The Future of Lip Augmentation
Beauty fads, by definition, come and go, slipping in and out of style over time, in a blur of nostalgia and regret. While our bodies shouldn’t be subject to the same whims as our hair or eyeliner or jeans, culture’s influence over anatomy is undeniably strong. Lips are a prime example, collectively waxing and waning in accordance with societal moods.
As a “trend,” lip filler charts a distinctly dynamic course. The highs and lows are dramatic and the transitions between are often instantaneous, making rich fodder for TikTok, where a growing number of lips are suddenly shrinking before our eyes. Among the most-watched lip filler videos are those hashtagged #lipdissolving (with 245.3 million views), #lipfillerdissolved (40.6 million), and #lipfillerdissolving (37.2 million). What these snippets typically fail to show, however, is what comes next—after the excess, lumpy, or migrated filler has been melted. After the lips have been reduced to half their former size.
The doctors we spoke to for this story confirm they are dissolving more filler than ever—validating the viral videos and Hollywood headlines we’ve been seeing of late—but they also stress that getting back to baseline rarely marks the end of a patient’s lip journey.
According to Dan Belkin, a board-certified dermatologist in New York City, many people who dissolve their lips “are often willing to do more filler, in good taste, once the problem they were having is corrected.” He attributes the rise in filler reversals to the leveling-up of patients’ standards and expectations. “People are no longer willing to tolerate signs of bad lip filler, like the migration that causes duckiness or the loss of natural contours leading to sausage lips,” he explains. “I think, in the past, people would accept those things for the sake of volume.”
But in 2023, size isn’t everything—in fact, it ranks fairly low on the list of patient priorities. “We’re slowly starting to go back towards a more natural appearance to the lips,” Miguel Mascaró, a board-certified facial plastic surgeon in Delray Beach, Florida, tells us. “We’re seeing a lot more patients asking for definition, hydration, and very little plumping.”
Beverly Hills board-certified facial plastic surgeon Ben Talei shares a similar observation—this burgeoning desire for refinement and authenticity, which he says can be achieved either with “more appropriate filler” or, in some cases, lip surgery. “The number of inquiries we’ve been getting for surgical stuff is really much higher than it used to be, because people view it as a more natural, substantial option than just doing fillers over and over,” he says. Still, he notes, for plenty of folks, lip filler is still a smart bet. While injectables lack the one-and-done appeal of, say, a lip lift, “fillers are actually very long-lasting and surgery just isn’t justifiable on everyone.”
Whether you’re starting fresh or starting over, figuring out what’s right for you will require a consultation with a specialist who can steer you toward treatments that will suit your anatomy and goals. The trailblazing options outlined here promise safe, timeless effects.
Conservative lip filler
for easy, versatile plumping with no downtime
Lip filler isn’t going anywhere. But if our experts’ predictions hold true, we will be seeing a lot less overdone lip filler in the future. “A modern lip look is going to be subtle, more of a gentle enhancement of one’s lip features,” says Belkin. “It’s not going to be an extreme transformation, where the size and shape of the lips are completely altered, leading to ‘bad filler’ symptoms.”
In Belkin’s practice, lip filler is as popular as ever. However, “first-timers are not always automatically trusting,” he notes. “They’ve done their research and they need reassurance that the results will be subtle and natural.”
With the appropriate product and technique, lip injections can deliver just that. Belkin uses small doses of hyaluronic acid (HA) filler, pays careful attention to elements of light and shadow when contouring, and builds the lips gradually, incrementally. “HA gel has no shape to it, so if we don’t build slowly, the lips will become shapeless,” he explains. “It’s better to put a few drops in, let it incorporate into the tissue over a few weeks, and then add a few more drops.” (Belkin will save the unused portion of a patient’s syringe to inject later, at no extra charge, “so there’s no price pressure to do more than we’d like in one sitting,” he says.)
The ideal fillers for lips are soft, moisturizing HAs that deliver adjustable volume without migrating or swelling excessively. Among Belkin’s favorites: Classic Restylane, which can be diluted for a more delicate effect; Belotero, which is very thin and rehydrates lips without giving them too much oomph; Restylane Kysse, specifically made for lips and slightly softer than regular Restylane; and Juvéderm Vollure, “for a more robust, juicy, and long-lasting result,” he says.
Coming soon are a new class of HA injectables designed to improve the quality and texture of the skin. These so-called skin boosters may eventually play a “role in rejuvenating the upper cutaneous lip [the skin above the top lip],” says Belkin, “since they’re able to improve fine wrinkling by hydrating the dermis without adding any projection.”
The deep plane lip lift
for customizable lip shape and definition
The lip lift isn’t new—it has long been performed as a routine add-on to face-lifts—but recent advancements to the technique have raised its profile, making it a go-to for younger patients wanting to perk up their lips (without filler) and bring balance to the lower face.
During surgery, doctors remove a wedge of tissue from just below the base of the nose to shorten the philtrum (the area above the top lip), which tends to stretch with age. Much like face-lifts of the past, lip lifts used to be skin-only operations, and tended to scar poorly and fail quickly. Today, top lip-lift surgeons work on a deeper plane, freeing the skin from the underlying muscle before tweaking the proportions of the philtrum.
