Everything You Ever Wanted To Know About Lip Injections

Illustration by Anna Sudit.
Read our lips: We're not saying you need lip injections. But hey, if you'd like to try them or are curious about the procedure (and it's kind of impossible not to be, given the current state of pouty celebrities and volumizing lip products), it's important to fill up on facts before you go plumping anything.

And that's where we come in. In the slides ahead, we discuss the best filler for beginners, how to find a doctor you can trust, and walk you through the procedure, step by step. We also put some rumors to rest and offer advice from top experts in the field. Oh, and there's even a cute GIF involved.

Ready to get your fill on the subject of lip injections? Let's get started!
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Illustrated by Anna Sudit.
The first step is to read up on injections everywhere you can — not just here! If you're still interested after you've done plenty of research, it's important to find the right doctor for a consultation. Not the first doctor you find, but the best doctor you can find.

A couple of tips: If a doctor wants to inject your lips without a thorough and transparent consultation, you should do one thing: run! walk out of the office at a safe pace. Why? Injecting lips is both an art and a science, which you'll realize the further you get into this article. Just because an expert has MD after his or her name does not make them qualified to inject your lips (but more on that on the next slide).

It's not only important to be clear about your expectations before signing up, but also to discuss side effects and see examples of a doctor's past work. Sure, we talked to a lot of doctors for this article, but that is not a replacement for the conversation you should have with your doctor before any elective procedure.

To put things in perspective, we look to Norman Rowe, MD, board-certified plastic surgeon at Rowe Plastic Surgery in New York. "It always amazes me that people will spend more time on which car to buy or which movie to see than on who they’ll let stick needles in their face." We couldn't have said it better ourselves.
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"Make sure [you select] a qualified medical professional," Dr. Rowe says. He notes that anyone with medical training can legally do injections, which means your dentist could technically start beefing up pouts on the side if he or she felt so inclined. "It's more common than you think," Dr. Rowe says, who sees many patients for corrective work.

In fact, all of our experts agree that it's best to go with an MD that is a plastic surgeon or dermatologist, preferably one that is board certified and comes with sterling reviews and a history of doing lots of lip injections. The consultation is the time to vet your doctor, get credentials, and see previous work to be sure your aesthetics align.

Expect to pay anywhere between $600 and $1,200 for a round of temporary injections, says Diane Berson, MD, board-certified dermatologist and member of the American Academy of Dermatology.

This is also the time you may want to bring up testing lip injections. For those who want even more reassurance, there are super-temporary saline injections, sometimes called a Cinderella Lip Treatment. Dr. Rowe does this often for apprehensive patients.

"I will inject saline, which is just salt water, into the patient's lips," he says. "It lasts about 24 hours and they can decide if they like it. If they do, they come back and we put the filler in, if they don't, there's no harm, no foul." Unlike fillers, there is no need for the saline to "settle into place," so once the swelling goes down (which should take a few hours), you'll see the results your doctor intends to reproduce with the filler, Dr. Rowe says.

But don't be mistaken, there are still risks if you're injecting a needle into your body — it's not the equivalent of trying on a platinum wig when you want to go blonde. Think: infection, swelling, and bruising.
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There are a lot of difficult decisions you have to make when it comes to getting lip injections, but fortunately, picking the right filler isn't one of them.

Hyaluronic acid, in a few different forms, is both the industry standard for temporary lip injections and the only temporary lip filler approved by the FDA. Lisa Chipps, MD, board-certified dermatologist in Los Angeles, explains.

"They’re marketed under different brand names — Restylane Silk, Belotero, Juvederm — but they’re all made from the same molecule, which is hyaluronic acid," she told us. H.A., as you may already know, naturally occurs in skin and is a top ingredient in hydrating skin-care products, since it plumps skin by capturing and holding onto water. Picking which of the formulas is best for you is really up to your doctor. For example, Dr. Chipps' practice uses all the options stated above, depending on the place of injection, patient, and desired result.

All of the experts we interviewed agreed on one thing: hyaluronic acid is not only the best option, but the only option for those new to the world of injections, since it will dissolve on its own and is well-tolerated, since it's already in your body.

There are irreversible fillers and implants, but those are not for beginners. "You have to crawl before you can run," Dr. Rowe says.
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We know what you're thinking: Get to the pain! We feel you.

"Lips are one of the more uncomfortable places to inject filler," Anne Chapas, MD, board-certified dermatologist at Union Dermatology in New York told us. "We have a lot of nerves in our lips, so we [can] do a combination of topical numbing cream and, sometimes, injectable numbing medications, so patients are comfortable." However, many of the H.A. injectables come with lidocaine (a numbing pain reliever) built right in, so some doctors opt out of additional measures.

