When Lip Fillers Are Not Enough

When it comes to achieving the perfect pout, most people immediately think of dermal fillers. While it is certainly the most mainstream and least invasive, there are other options, especially if you're looking for a more permanent option.

What Are Lip Fillers?

But first, what is dermal filler exactly? Dermal filler is a soft tissue injectable that can be used on various parts of the body to smooth out unwanted lines and wrinkles, reduce sagging, and plump lips. Most fillers are made of collagen (like Zyderm® and Dermalogen®) or hyaluronic acid (like Restylane® and Juvederm®). The most significant difference between dermal filler and other forms of lip augmentation is that dermal filler is not permanent. The body breaks down and absorbs the filler, so most patients see results lasting around four to six months (for lips) depending on the person and the type of filler used.

"Filler offers a very good solution which, although it does wear off over time, is reliable and by in large very safe," says board certified plastic surgeon David Rapaport, MD. "Hyaluronic acid fillers, which are the only kind of fillers I use in the lip, also have the advantage of being fully reversible with a simple injection.”

Each session can range from $400 to $1,000 and most patients need to get lip filler two to three times a year. Each session typically lasts around 30 minutes and doesn't require anesthesia. It also has minimal after-care – just icing and taking it easy – and most patients find that the swelling from the injections goes away after one or two days. Because of its relative ease, filler can be a great option for those who want to experiment with lip size before going through with a more permanent procedure.

If the thought of a temporary solution leaves you wanting more, there are more long-lasting options.

Lip Implants

Lip filler and lip implants have the same goal: creating full, plumps lips. However, they are entirely different procedures. Lip implants are semi-permanent, which makes them ideal for long-term lip augmentation. They are also more customizable and give patients more control over the shape, size, and firmness. As the name implies, the procedure involves placing a semi-permanent implant under the skin of the lips. Depending on preference, lip implants can be made from skin (AlloDerm®), silicone, non-reactive polymers, or saline. They can also be made from a person’s own body (SMAS Lip Augmentation) if the procedure is done in conjunction with a facelift. Like most lip procedures, patients can opt to plump up both lips or choose just one.

After administering local anesthesia or sedation, a board certified plastic surgeon will make two small incisions at the corner of the patient’s mouth and create a thin “tunnel” in the lips to accommodate the implant. To finish up the surgery, the doctor will thread the implant through the lips, trim off any excess, and close the incisions in the corners of the mouth.

While it is not an extensive surgery, it still requires up to three days of downtime and many patients see bruising and swelling after the procedure. “A lip implant involves implanting a foreign substance into the lip and there may be a prescription for oral antibiotics for a day or more after the implant is performed,” Dr. Rapaport explains. "But once those few days are over, there is no real maintenance.” Risks are minimal, but it is still important to discuss potential side effects with your board certified plastic surgeon. In particular, review any known allergies to diminish any chances of lip rejection or infection and outline a plan to prevent any scarring or unwanted stiffness.

Lip implants are the ideal option for those seeking a long-term solution with minimal maintenance, but it is important to consider that lip implants are not always the most discrete, are difficult to remove, and would require another surgical procedure to do so. Some doctors will advise against them as a means for lip augmentation. “I rarely perform insertion of an implant into the lip for the simple reason that in certain positions the implant can be visible,” Dr. Rapaport says.

On average, lip implants cost around $1,500 to $3,000, which is comparable to between one and six years of lip injections.

Lip Lifts

Lip lifts have been steadily rising in popularity in recent years. They are commonly performed at the same time as a facelift, but more and more patients are opting for lip lifts by themselves. Lifts are typically used to diminish signs of aging, but are also options for those with thinner lips, asymmetrical lips, or frown lines. Of all the lip augmentation options, lip lifts are the most permanent and can cost anywhere from $3,000 to $8,000.

The procedure is performed with local anesthesia while the person is awake. During the hour-long procedure, a board certified plastic surgeon removes a piece of skin to shorten the space in between the nose and mouth (for the upper lip) and the space below the mouth (for the lower lip). By taking out a larger piece of skin, patients will see a larger lift and doctors can customize the shape of the incision to alter the patient’s Cupid’s Bow.

Since it is a minor surgery, most doctors only administer local anesthesia, and recovery is similar to a lip implant. The lips will look full immediately after surgery but can take a few months to fully heal. Most patients experience some discomfort like bruising and swelling and are advised to ice and take over-the-counter medication for pain relief. Like a lip implant, there is no real maintenance after the procedure.

Fat Injections

Another alternative to dermal filler is fat injections (also known as fat grafting), and is suited to people who are looking to augment their lips with natural substances rather than foreign materials. This procedure involves using fat from another part of your body, usually from the buttocks, thighs, or abdomen, and injecting it into the desired location. No incisions are made, but there may be tiny marks left behind from the needle and syringe. Since not much fat is required for the lips, the removal site does not undergo much noticeable difference. However, it is an option to combine it with a liposuction procedure should patients want to target a problem area as well.

With fat grafting, there is less risk of allergic reaction or infection since it uses the patient’s own skin. However, like all surgical procedures, there are downsides to consider, like a certain level of unpredictability. When the fat is injected back into the body, it has to redevelop a blood supply or else it will die off. While it is common that only half of the fat injected survives, and stays indefinitely, it is a general rule of thumb rather than a certainty. Some patients find that they need to have multiple fat injections in order to achieve the fullness they desire.

“The problem with fat injections is that they generally do not take well at all and it is not uncommon to perform a significant fat injection only to have it all disappear within less than 6 months,” Dr. Rapaport advises. “The other side of the coin is that if a fat injection takes well and the patient gains weight, the lips will become larger and that can obviously be a problem, especially since there is no injection that safely reverses the fat in the lip.”

Because fat injections require the fat from a different site, the process is a little more extensive than the other lip augmentation solutions. However, the general recovery time is only a day, which is less than most other lip augmentation procedures, and the fat transfer only requires local or light anesthesia.

The Takeaway

At the end of the day, there is no one-size-fits-all solution for lip augmentation. Dermal filler may still be the number one choice when it comes to the most natural look, but it does require significant money and maintenance over time. If you're looking for a more permanent solution, always consult with a board certified plastic surgeon before making any decision.