Lip augmentation with dermal filler is consistently one of the top non-surgical aesthetic procedures performed each year, and not even COVID-19 face coverings could dampen the enthusiasm for plusher pouts. At this point, you likely know someone who has tried lip filler, and social media is ripe with perfectly plump lips. But, if you are considering the injections for yourself, it’s important to remember that it is a real procedure with real risks that need to be taken seriously and considered carefully before going under the needle.
To better understand what it’s like to get lip filler for the first time, we spoke to a first-time patient, fashion stylist Megan of Belles&Rebelles, and her provider, New York City-based board certified dermatologist Dendy Engelman, MD, about what to expect before, during, and after getting lip filler.
Megan says she has been “super interested” in getting lip filler for a decade and went so far as to thoroughly research and book an appointment for treatment a few years ago before cancelling at the last minute because her fear of needles held her back. “I am mortified of needles,” she admits. “I am 35, and I don’t even have my ears pierced!” Another concern? “All of my friends who have lip filler told me it’s the most painful,” she says. “I don’t have a high pain tolerance and am afraid of needles, so they told me that lip filler is not the one to get.”
Even so, it’s the only aesthetic procedure she’s ever been interested in. “I am not really into beauty, to be honest,” Megan says. “I really don’t do anything other than wash with soap and water and I’ve had a facial like once in my life, but I’ve always considered lip filler.”
Like so many lip filler patients, her interest in pout plumping stems from the way she views herself in photos. “Whenever I smile in pictures, I wish I had more of a top lip,” she explains. “My top lip kind of disappears.” Overall, she also thought she “could probably use a little more volume,” too.
With COVID-19 face coverings offering the opportunity to conceal any post-procedure side effects, Megan once again started to think about getting lip filler, and a client she was working with recommended Dr. Engelman. In January, she finally overcame her fear of needles and followed through on her decade-long dream of a fuller pout — and she’s thrilled with the result:
A look at Megan before (left) and immediately after (right) her lip filler procedure.A look at Megan before (left) and immediately after (right) her lip filler procedure.
If you are reading this article, it’s probably because you are considering lip filler and have a whole host of questions. From finding the right provider and filler type for your needs to understanding how much it hurts and what the side effects may be, we’re breaking down the 10 most important things to know before getting lip filler for the first time.
We’ve said it before and we’ll say it again: take great care in finding the right provider. “Regardless of where you are going for fillers, it is very important to make sure you are going to a reputable physician,” Dr. Engelman cautions. “Make sure they are board certified, licensed, and trained.” While lip filler is often billed as a quick, minimally-invasive procedure, it requires expertise. “Without a clear understanding of facial anatomy, an untrained professional can inject into a blood vessel, damage a nerve, and potentially cause irreparable damage,” she explains.
It’s also important that you feel comfortable with the provider’s bedside manner and body of work. “I would definitely say to go to the right person,” Megan says. “I remember Dr. Dendy saying that she doesn’t have a heavy hand. For someone like me who is new to it, I didn’t completely want to change my appearance.”
If you don’t know how to go about your search, consider asking for referrals. “I work with an influencer who has been going to Dr. Dendy,” Megan shares, adding that she also looked at her Instagram and recognized her from her appearances on the Today Show. “I trust her and really felt like she knew what she was doing,” she says.
Not all lip filler is the same. There are both temporary and permanent options, but temporary hyaluronic acid (HA)-based injectable gel fillers are the most popular (yes, that’s the same HA found in your favorite hydrating skincare). Dr. Engelman likes the Juvéderm® suite of HA filler, which includes Juvéderm® Volbella XC and Juvéderm® Ultra XC. Both are approved by the United States Food and Drug Administration (FDA) for lip augmentation and the correction of perioral rhytids (a.k.a. perioral lines). Restylane® is another common hyaluronic acid filler that is FDA-approved for lips.
HA filler naturally degrades and is absorbed by the body over time (hence why it is a temporary treatment), but, in the case of complications or an unsatisfying result, the process can be sped up by hyaluronidase — a family of enzymes that catalyse the degradation of hyaluronic acid.
What comes to mind when you think of lip filler? Is it the overfilled pouts that inhabit your social media feeds? Well, lip filler — particularly, hyaluronic acid-based ones — can provide very natural results that simply enhance what you already have. “I was surprised that it can be done naturally,” Megan admits. “I look at myself and it doesn’t even look like I got it done. They still look completely natural.”
Needless to say, being able to communicate your aesthetic goals is key. And while inspiration images may help guide the conversation, don’t expect your provider to be able to simply recreate Angelina Jolie’s pillowy pucker on your face. “I love when patients share with me what they are looking for or interested in. A visual is another tool for me to better understand how I can help my patients,” Dr. Engelman shares. “That said, my goal is to make someone the best version of themselves. So, if their ‘ideal’ isn’t fitting for their features, this needs to be discussed prior to injections.”
