There are so many lip fillers on the market it’s hard to distinguish and choose which one is right for you. Lucky for you, that’s not your job! A good injector can decide what filler would be best for that patient based on desired patient outcomes, patient presentation (what is your baseline, is there asymmetry), has this person ever had filler before or are these virgin lips, the list goes on and on.

Most people are concerned with looking natural. Gone are the days where overly exaggerated lips were “in.” People want to look plumped and at the same time look like they got nothing done. I get a lot of requests for “natural lip fillers.” The truth is, most fillers can give you a natural look. It’s all based on quantity of product used and the injectors technique.

Types of Lip Filler

Let’s talk about some popular fillers that are on the market you may have heard of. To name a few, there’s Juvederm Ultra XC, Juvederm Ultra Plus XC, Volbella, Restylane, and Restylane Silk. Each filler on the market is made with its own unique properties. To name just a few, these fillers vary in viscosity (how thick they are), water affinity (how much it attracts water, this helps gauge how much swelling one may have), and duration (how long they last).

Each one of these fillers are Hyaluronic Acid fillers. What is Hyaluronic Acid you may ask? Hyaluronic Acid, or HA, is a molecule that your body naturally produces. It allows for skin moisture and has the capacity to retain water. “It’s produced by fibroblasts, the same cells that make collagen, in the dermis, the second layer of skin,” says Neal Schultz, M.D., NYC dermatologist and founder of BeautyRx by Dr. Schultz. “It’s the key molecule involved in skin moisture because it absorbs up to 1,000 times its weight in water.” You can think of HA kind of like a sponge that holds on to moisture to keep your face looking fresh, plump and rejuvenated.

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Who should get lip fillers?

A good candidate for lip fillers is anyone who feels as though they have genetically thin lips, asymmetries, women who have volume lost due to age, weight loss, etc., or anyone who wants a little boost in their confidence.

Who can’t get lip fillers?

The main contraindications to any dermal filler treatments, including lip treatments, are pregnancy and breastfeeding. Sorry ladies, if you are with child or breastfeeding a little one, you’ll have to wait! Other things to think about with dermal fillers is if you’ve had recent dental procedures within the past two weeks, if you’ve been sick the past two weeks with a cold, sinusitis or the flu, if you’ve been on antibiotics the past two weeks, it’s important to wait 2 weeks until all of that passes before having any kind of dermal filler treatment. Our immune systems are low when we are in the above mentioned situations (ie cold, on antibiotics), and we don’t want our bodies potentially attacking the site where the filler was placed, so it’s best to wait!

Lip Filler Versus Lip Flip

The topic of lip filler versus lip flip often comes up. The biggest difference between lip filler and the lip flip is that it’s two different treatments, thus done with different products. Lip filler is done with, you guessed it, filler! That good ol hyaluronic acid we’ve talked about. The lip flip is done with Botox. A few units are placed slightly above the lips. The Botox relaxes that muscle where it was placed, flipping the top lip up and out, giving it a cute pout.

On average, Botox placed in this area doesn’t last very long, as this muscle we use to eat, drink, and speak. So its metabolized quickly. The lip flip will only last you about 6 weeks. Whereas lip filler can last 6-12 months. I like to say that the lip flip is a great way of seeing how you like your lips a little pouty, if you’ve never had filler before and are thinking about it or you’re on the fence.

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Lip Filler Pre Care: What To Do Before Your Appointment

There are a few things you can do to prepare for your lip filler treatment. Two to three days before your treatment, I recommend stopping a few supplements such as Vitamin E, Ginkgo Biloba, Omega 3, and Fish Oil as these thin your blood and can make you more prone to bleeding and bruising. Similarly, if given the thumbs up from your PCP, I recommend stopping any blood thinners and also NSAIDS (non steroidal anti inflammatory drugs) such as Ibuprofen, Motrin, Naproxen, and Advil. These too, thin your blood making you more prone to bleeding and bruising. Last but not least, I recommend eating fresh pineapples 3 days before your treatment and 3 days after your treatment. Pineapple has an enzyme called bromelain, that some studies suggest can help the body decrease inflammation, swelling and bruising.

