effect if the treatments are stacked which means the patient doesn’t allow the product to completely dissolve before having repeated injections.

Shading the lips by wearing a hat can help filler results last longer since the sun dehydrates the tissue and accelerates the aging process.

Most filler is temporary and will be broken down by the body as time passes and reabsorbed. If the patient does not like her, or his new lips, many types of filler can be quickly dissolved by injecting an enzyme called hyaluronidase.

Limitations and Risks of Lip Fillers

Lip fillers have a LIMITATION in providing the proper aesthetic proportion of the upper lip to no more than 75% of the volume of the lower lip. Patients who overfill their lips will not have aesthetically pleasing or natural looking results. Natural looking results are not based on the filler but rather on the skill of the doctor injecting it. Therefore, lip fillers can be limited by the procedure itself and the skill of the doctor.

Artefill is limited by the FDA for use only in the nasolabial folds or smile lines. Due to the composition of Artefill, it is not safe to use this product on thinner skin such as the crow’s feet at the corners of the eyes or the eyelids.

Common RISKS of fillers:

• Temporary redness
• Pain
• Bruising
• Swelling
• Itching at the injection site
• Lumps
• Bumps
• Discoloration or change in pigmentation
• Allergic reaction
• Asymmetry
• Injection of filler into the blood vessels in the lips causing blood clots and tissue loss
• Abscess formation
• Scarring or stiffness of the lips

Fat Transfer RISKS:

Patients undergoing a fat transfer may have the associated RISKS of:

• General anesthesia risks such as respiratory complications, pulmonary complications, blood clots, nausea and vomiting
• Bleeding
• Scarring
• Infection
• Asymmetric appearance since a portion of the transferred fat will not survive

There is also a high risk of fraudulent, tainted and/or harmful fillers being sold online, and in person, by unlicensed practitioners. Some doctors still inject substances such as silicone and call it permanent filler. Patients need to know that medical grade silicone is not approved by the FDA for injections into any soft tissue. Silicone is unstable and can migrate to other areas. Furthermore, silicone will not dissolve on its own and cannot be easily removed. Patients should not purchase fillers online and should always visit a board-certified doctor for their treatment.

How to Get Started?

When performed by an adequately skilled cosmetic physician, lip fillers can improve the appearance of the lips and heighten self-confidence. A patient considering lip augmentation with fillers for the first time should consider temporary hyaluronic acid filler which can be dissolved within 5 minutes with an enzyme. The filler can easily be removed if the patient does not like the results. However, most patients are very pleased with their lip augmentation and choose longer lasting filler the next time around. Once the filler is gone, due to the passing of time or dissolving it on purpose, the lips will return to their natural pre-procedure shape.

Written by Cosmetic Town Editorial Team - SP

Based on an exclusive interview with Francis Palmer, MD in Beverly Hills, CA