“What we’ve discovered is that by releasing the tissues in the right places, we can manipulate the lip in ways we weren’t able to with the simple skin-only lip lift,” Mascaró explains. Rather than just hemming the philtrum, surgeons can finesse the peaks of the Cupid’s bow or roll out the upper lip to reveal more of the red vermilion and allow a sliver of the incisors to show when the lips are slightly parted. Involving the muscle also reduces tension on the incision line for less obvious scarring in patients of all ages and skin tones.
In a study published last December, Talei maps out a nuanced and reliable design for the deep plane lip lift (which he’s dubbed the “Cupid lip lift”). “Nobody really had a guideline before,” he says. “They just cut away a certain amount across the upper lip without knowing precisely how to get the proper amount of tooth show or balance, or how to avoid exaggerating someone and making them look strange.”
While doctors field lip-lift requests from patients of all backgrounds, not everyone is a candidate. When examining contenders, surgeons consider not only philtral measurements, but also face shape and the length and positioning of the teeth. Many will also weigh the degree of change they can reasonably create with the lip lift. “I tell all of my patients: The view has to be worth the hike,” Mascaró says. In other words: “If you’re going to have a little scar in the middle of your face, the results have to be worth it.”
While a scar is inevitable with a lip lift, it tends to be hidden in the shadow of the nose. Talei estimates that in about 20 percent of lip lifts, the scar winds up needing “a little bit of love”—be it a laser treatment or an injection — but says “we almost always get it to a point where people can’t really see it.”
Asymmetry is another potential side effect of surgery. Nerve damage is also a risk, mainly with more aggressive surgical techniques, says Mascaró, but even then, it’s exceedingly rare.
Following a lip lift, most people look presentable, albeit still swollen, at about 10 days out, he adds. “But you’re going to feel tight for a good six months.”
Natural lip implants: tissue grafts
for modest volume and hydration
Have you heard of a SMAS graft to the lips? (SMAS stands for superficial musculoaponeurotic system and refers to the fibrous tissue covering our facial muscles.) This procedure has been getting airtime on Instagram lately, piquing public interest in the idea of a natural lip implant.
“The beauty of the SMAS graft is that it’s your own tissue, so the lips feel super soft, like nothing was placed in there,” Mascaró says. And in most cases, they look “very similar to how they used to look in your younger years—a little plumper and more hydrated.” Another boon: The graft ages with you, requiring none of the upkeep of injectables.
In Talei’s experience, when the procedure is done right, using thin pieces of SMAS that won’t misshape the lips or restrict their movement, it “doesn’t give a big volumetric change, but it can be nice for somebody who’s always had dehydrated, thin lips.”
The catch? Surgeons can only harvest SMAS during a face-lift. (They then insert it into the lips through two tiny punctures at the corners of the mouth.) For those who don’t need or desire a face-lift but want to augment their lips in a natural way, doctors might suggest a fascial fat graft instead. “Fascia is a type of tissue found all over the body, which has fat attached to it,” Mascaró explains. He usually accesses it through a small incision in the crease of the hip. “We trim it, contour it, and slide it into the lip in similar fashion as we do with the SMAS.” Here again, with slender strips of fascia, the volume gains are modest and controlled.
After a tissue graft, lips will be swollen and stiff for about a week. Potential complications include asymmetry, contracture (a tightening of the tissues that can hinder movement), and minor scarring within the lip—all of which occur infrequently, according to our experts.
Nanofat plus PRP
for lip rejuvenation and repair
Fat injections to the lips are controversial, because they can deliver unpredictable outcomes. If each individual morsel of fat doesn’t establish blood supply upon transfer, it dies, raising the risk of lumpy or lopsided lips. (Fascial fat grafts tend to fare better than traditional fat injections, Mascaró notes, “because you only need one little area to get blood supply for the entire graft to survive.” He likens its perfusion to the powering of a string of Christmas lights.)
Talei makes the point that “fat doesn’t really belong in the lips,” and when injected as microdroplets, it may not integrate well and can spread from its intended location. While he generally recommends HA filler to those looking to enlarge their lips, he finds that a mix of nanofat and platelet-rich plasma (PRP) can work well for someone seeking a body-derived alternative to filler, as long as they’re not expecting a major bump in size.
Nanofat is processed in a way that actually ruptures the volumizing fat cells, leaving behind only their regenerative byproducts (stem cells, growth factors, and the like). When combined with PRP and injected into the lips—a treatment Talei has coined Phat Lips—“you’re not actually grafting any volume; you’re putting a stem cell potion into the lips that stimulates the tissues to regenerate and regain some of their water-retaining potential.”
With this treatment, Talei is typically targeting the lamina propria—a thin layer of connective tissue in the body of the lips—but says the same cocktail can be injected into the philtrum (above the lip) to rejuvenate the underlying SMAS while helping to smooth the overlying skin. “The results diminish with age,” he says, so most people repeat the treatment every five years.
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