Myth Debunking: The Lip Edition
Duck lips, trout pout…
Those two terms are so well known they’re practically legendary in the aesthetic community – or dare I say mythical? 
Collectively, we have a love/hate relationship with lip augmentation
Perhaps on TV or even on the street, we’ve all seen examples of overdone, obvious lip augmentations. Type ‘bad lip filler’ into Google and the images abound along with critical running commentary. And, while some are very intentional – where the patient is chasing an over-the-top, perpetually bee-stung look – are most people flaunting an over filled esthetic? Standing out in a crowd like that was decidedly not the intent.
No wonder lip augmentation strikes a minotaur-like fear into many.
So today, to cut through the fears and misinformation, I’m tackling lip augmentation.
Below you’ll find my thoughts on 8 popular lip augmentation lip myths.
Are lip fillers permanent? Should you have a lip lift instead? Is a trout pout the destined end state of all lip filler dabblers?
Read on to find out!
- Lip fillers are permanent and cannot be reversed
Fictitious: Now, a caveat I want to put out front is that this very much depends on the type of filler used. Some lip fillers are permanent, including polymethyl-methacrylate (PMMA) and silicone. They won’t dissolve, and the only way to remove them if you have complications (such as hard beading) is to cut them out.
However, the most popular filler material on the market for lips is hyaluronic acid (HA). Not only is it dissolvable with the enzyme hyaluronidase, but hyaluronic acid is a biologically similar product – you make your own hyaluronic acid – and this means that over time your body can and will break it down.
How long does it take to break filler down? That’s actually up for debate in the medical community at the moment. We know that most HA fillers can last between 6-18 months, but that doesn’t mean fillers can’t last longer. MRIs show that HA fillers can hang around for a surprising amount of time, potentially upwards of a decade. And just because HA fillers are metabolized doesn’t preclude them from having permanent effects in other ways. If the skin is stretched out repeatedly over years of filling, even when filler is dissolved, the lips may never return to their natural shape and size. It’s one of many reasons I advocate for natural results.
2. You can always spot lip filler (because it looks fake)
Fiction: Lip filler can absolutely be performed elegantly. In fact, there are wonderful, natural lip filler results you likely see every day – visually they whisper, not shout. What you notice is the balanced face, not a pair of lips. And lips can be customized and tailored to your particular anatomy, whether your goal is subtle or a more extreme aesthetic. You have options.
How do I achieve ‘whispering’ lips? By injecting smaller amounts of filler over time rather than a lot of filler all at once and avoiding injecting into trouble areas.
What do I mean by trouble areas? There are a few regions of the lips that I’m not fond of injecting, as (in my opinion) the results tend not to look natural. One area I avoid injecting is the vermillion border (see image below). Filler placed along this lip margin can lead to the ‘ducky’ look people dread. Another location I’m not fond of injecting is into the philtral columns (see image below). The intention is well meaning – to highlight and better define the peaks of this concave area – but the results almost always end up looking unnatural and the filler tends to migrate, making the columns less distinct, not more. The last area I’m not fond of injecting is the rhytids around the mouth, better known as the smoker’s lines.
In short, I’m a fan of respecting the lip’s natural shape.
Injecting into the vermillion border or philtral columns won’t get you beautiful, natural looking lips like these. Instead, the results can appear ‘ducky’.
Keep in mind that it can take a few weeks to see the full results from a treatment with lip filler. The images you see online are immediate, and some of the volume is from swelling. It takes weeks for swelling and bruising to go down which is when you see the full results.
And yes, if you want to maintain the results from lip filler, you’ll need to get touch-ups every 3-9 months.
3. Lip filler isn’t for men
False: Men can definitely get lip augmentations and the results can be great for the right candidate. Men tend to have a thinner upper lift and a longer philtrum, and when lip filler is done well it can increase the upper lip proportion without losing masculinity. Men do need to be careful with both lip augmentation, as it can have a feminizing effect, particularly lip lifts. It all comes down to candidacy and what your aesthetic goals are.