You’re used to being asked about any medications you are taking on intake forms at the doctor’s office, but, in this era of wellness, you’re going to want to disclose your vitamin and supplement routine, too. Your provider will likely recommend laying off most supplements for a few days before your procedure, as taking them can increase the risk of bleeding and, therefore, bruising. “Avoid blood thinners, NSAIDS, vitamin E, fish oil, and alcohol in order to reduce the risk of prolonged swelling and/or bruising,” Dr. Engelman says. She also tells patients to “avoid facial or body massages for up to 48 hours” before lip filler injections.
You may have heard lip injections referred to as a ‘lunchtime procedure,’ and it does live up to the hype. In the case of first-time patients, you will likely start the appointment with a short consultation to discuss your medical history and goals. From there, ‘before’ photos might be taken and numbing cream may be applied (more on that below!). “Injection can take as little as two minutes,” Dr. Engelman notes, though she treads carefully with patients who are nervous about the process. “I take breaks with clients that are uncomfortable with needles,” she says.
Dr. Engelman injecting Megan's lower lip with Juvéderm®.Dr. Engelman injecting Megan's lower lip with Juvéderm®.
Megan estimates that her appointment, which included a consultation, photos, and numbing, took less than an hour. Future touch ups could be done in as little as a half hour. “The process itself can be very quick,” Dr. Engelman says.
Most fillers on the market today are pre-mixed with lidocaine to improve the comfort of the injection, and many providers also employ topical numbing cream to further take the edge off. That takes about 20 minutes to kick in, which, as we learned above, is the lengthiest part of the treatment. “Patients feel very little discomfort in the hands of a skilled injector,” Dr. Engelman shares.
Some providers also employ a vibrator (yes, you read that correctly), which is believed to trick the sensory nerves surrounding the injection site into not knowing exactly where the needle is coming from. The result? Even less possibility for pain. Megan’s treatment didn’t include a pulsating tool, yet she still hardly felt a thing. “I was most surprised by how little it hurt,” she says. “I felt little pricks, but I was not in pain at all. ”
While Megan avoided any discomfort during the procedure, she did experience a very common side effect of lip injections: bruising. “Bruising and swelling are both common post-treatment,” Dr. Engelman notes. “They usually last a few days.” Ice packs are typically employed immediately after treatment to offset the impact, and she says oral and topical arnica may also help reduce the chances of bruising.
Megan says she bruised on her top lip, and it resolved over the course of about five days. “The first couple of days, it was noticeable and then it started to fade,” she explains. “If you didn’t know me, you’d probably think it was a beauty mark.” And since face masks are still the accessory de rigueur, hardly anyone saw a thing. “I just wore a mask and didn’t tell anyone but my mom and close friends,” she says. “No one even noticed.”
The process of plumping your pout for the first time is often a gradual one. “I never want to over-treat a patient,” Dr. Engleman shares. “My personal philosophy — especially with those getting filler for the first time — is to start with a little filler and have my patients come back in a week or two if they need more to achieve their desired result.”
When we talked to Megan, she was anxious to get back into the office: “She offered me a two week check-in, and I am thinking I want more filler. I know it is a little aggressive considering I was mortified of getting anything done, but I want a little more so that it looks a little plumper.” She subsequently went back for her follow up and got a bit more filler.
If are familiar with neurotoxin injections (i.e. Botox®, Dysport®, Jeuveau®, and Xeomin®), you know they require a bit of patience. Results can take anywhere from five to 14 days to fully reveal themselves. That is not the case with hyaluronic acid-based filler. “The results are immediate,” Dr. Engelman says. With that said, there is a brief recovery period. “The area will swell and settle within five to seven days,” she adds.
If you are wondering how long you’ll be enjoying your new lip look, Dr. Engelman says Juvéderm® fillers last about nine to 12 months depending on the patient. Other brands of HA filler may need to be touched up more often (think: every six months), so be sure to ask your provider what you can expect.
Last but not least, we need to talk turkey on cost. Lip filler is not cheap. A lip augmentation procedure can cost between $500 and $2,000 dollars, depending on the type and amount of filler, the provider, and your location. In case it’s not clear, that is the cost of each treatment. If you want to maintain your results, you’ll need to budget in that recurring cost every six to 12 months. As tempting as it may be to look for a discount, this is not the time to be a bargain hunter. Finding a trained provider with proven expertise is essential to avoid unnecessary risk.
So, what advice does Megan have for anyone considering getting lip filler for the first time? Do your homework. “I feel like I had researched and been thinking about it for so long that there wasn't anything I didn’t know,” she says. Her pre-injection lip care routine was pretty simple (think: Chapstick), but she did like to employ the occasional lip plumper to simulate the results of professional treatment. She’s still using those plumpers to further enhance her pout, and, in the future, she won’t hesitate to go under the needle again. “I am relieved; I am excited; I am happy,” she shares. “I am so glad I finally went through with it.”
