Whatever You Do, Please Don't Use A Hyaluron Pen For Filler

In the hands of the wrong injector, fillers and injectables can be a slippery slope. Yet, the idea of DIY, at-home needleless methods to plump up limp lips is no alternative (the words ludicrous, unsafe, and downright senseless come to mind). Nevertheless, the troubling trend is all over TikTok and Instagram, pushing the talk of makeshift ‘injectables’ into the mainstream. But here’s the thing: The fact that you can purchase needle-free devices (a.k.a. hyaluron pens) online, doesn't mean you should – nor should you use them due to the mounting list of complications. “Just because something does not have a needle does not make it safe, effective, or good to perform at home,” says Ava Shamban, MD, a board certified dermatologist in Santa Monica, CA.

If you're looking to inject your lips or anywhere else on the face or body, a board certified provider who specializes in the treatment you are interested in is the only way to go. But, in case you need further convincing, we’re here to outline why hyaluron pens are never a good idea.

The Danger Zone

Hyaluron pens are rapidly coming under fire — and have been for much of the past year — for their ability to augment the lips and other facial features unsafely. Marketed as do-it-yourself injections that replace the need for hyaluronic acid (HA)-based dermal fillers legally procured and injected by medical professionals, providers have been trying to warn patients to stay away from these gadgets at all costs. Even the United States Food and Drug Administration (FDA) weighed in. Last fall, the agency issued statements cautioning both “the public and healthcare professionals not to use needle-free devices such as hyaluron pens for injection of hyaluronic acid or other lip and facial filler.” In theory, the idea of do-it-yourself-when-you-need-it injectables sound like a dream come true, but they're anything but that.

Needle-free devices go by a variety of names, including hyaluron pens, Hyla-Pen, microinjectors, non-invasive injection pens, non-invasive nebulizer syringes, high-pressure pens, and sprayer pens. These pressure-powered pens serve as a way for people with diabetes to safely administer daily insulin and deliver anything from vaccines to Cortisone. However, illegal hyaluron pens force hyaluronic acid and other unknown filling agents into the lips (or other facial features) creating a recipe for disaster.

Their accessibility makes hyaluron pens popular, but no at-home cosmetic procedure that entails supplies bought through Amazon is a good idea, says Douglas Monasebian, MD, a New York City-based board certified plastic and maxillofacial surgeon and assistant professor at the Mount Sinai School of Medicine. “An individual should never perform do-it-yourself injections,” he explains. “When a board certified physician performs the procedure, the patient can rest assured that the product is safe, sterile, and certified.” Both cannulas and needles are safe injection techniques that allow the injector to place filler in specific planes and depths of tissue to achieve a desirable outcome safely, says Snehal Amin, MD, a board certified dermatologist in New York City. So, without a needle, how does the assumed hyaluronic acid enter the lips in an attempt to make them look fuller?

Unlike syringe-based injections performed by a professional, these dodgy devices use high pressure to force the filling product into the body. “Hyaluron pens work by an aerosolized air pressure that forces hyaluronic acid gel into the face, most commonly the lips,” explains Dr. Monasebian. “There are dangers associated with this as it would be difficult to control the amount of pressure that is exerted on the lips and also where it settles.” Whereas a needle or cannula allows for controlled injections of the filler exactly where desired, these hyaluron pens don't offer that mechanism because there's no ‘press’ via the plunger. This makes the treatment much harder to control and leads to far less predictable results.

Don’t let the naming convention fool you. Although these now-popular tools have the prefix of ‘hyaluron’ in their name, they don't contain hyaluronic acid – yet many users assume they do. Furthermore, they will not accomplish what you want them to, says Kenneth Beer, MD, a board certified dermatologist in West Palm Beach, FL, and founder of Scientific Rx Skincare. “I find them to be a waste of time and money,” he adds.

How Hyaluron Pens Became Trendy

Blame the uptick of this scary treatment on the virality of social media coupled with COVID-issued stay-at-home orders back in March of 2020. “People interested in cosmetics and aesthetics respond positively to the words ‘non-invasive’ or ‘needle-free,’” Dr. Amin says. The marketers behind many needle-free devices imply that these pens are nearly equivalent to fillers administered by a dermatologist or plastic surgeon, which is far from the truth. “The only people one should listen to about the safety and effectiveness of medical procedures are the physicians who are doing these procedures — a layperson should never offer medical advice,” Dr. Monasebian says.

Unfortunately, most patients who opt for DIY fillers are not licensed or do not know what they are doing. “It is especially enticing to try these filler pens if you see it being done by your favorite YouTube star,” Dr. Amin shares. “The issues always are: it's not clear what someone is injecting; the location and depth of the injection are highly variable; and the injection is very superficial but can cause bruising, infections, and lumps.” When administered by a reputable provider, a syringe is precise, easily controlled, sterile, and guaranteed to have a safe, FDA-approved product within it. The same cannot be said for these needle-free tools. “It's like the difference between a toddler and an adult driving a car — one knows what they're doing, and the other is clueless,” Dr. Beer notes.

A cheap (pens range in price from $50 to a few hundred dollars) and easy-to-get-your-hands-on alternative to professionally administered treatments, you can purchase hyaluron pens on a plethora of websites. But, as Dr. Beer says, there is no clear purpose of using hyaluron pens other than a shortcut to avoid injections and their cost.