Managing Expectations

Knowing what to expect regarding your lip filler treatment is so important! Most of the time we have an idea in our minds of what we expect and what we want out of our lip filler treatment. It’s important you communicate with your provider what you like, what your lip goals are, and what you’re hoping to achieve once the treatment is completed. This will help the provider select the appropriate type of filler for you and also give you realistic expectations.

Sometimes people bring in photos of what they want their lips to look like. For example, “omg, I love Angelina Jolie’s lips, they are so so perfect!” It’s great to give your injector an idea of what you’re looking for. But that’s all it is, an idea.

The anatomy of your lips, is the anatomy of your lips. We can transform the height, slightly the shape, volumize it, and correct asymmetries, but it will never be EXACTLY just like Angelina Jolie’s lips. Your lips are unique to you, and we’re simply just trying to enhance your natural beauty. It’s also important to note, if you have pretty thin lips, and want a significant pout, it will take a few syringes to achieve that look, ie more than one appointment. Just like Rome wasn’t built in a day, sometimes neither are lips! So it’s important to be patient as we take it step by step to achieve the look you want.

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Lip fillers Before and After 1ml

1ml filler,before and after
Lips: Before & After 1ml of Filler

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Lip Filler Pain

During Treatment
You may have heard the rumors, lip fillers hurt! And they’re not lying… it does. But it doesn’t have to! There are a few options for pain management during your treatment. One option is to use ice during the treatment along w/ a small vibrator device designed to distract your brain from the injections. You apply the virbator near the lip, I have my patients hold it while I injected simultaneously.

Regarding the ice, you apply ice for a few seconds, then get injected. More ice for a few seconds, the cold will help with numbing, then more injections. And so forth, you get the idea.

Another option is to have a topical numbing cream applied 20 minutes before you get injected. This doesn’t mean that you won’t feel anything at all, but you feel significantly less discomfort. Most people don’t need the ice when they have topical numbing cream on, but you can still use ice if needed. Last but not least, you can also have a dental block or a “ring block.” This is similar to when you go to the dentist office and they numb you, and you don’t feel a thing.

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After Treatment 
Immediately after you get your lips injected, you continue to be numb from either the numbing cream or ring block, if you chose that option. Once that wears off (roughly about 30 minutes or so), your lips will feel and look swollen and tender to the touch. I personally also felt my lips tender when chewing, talking or brushing my teeth, aka any kind of movement. Tenderness is most prominent the first 3 days and then day by day they subside.

Expected Lip Filler Reactions and Healing Process

Lip Filler Swelling Stages 
This image always makes me chuckle. But I love it so much because it’s pretty spot on. The day after your lip filler, you wake up and if you’re a newbie, you’re like, “OMG what did I do?!” Your lips are always more swollen the next day then when you left the office. I always make sure to warn my patients of that so they know this is to be expected and that it’s normal. Give it a few days, swelling goes down and you’ll be obsessed. Most of my patients call me telling me they miss when their lips were more swollen and want more filler.

Lip Filler Bruising 
Some bruising after filler is completely normal and to be expected. The lip is a very vascular area, and even though I always aim for no bruising, and give my patients instructions on what to do before their lip filler to avoid this, it’s still expected you’ll have some mild bruising. Bruising on the lips is like bruising anywhere else on the body, it can take 10-14 day to fully go away. Bruising goes away in stages. First purple/blue looking, then it gets lighter, then that light yellow hue and then it’s gone.

lip filler healing process
Example of Lip Filler Healing Process

How to Reduce Swelling After Lip Injections

My biggest recommendation for lip filler post care is to ice. Icing the first 24hrs is very important. I typically recommend 2-3x/day is possible, for 15 minutes. I also advise patients to have fresh pineapples, as the enzyme bromelain in the pineapple helps with inflammation.  The other key component in your post care is an anti bruise cream like Arnica. Last but not least, as tempting as it is, it’s best to wait 24hrs before putting on lipstick to help diminish the possibility of infection.

Complications/Adverse Events

Swelling that is asymmetrical (i.e. uneven) after your lip filler treatment can be caused by a few things. First there’s the obvious, you had a botch job done and you have more filler on one side than the other side. And then again maybe it was a reliable injector but for some reason or another, your lips seem a little more swollen on one side than the other. I recommend waiting a full two weeks for full healing, then making a follow up appointment with your injector to discuss your concerns if you still feel they are somewhat uneven after all the swelling has gone down.  Any good injector will be highly concerned with your thoughts and opinions and will add a little filler on the other side, evening out any asymmetry. Sometimes all it takes is a few drops of filler.