One, or a combination of the above pain-reducing options, will normally temper the pain of the actual procedure, but you're likely to experience pain later, since the skin is being stretched. Dr. Chapas describes the pain as mild to moderate and notes that it can last for a few days.

It's easy to talk about pain, but sometimes, it takes someone who actually went through the procedure to get a firm grasp on what to expect. R29 staffer Jenna Rosenstein got H.A. injections (Restylane-L, which has built-in lidocaine, to be exact) and says she barely felt anything during the actual injections, since she opted for numbing cream beforehand.

"Once or twice, I did feel a little bit of pressure in my lips — it was uncomfortable, not painful," she says. "I didn't feel any pain until about three hours after the procedure. It felt like someone had slapped me really hard on the mouth...I couldn't make a kiss-y face without wincing. But the pain went away by day two, and then all uncomfortable feelings went away completely by day three."
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It's no secret that some lip augmentations look incredibly natural and some look, er, not so incredibly natural. This is partially because of the size that you and your doctor select, but it goes deeper than that. The fact of the matter is that some doctors have a better feel for nuance and aesthetics than others.

"It’s something you have to have an appreciation for, to get the proportions right for each person" Dr. Chapas explains. "There is a lot more artistry to injecting lips than just injecting a wrinkle or a line." That is another reason why the consultation is so important. "We show actual before and afters of our patients, so that everyone has a realistic expectation for the type of filler we do."

Selecting where, and at what volume, to inject the lips is also an important decision to make in the consultation. "The lips are supposed to be filled in a natural ratio, where the upper lip is approximately 2/3 the size of the lower lip," Jessica Weiser, MD, board-certified dermatologist at New York Dermatology Group told us. That means that sometimes, only one lip needs to be filled, sometimes both, and often at different volumes, since not everyone's pout is symmetrical.

Where to inject is also a delicate matter. The lips can be injected into the skin surrounding the lips (to define the Cupid's bow, for example), into the lips (for fullness), and into the lipline (for definition). "It's like sculpting, " Dr. Chipps says.
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Dr. Chipps says that it's important to see your box of injectables opened in front of you and to be sure only your dermatologist or plastic surgeon is doing the injections. Avoid blood thinners, like aspirin and fish oil, for at least a day beforehand, which can increase bruising.

If you opt for numbing cream, expect it to be placed on the lips for approximately 10 minutes, Dr. Weiser says. "The lips absorb quickly and do not require lengthy topical anesthesia. [Then,] the skin surface should be cleansed properly and then injections are performed."

Your doctor should go very slowly, often pausing to show you the progress that he or she is making. "There is a real balance and art to it," Dr. Chapas says. "I find that you really need to go little by little, so you normally inject the top lip first, balance it out on the other side, then inject the bottom lip. It takes about 15 to 20 minutes." She continues: "What you see is what you get, you’re not waiting for it to work, like Botox."

Some doctors will gently mold the filler with their fingers after it is injected by squeezing and patting it into place, while others aim to inject it exactly where they want it and avoid molding, since it can increase bruising and swelling. Based on our research and the experts we consulted, there is no single stance on molding — it's a technique that some like, while others do it sparingly.

What all our experts do agree on is that your doctor should let you chime in along the way and help decide whether or not to add more or stop. Dr. Rowe even recommends his patients go lighter than they think they may want, live with it for a week, and then decide whether or not to do more. "It’s best to start with baby steps, " he says.

After the injections, ice packs are applied. That evening, Dr. Chapas suggests patients sleep on two pillows to decrease swelling. Use ice sparingly at home (getting the H.A. too cold or hot can prevent it from settling properly) and ask your doctor if additional anti-swelling measures are right for you, like oral antihistamines, pain relievers, or topical corticosteroids.

The entire procedure should take under 30 minutes, our experts say.
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Dr. Chipps says it best: "Any time there is a needle crossing the skin, there is a risk." Bruising, swelling, and pain — all of which can last up to days and in rare cases, even weeks — may occur. There is also the risk of infection. Naturally, this makes it very important to check in with your doctor post-treament, especially if you're feeling nervous about side effects.

While hyaluronic acid is a naturally occurring substance in your body, you can still have an allergic reaction to H.A. injectables, since there are often inactive ingredients (like carrying agents) and pain-reducing ingredients (like lidocaine) in the formula. Tip: Those prone to allergies or are just plain nervous can do a patch test on their forearm a few days before the procedure to be sure they won't have an adverse reaction.

Dr. Rowe also notes that injecting the lips can prompt cold sores for those who are prone to them, so he normally pretreats those patients with a round of anti-viral medication, like Valtrex.