Similarly, it’s also false that filler is only for the thinned lips. Many people seek out lip augmentation for different reasons. Someone with already full lips might want filler (or a lip lift) to improve symmetry.
Lip augmentation can look great on men but as it can be a feminizing procedure, make sure to communicate your goals with your provider.
4. Filler prevents chapped lips
False: Online I’ve seen a number of clinics advertising HA lip filler as a way to prevent chapping. HA filler does attract water – it’s one of the reasons it’s such a great volumizer – but it does so under the skin. Chapping happens when the delicate, red mucosal tissue is exposed to the elements (sun/cold/wind) and/or they’re frequently licked. Filler and any surgery that exposes more of this delicate mucosal tissue can actually make chapping worse by exposing even more lip real estate to the elements.
5. The sun will destroy my lip filler!
This one is a…possibly? A number of clinics are warning that UV exposure could degrade your lip filler, but what does the research say? One study in mice from back in 2007 looked at the effects of UVB radiation on hyaluronic acid in the mouse dermis and found that UVB exposure did cause loss of HA in the skin. But keep in mind this HA was naturally occurring, not injected. In contrast, a much more recent paper from 2023 showed that hyaluronic acid produced by bacteria had a protective, antioxidant-like effect on keratinocyte cell cultures exposed to UV radiation.
So, could HA filler be protecting skin?
We have absolutely no idea how this might work in humans.
Regardless, we do have ample evidence that sunlight is damaging to your skin, especially your lips, so regardless of what the sun might or might not be doing to HA filler, protecting your lips from the sun is still a good piece of advice to follow.
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6. Augmented lips feel no different than natural lips
This one depends. Once the initial swelling from lip filler (or a lip lift) settles down, most people report that their lips feel completely normal.
However, certain types of lip augmentation – such as solid silicone implants – can change the way your lips feel sensation. People who’ve over-filled their lips pursuing an extreme aesthetic or used permanent filler can also sometimes report a change in sensation due to a build-up of material and/or scar tissue.
I stay away from using any type of silicone in the lips.
7. Lip filler is dangerous
It depends: When performed by a licensed, qualified, and experienced provider lip filler is usually very safe. But that doesn’t mean there aren’t rare, catastrophic complications. A vascular occlusion (blockage of an artery in the face) can lead to skin death, blindness, and even stroke. The filler injection ‘danger zones’ are the forehead, glabella (frown area between brows), and nose, but the lips still carry a moderate risk of vascular occlusion as there are a lot of vessels and we can’t see them while we’re injecting. If you opt for lip filler, make sure your provider has a plan in case of an emergency. Lip lifts don’t have the risk of vascular occlusion – which is sometimes why I prefer performing them.
And though not dangerous, swelling and bruising are common after filler and can take up to 14 days to subside. There’s really no way to prevent bruising, and a bruise isn’t an indication the procedure didn’t go well. Like I said above, there are a lot of blood vessels.
Lip filler can also cause scars and cold sores. The repeated injection of filler can lead to scar tissue building up under the surface, and any trauma to the lips (such as a needle) can trigger cold sores. If you’re considering lip filler and you’re someone prone to cold sores, let your provider know – they can prescribe an antiviral to prevent a flare-up.
8. A lip lift is a better option than lip filler
Once again, it depends: For a person with a short philtrum, a well arched upper lip, great upper tooth show, and looking for volume, lip filler makes sense. For a person with a long philtrum, a thin or flat upper lip, and no upper tooth show, a lip lift might be a better choice for achieving their aesthetic goals.
Lip filler is not a way to test run a surgical lip lift, the same way nose filler will not give you a preview of a rhinoplasty.
At the end of the day whether a lip lift or lip filler is right for you depends on your aesthetic goals, your underlying anatomy, and surgical candidacy.
Whether a lip lift or filler is a ‘better’ option depends on aesthetic goals and starting anatomy.
If you’re considering a lip augmentation, talk to your provider about which might be best for you. To see some of my ElelyftTM lip lift results, head to City Facial Plastics. And to see more of my commentary on popular lip myths, you can visit our channel here!
The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.