The second most common reason is if you have a hematoma (bruise) on one side, you may have more accompanied swelling on that side, in comparison to the other side. This reaction is normal. I recommend waiting two weeks for full healing. By then the bruising will be gone, and you can then reassess and see if in fact your lips are symmetrical. If you still feel as though they are slightly uneven now that they’re fully healed, make a follow up appointment! Again, any good injector wants to please their patient and make them happy so don’t be shy to give them a  call.

Lip Filler lumps

A mild lip filler lump can be common depending on what kind of filler is used and how that persons body absorbs it etc. Nonetheless, there should never be any visible lump or any underneath your lip at all post lip injection. Once your lips are fully healed, they should feel completely normal, natural, and smooth.

Multiple lumps can be indicative of a novice injector (improper filler placement), or perhaps even inauthentic product. Always follow up with your original injector if you notice a lump(s) as they should be able to dissolve this for you.

Lip Filler Removal

Removal of lip filler can be done with some dissolving agents like Hyalenex or Vitrase. If you have a lump or bump that’s what they’ll use to dissolve it. Depending where you go to get your lips injected, some injectors prefer starting fresh with their techniques and skills instead of adding more filler on top of what you have. So they’ll dissolve your lips first, and then do your lip filler treatment. If I dissolve someone’s lips completely, I like to wait two weeks, then have them come back and I will then do their lip filler treatment.

If you want your lip fillers removed contact us and to make an appointment.

White Lips After Filler

Just like any other medical procedure, dermal filler filler treatments also come with risks. The #1 concern with dermal filler, and what every careful expert injector is always attempting to prevent, are occlusions. Don’t be fooled, this isn’t just a potential for novice injectors, this is a possibility for even the most elite, expert, world renowned injectors. No one escapes this risk. You see, the face is extremely vascular.  And it is of utmost importance to know your anatomy so you know not only where the most important vessels run, but what patterns they follow and their depth. This will allow injectors to be safe, but sometimes even with all this extensive training and caution, injectors can still experience this stressful situation of an occlusion.

So what the heck is an occlusion? To put it simply, this is when dermal filler gets lodged into a vein or an artery, obstructing blood flow and circulation. The problem with an occlusion, is that due to the obstruction in the vessel, we are now blocking oxygen from free flowing, and with no oxygen, then comes tissue death (necrosis). Sounds scary, right? I know. That’s why it’s so important to choose your injector wisely. You want to make sure they are well educated, experienced, and that they know what to do in an emergency (occlusion). For example, every year I take a cadaver course to further enhance my anatomy knowledge. Dissecting the human face to learn skin tissue layers and blood vessel placement is indispensable to injectors who want to protect their patients.

So how do you know you have an occlusion, you may wonder? Occlusions can happen either immediately while you’re still in your injectors chair, or it can happen hours after you’ve left the office while you’re home, or running about your day. Symptoms to look out for is severe bruising, blanching, (whitening of the skin near bruising), mottling of the skin (blotchy, red/purple marble looking appearance of the skin), pain, and small pustules (almost like little pimples). And don’t just look for these signs and symptoms near where you were injected, but also up through the nose area and middle of your eyebrows. If you ever were to notice any of these signs and symptoms, you need to immediately call your injector.

symptoms of occlusions caused by filler
Example of an Occlusion

They need to see you immediately so they can flood the tissue with a dissolvent as mentioned above. If this goes untreated not only can you have necrosis but also blindness and stroke.  If this is done in a timely manner, the tissue can still be salvaged. Again, this is time sensitive. If it gets dissolved as soon as you notice something “may not be right” you will heal beautifully and all will be well. I always keep 12 vials of dissolvent in my fridge as part of my emergency plan! On a lighter note, according to JCAD, the incidence of necrosis occurs 1 in 100,000 cases.

At Roddy MedSpa, the utmost care and caution is always taken with continued education, private trainings, an emergency plan set in place, surrounding supportive colleagues, and a plastic surgeon as a medical director.