So what are dermal fillers? Essentially, they’re gel-like substances that are injected into different areas of the body in order to restore volume, enhance structure, smooth wrinkles and even fill scars.
Dermal fillers come in different varieties. The vast majority of dermal fillers are made of hyaluronic acid (HA), a substance that naturally occurs in the body, binds to water and helps to keep skin looking plump and youthful.
Fillers are injected into areas that have lost collagen, the protein that provides structure to your skin.
Almost all dermal fillers are reversible with a hyaluronidase/vitrase solution (with the exception of those that stimulate collagen production which include Bellafil, Radiesse and Sculptra).
Dermal fillers are considered safe and minimally invasive. They’re approved by the FDA as medical devices, and have been around for decades. These days they’re safer than ever, with more options tailored to different parts of the body.
Most people believe that dermal fillers are just for cheeks and lips, and those may be the most obvious areas for usage. But actually, dermal fillers can be used all over the body! The areas dermal fillers are best for treating include:
Chest — Sun damage and wrinkles on your chest area can be mitigated with Sculptra and PRP, which stimulate collagen.
Hands — Signs of aging on the hands, including more obvious veins and tendons, can be minimized with the use of Radiesse or Restylane LYFT.
Above the Knees — Crepey, wrinkling skin above the knees can be fixed with Sculptra, sometimes mixed with PRP. This area can also be treated with Radiesse or another large molecule filler.
Arms — If you’re dealing with “wings” or wrinkles in the creases of your arms, Sculptra, PRP and fat transfer can help to fill in and smooth these areas.
Buttocks — Sculptra, PRP and fat transfer can lift and fill out your buttocks area.
Thighs — Sculptra and PRP can stimulate collagen to smooth out the appearance of cellulite.
Feet — With aging, the pads on the bottom of your feet can wear down. Sculptra can stimulate collagen to enhance this area and make you more comfortable when walking.
Earlobes — If earrings have pulled your earlobes down, Radiesse, Restylane LYFT, and Bellafill can plump and lift them back to their original position.
Under Eyes — Dark circles and hollows under the eyes can be filled in with Restylane, PRP and Belotero, giving you a more rested, youthful appearance.
Acne Scars — Bellafill can fill in acne scars and significantly minimize their appearance.
Chin — Bellafill can stimulate collagen production in your skin, giving it structure and enhancement.
Jawline — Sculptra, LYFT, Voluma and DEFYNE can all lift the skin around your jawline and restore its structure, giving you a more sculpted, youthful appearance.
Nose — A non-surgical nose job using dermal fillers like Restylane and Bellafill can change the appearance of your nose without the downtime of surgery.
Scars — Restylane (including REFYNE and DEFYNE), PRP and Bellafill can stimulate the production of collagen around scar tissue, smoothing out the area and helping minimize your scar’s appearance.
Lips — Restylane, Juvederm and Restylane Kyss can all plump up your lips and help to make them symmetrical.
When it comes to choosing a dermal filler, it’s best to trust the advice of an experienced practitioner who has extensive knowledge around this subject. Different fillers are best for different areas and different people, and your practitioner can recommend the appropriate product based on their experience and your unique needs.
While both can help you look younger, dermal fillers and neurotoxins are very different substances.
Neurotoxins relax muscles using a substance called Botulinum Toxin Type A. The process involves the toxin sending an impulse to block the facial muscle’s nerve impulses. This relaxes the muscle, which softens wrinkles. Neurotoxins we use include BOTOX® Dysport® and Xeomin®.
Dermal fillers, on the other hand, are primarily made of hyaluronic acid (HA), a substance that naturally occurs in the body, and they’re used to repair the volume loss that comes with age. Filling in the cheeks, for example, or smoothing out scars. Some HA fillers also include lidocaine, a painkiller that helps the procedure be more comfortable for the patient.
Given their safety and effectiveness, the majority of people are good candidates for dermal fillers.
Really, anyone who’s trying to achieve facial balance or correct an obvious asymmetry.
It is important to note that facial structure is a significant factor when it comes to filler choice and placement. You’ll want to choose a provider who uses what’s called the Phi proportions system to figure out which areas of your face need attention.
Phi proportions are a set of measurements including brow height and length, the length of the nose, peak of the cheek, size and shape of lip, and lip and chin length on a lateral profile.. From those numbers, your provider will determine where you need filler. If you have the beginning of jowls, for instance, it’s caused by volume loss in the cheeks, so that’s where the filler would be placed.
It’s a scientific system, and your provider knows best!
As far as who isn’t a good candidate for dermal fillers, anyone with extensive autoimmune disorders or blood disorders; anyone with an active infection; and anyone with a known allergy or sensitivity. Also, those with body dysmorphic disorder are highly dissuaded from using fillers because it can amplify their underlying psychological issues.