Doctors Are Up in Arms

Hyaluron pens make dermatologists and plastic surgeons livid, and we don't blame them for being irate. Some beauty and anti-aging trends that surface on social media push for positive shifts and waves for professionals. Still, this one isn't. Dr. Shamban says the hyaluron pen trend is shocking and its substantial social media presence is quite scary. “There are tremendous risks for using a pneumatically-driven device to deliver potentially contaminated – with either an infectious agent or a chemical – product to the face,” she says. “Add to that it is administered by a non-medical professional, and there is likely to be a dermal disaster.”

Patients pay a premium for professional expertise, but it helps minimize the risk of complications (all elective cosmetic treatments and procedures carry some potential risk) and maximize the result. “In the office of a board certified dermatologist, you receive controlled injections by a highly skilled individual using a product that is manufactured according to FDA specifications, which includes a safety profile,” Dr. Shamban shares. Plus, patients are also dolling out their hard-earned cash for their doctor's experience in artistry and their ability to intervene, manage, and mitigate any reactions or problems that may arise. But with hyaluron pens, none of that exists. “It looks simple, and it appears to be a quick fix that anyone can do because it does not engage a needle, but it's not an inexpensive way to plump at will,” she adds.

What Can Go Wrong with Hyaluron Pens

Besides the fact that hyaluron pen injections are far from pain-free as many users on social media claim them to be, there's a slew of potential problems that can quickly arise. Dr. Shamban cautions patients to be extremely wary about performing these treatments on themselves or having the device used by a non-medical professional. “It is taking a major risk with innumerable complications, particularly in the wrong hands,” she says. “Risk to reward will never be worth it, and there's documentation of countless medical issues with these devices.”

Suppose using a pen results in adverse effects. In that case, it's not as easy of a fix as injecting some hyaluronidase (an enzyme that dissolves hyaluronic acid) and waiting for the filler to vanish. There's also the risk of permanent complications and possible disfigurement. Plus, Dr. Monasebian says patients do not know the delicate anatomy of the face, and this is how and why complications occur. All of that adds up to a high probability of something going wrong. Such adverse effects include:

• It places filler in the wrong area. There's usually a lack of facial anatomy and medical experience among hyaluron pen users, making it super easy to administer the filler into the wrong area. “Hyaluron pens merely ‘push’ a thin hyaluronic acid filler into the dermis (a superficial layer of tissue) where it disperses in a nondescript fashion,” Dr. Amin says. “Lacking specificity, it is much less likely to produce an aesthetically pleasing result.” There are vessels and nerves in the face, and, if someone does not know where they are, they can easily get the product into the wrong area.
• The pressure can cause issues. Since pressure is the method of product disbursement here, a bevy of severe problems can quickly ensue, including skin necrosis, long-term swelling and bruising, blocked blood vessels, and hard-to-fix lumpiness. As Dr. Shamban says, “operator error is just one aspect of the problem.”
• Duck lips are pretty much to be expected. The only way to fix them is with hyaluronidase, an injectable enzyme that deflates the area treated with hyaluronic acid by breaking it up.
• Reports of infections exist. Any dermatologist, plastic surgeon, or certified injector knows that it's a sin to inject the lips – or any other facial feature – without thoroughly cleaning them first. However, most at-home users don't follow the proper and necessary protocols to sterilize an area, making it prone to infection. “High pressure can also deposit bacteria, which can lead to infections,” Dr. Beer explains. “The problem is that these infections can be from bizarre types of bacteria.”
• Vascular occlusions can occur. Perhaps the most serious complication is vascular occlusion, which occurs when an injectable gel or substance enters an artery and limits blood flow, possibly leading to skin loss, blindness, or stroke. Of course, any filler poses the potential for this, which is why dermatologists constantly stress the importance of only seeing a board certified, experienced injector. There's also misinformation swirling around out there that says that these pens can't cause a vascular accident, which is not the case.
• Asymmetries and bumps are common. We've already explained the rule of predictability and understanding of facial anatomy. Without either of those, there's no way to ensure a smooth, successful result. Also, the force and pressure used to insert filler into the face cause the product to spread uncontrollably, resulting in asymmetries of some sort. On the other hand, not depositing the filler deep enough can lead to lumps, bumps, and even a blue tint on the skin.

The HA Factor

As if the concept of performing your injectables with a non-FDA-approved device isn't scary enough, it's important to shed light on what's inside these tools. Unlike in-office, doctor-administered treatments that use hyaluron pens under a prescription for entirely different (read: non-aesthetic) purposes, these pens almost never use the same quality filler as what professionals inject. Most times, what goes into the pen is equally as frightening, if not more so than the act of self-injecting.

So, where do the products that everyone is putting into their pens come from? No one knows, to be honest. “It can be anything from water to Jell-O or counterfeit fillers, which are a large-scale problem as recently reported in a study published in the Journal Dermatologic Surgery,” Dr. Amin says. Another article in the Journal of the American Academy of Dermatology references the rise in unregulated internet injectables and the growing trend of self-injecting unregulated neurotoxins and fillers under the guidance of YouTube tutorials. “So there's a lot of concern about what people are putting into these pens,” he adds.

Often, most hyaluron pens are sold separately from the ‘filler,’ making it hard for consumers to know what they're injecting into their faces. Not knowing what lives within a patient’s face can make it downright impossible to properly correct an issue – especially if the product is contaminated. “Sometimes, you can have a lifelong complication of a very difficult-to-treat fungal infection or even a foreign body reaction that ultimately will result in a lot of scarring,” Dr. Shamban warns.

The Takeaway

If fuller lips, more defined cheeks, or smoother wrinkles are on your goal list for 2022, do yourself a favor and visit a board certified dermatologist or plastic surgeon rather than taking matters into your own hands with a hyaluron pen.