We can thank influencers like Alex Earle for normalizing transparency when it comes to once-taboo topics like aesthetic treatments. Earle recently vlogged her lip filler appointment, sharing precisely what she gets (one syringe of Restylane Kysse). In the comments, she added a disclaimer that she’s not encouraging any of her 5.9 million followers that they need lip filler but simply wants to share her own personal experience.
Likewise, 26-year-old Jenna Palek, another TikTok creator, recently treated herself to upper-lip filler for her birthday. Supporters sounded off in the comments, writing, "You will never regret lip filler," and "It's addicting."
Lip filler transparency
It's clear to anyone on TikTok (or these streets): Lip filler is enticing to many people. "Lips are the new gateway; it's no longer Botox," says Corey Hartman, MD, FAAD, a dermatologist and injectable expert based in Birmingham, Alabama, who says that some of his youngest lip filler patients are in their early 20s. NYC plastic surgeon Melissa Doft, MD, agrees that patients are coming in younger and younger, and there's a definitive vibe shift. "I think that young people now think about filler as 'let's try it out.'"
The casual "come with me" transparency around filler content online is helpful in some regards. "Instagram and TikTok influencers are doing these 'drops' of information — I think it's great if we're talking about, 'I had this experience, this is what it was like,' explains Dr. Doft. "A lot of people want to hear about that experience because surgery is kind of scary; even these noninvasive procedures like fillers are intimidating." What's missing, though, is medical context. Dr. Doft believes that if these influencers sat down with their doctors to share their experiences, it would be more helpful and informative for their followers.
Filler is, after all, a medical aesthetic procedure. There are risks, and for some people, a lot of regret. From a safety perspective, the biggest risk is unintentional injection into a blood vessel, which can result in necrosis or skin death. Other than the pain, swelling, and bruising, there's also the risk of filler migration, which while generally uncommon, is more likely to happen with lip injections than any other. "In areas like the mouth, which you’re moving a lot, it's possible that your filler could move or migrate," facial plastic surgeon Jennifer Levine, MD, told R29. "If the person is over-injected or the injection is not perfectly in the right plane, which is not super easy [to pinpoint], then [migration] can happen."
Many celebrities have been speaking out about being remorseful about getting dermal fillers. Case in point, Ariana Grande recently filmed her getting-ready routine for a Vogue Beauty Secrets video. Before applying lip liner, she says, in full transparency: "I've had a ton of lip filler over the years — and Botox. I stopped in 2018 'cause I just felt so...too much." Likewise, Courteney Cox had all her filler dissolved in 2017. Blac Chyna dissolved filler from her cheeks, jawline, and lips and documented the process on Instagram. From a PR standpoint, that seems like a more straightforward story to tell the world. It can be admirable if a celebrity finally admits to getting some sort of work, like fillers, done, then decides to stop and “let their face be natural.” Of course, we never really know if that's true.
We're not talking enough about "perception drift," a term coined by dermatologist and cosmetic surgeon Sabrina Fabi, MD. Perception drift is when a person's perception of their face becomes altered by cosmetic procedures. This can happen to people who get filler in their face — enhancing their lips, elongating their jawline — causing them to want more and more filler until it looks like, in Grande's words, "too much." It's a slippery slope for celebrities and influencers, for whom cost and access are often limitless.
It's not a problem unique to celebrities (though those cases are more public), but those influenced by them. "It's dangerous, and it does happen, even putting in minimal amounts of filler," explains Dr. Doft. She's seeing regret play out firsthand, from people complaining of "lumpy" or uneven filler or just too much of it. "Every week, we're seeing somebody who wants [filler] dissolved that was put in elsewhere," says Dr. Doft. "People are finding that there's too much filler or that over the years, not all the filler has dissolved uniformly — sometimes it dissolves in nonuniform ways; there's an interest in taking that out."
The problem with dissolving filler
Unfortunately, dissolving filler, done by injecting an enzyme called hyaluronidase, can cause issues, too. "You're dissolving filler made of hyaluronic acid, but you also have natural hyaluronic acid," explains Dr. Doft. "So when you're dissolving [filler], it tends to over dissolve your natural hyaluronic acid, making you look a little saggier or a little more hollow. Then, it's hard for the patient because they could look worse than their baseline. Your body will replenish it, but it takes a while."
People are also disillusioned by the cadaver studies that indicate filler may never fully leave the body once injected. A 2020 ultrasound study looked at the "bio-integration" of hyaluronic acid injections into the skin's subcutaneous cellular tissue, finding thirty days after injection, researchers found a "total integration" of HA in the tissue. This is not bad or worrisome, but speaks to the fact that filler injections change the soft tissue of the skin on a cellular level and may be more difficult to completely reverse.
"I think there's enough information out there for people to think, maybe fillers are not so great for you," offers Dr. Doft, explaining that there are alternatives. "Sometimes we're using filler as a catchall," explains Dr. Doft. "I say that all the time. Instead of injecting your lips, we could do a peel or a laser to brighten your skin, or let's do something different with your skincare."
One alternative is platelet-rich plasma (PRP) treatment, which injects a concentration of a person's own platelets (taken from a blood sample) back into their skin via microneedling. The treatment stimulates collagen and elastin. NYC-based blogger Roma Abdesselam (she goes by Stay At Home Daughter) recently posted about switching from fillers to PRP therapy. While PRP is not a filler alternative — it's not going to change the contours of your face or plump your lips — it can help improve skin quality, which might be an effective treatment for some people. "Will I get fillers in the future? 100% yes," explains Abdesselam in the caption. "But [right now] I'm really enjoying how natural my PRP looks."
If you're looking to enhance your upper lip without filler, a lip flip may be an alternative. Instead of hyaluronic acid gel injected into the lips, Botox is placed directly above the lip to weaken the muscle above the mouth and create a slight 'flip' to the upper lip, creating a fuller appearance. While most doctors still prefer filler to Botox when it comes to addressing the lip area, it might be worth talking to your doctor to see if a lip flip might be a better option for you, especially if you're wary of filler.
But filler is not something to be scared of. If anything, through my reporting I've found that filler in the hands of a trained medical professional is safe and if it makes you feel more confident, go for it. My biggest recommendation is do your research (which you're already doing by reading this) and consider the stories of regret as seriously as the rave reviews.
Personally, as someone with access to filler — who’s been recommended different forms a few times — I’ve found it most helpful to take filler-related content as someone's personal story and not a general aesthetic prescription. Filler is not like a Drunk Elephant moisturizer that you can try once and move on once the last pump is gone; it stays with you, and there’s a risk of regret, which is a significant de-influencing factor. Of course, you do you, but I’m sticking with my plumping lip gloss.