There are also less common side effects that are important to consider. "More rare side effects include nodules or palpable material within the lips," Dr. Weiser says, those are basically bumps of H.A. that don't settle or feel natural. "Extremely rarely, lip filler can be introduced into a blood vessel in the lip, which can have more significant consequences if not dealt with immediately and appropriately."

Dr. Berson elaborates: "Around the lips, there are important [blood] vessels," she says. "If you inject into a vein, you’re going to get an ecchymosis, [which will make the lips] black and blue." But what's worse is that in the rare cases when H.A. is injected into an artery, you can end up with necrosis, or a "non-healing sore" that requires immediate medical attention. A more catastrophic reaction, such as blindness, could result.
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One of the great things about lip injections is that the results are instantaneous, so you'll leave the office with fairly accurate (albeit swollen) results.

For the first 24 to 48 hours, the filler is malleable and your skin is prone to swelling, which means be gentle! This is noted as the time that your injections need to "settle." No facials, yoga, or exercise is recommended, which can alter the placement of the filler and increase swelling and bruising.

"Lips often swell for one to three days after treatment, but this is highly variable and some patients will experience no swelling and some will have more dramatic swelling that will take longer to subside," Dr. Weiser says. "Bruising can last approximately one week, but can be covered with makeup or lipstick, as needed. Some doctors will offer to treat more significant bruising with a laser treatment if necessary."

While the average length of time H.A. fillers will last is about six months, it varies for everyone, from around three months to a year. Why?

"H.A. lasts different lengths, depending on where you put it and how active that body part is," Dr. Chapas says. "I find that if the labeling says six to 12 months, [patients] normally come back every three to six months."

Rosenstein (our own staffer who got injections) said this at the time of publishing: "It's been eight weeks and I can tell that the fillers are slowly fading. But my top lip is definitely still a little more plump. I noticed them going down after a month."
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You may have heard that H.A. lip injections are reversible — that there's an "antidote" that can be injected into the lips to dissolve the filler. This is true, but it isn't a get-out-of-jail-free card.

As you already know, H.A. lip injections will eventually dissolve on their own. Why? This is thanks to hyaluronidase, a naturally occuring enzyme in the body that metabolizes hyaluronic acid. This is part of the reason why injections fade at different rates in different people. "It may be more active in some people than it is in others," Dr. Chipps says.

So, you guessed it: Doctors can also have hyaluronidase injected into the body to completely dissolve the H.A. injections — in as little as 24 hours. But here comes the ironic bit: "Hyaluronidase doesn't discriminate," Dr. Rowe says. "It will eat up all of the hyaluronic acid, both what you injected and your native hyaluronic acid."

Translation: Your lips may appear even smaller than they were before you had them injected, since the enzyme will dissolve your body's natural H.A. "While you can do it, I don’t recommend it," says Dr. Rowe. (Another reason to go slowly, it's far easier to add more a week later than remove too much.)

Dr. Berson agrees that it should really only be used when it's medically necessary to have the H.A. break down rapidly, like if it was accidentally injected into a vein.
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"When you first get them, you can tell that there's something in there, but it's only discernible to you," Rosenstein says about her own experience. "But by day three, they just felt like my normal lips, other than the one tiny weird bump I had on the inside of my upper lip. [I was told] these bumps are common — I'm not sure if it's scar tissue or a ball of hyaluronic acid, but the ball remained there for, like, a month."

Our experts agree that you really shouldn't be able to feel or see H.A. injections once they settle. Dr. Rowe notes that tiny balls (which is likely what Rosenstein experienced) can be due to the filler being injected too close to the surface of the skin.
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You may have heard that to make lips dramatically bigger, you must opt for implants — that filler can only go so big. The verdict? Fiction. "You can keep injecting until you get the size you want," Dr. Rowe says. "Honestly, the limit of how big your lips can be with an injection is based on your wallet and the willingness of the doctor."

But perhaps the worst rumor is that your lips will become stretched out after repeat injections. Verdict? Fiction — to a point. Our experts agree that there is no scientific proof that injections will eventually deflate the lips. In fact, if anything, lips will increase in size due to remnants of H.A. and scar tissue from the injections. Dr. Chipps notes that in some cases, injections can even prompt your body to create more collagen.

That is, unless you go excessively large for extended periods of time. "Stretching is only a risk if excessive volume of filler is placed," Dr. Weiser says. "The lips are able to accommodate a certain amount, depending on their size and elasticity, which varies from person to person and should be obvious to an expert injector." Translation: Don't get crazy. But you already knew that.
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