Nobody Wants to Kiss a Duck – Best Approaches to Natural Looking, Fuller Lips

Lisa Vuich, MD Renew MediSpa
Lip injection feature by Lisa Vuich, MD with Renew MediSpa for NH Women Magazine

One of the most commonly requested procedures at a medical spa is lip filler, and at least here in the Northeast the most common fear is that the result will look comical, unnatural, or “duck like”. Lips have been getting even more attention in the media in the past few years, fueled in part by celebrities such as Kylie Jenner. It seems there is no end to topicals and devices in the cosmetic industry, promising a bigger pout for not a lot of dough. 

Suction type devices produce only a fleeting effect and can easily cause bruising and contribute to skin stretching and potentially more fine lines down the road. Topical lip plumpers attempt to enhance blood flow as well as hydration, albeit very temporarily.   None of these will address the very common associated concern of unwanted lines around the lip. Most clients are not looking to go under the knife (silicone implants, fat transfer) for 3 main reasons- cost, risk, and the fear of looking unnatural. 

The dermal fillers used for lip enhancement are primarily made of hyaluronic acid or “HA” for short. HA is a substance found throughout your body, and in fact it is a naturally occurring sugar. 

Nobody Wants to Kiss a Duck – Best Approaches to Natural Looking, Fuller Lips

 by Lisa Vuich, MD with Renew MediSpa

All of the dermal filler manufacturers use the same HA. What differs is how they then process and cross link it which will affect the physical properties of the filler- how stiff, how elastic, how much it resists deformity and to some extent how long it will take to dissolve.

The least traumatic placement is with the use of a microcannula. A microcannula is a thin, mildly flexible and blunt tipped hollow probe. It has a hole at one end allowing filler to flow into the target region, and the filler syringe is attached to its base.

Microcannulas have enabled us to deliver smoother results with greater safety and less bruising. Sharp needle technique requires multiple punctures which means more lip trauma, more pain, more swelling, more bruising, a greater likelihood of “lumps” and greater risk of blood vessel occlusion which is a dreaded albeit rare complication. 

How much filler do I need?

It can be difficult to know, especially if you have never done lip filler before. In some instances, it will take more than 1 syringe to achieve the ideal correction, but it is a good idea to start with one and then re-evaluate. 

How long will I be swollen?

This is variable and depends on several factors including your own genetics (histamine response), the technique of placement, and the characteristics of the filler brand used. In general it is usually a few hours up to 2 days.

Once the filler goes away, will my lips be “stretched out”?

The answer is no. Our body tissues accommodate to subtle changes in volume up and down thanks to tissue elasticity. In fact there may be improved volume due to the small amount of collagen stimulation produced by the filler while it is present.

Which filler is “best”?

There is no “best” filler. I advise clients to worry less about what is in the syringe, and more about who is holding the syringe. Choose an injector the way you would chose an artist, expect to see before and after images of work they have personally done, and be sure your questions have been answered to your satisfaction.

I don’t smoke so why do I have “smoker’s lines”?!

Think about how much movement occurs about the mouth on a daily basis and it is easy to imagine why collagen breaks down sooner here than many other places. Of course, genetics and muscle habits play a role. Chewing gum and sipping on straws can lead to the formation of more lines. Sun damage will also lead to premature collagen loss. Patients treated for cancer very often report that chemotherapy seems to cause their skin to show premature signs of aging, which they look to reverse once they are done with their course of therapy.


Lip injection is one of the most common procedures performed in any medical spa. Injector experience and artistic eye are of paramount importance in ensuring an aesthetically pleasing outcome. There are some non-filler options which can also be considered and are offered at more advanced spas, such as platelet rich plasma and PDO smoothing threads. Your aesthetic service provider is your best resource, helping you navigate the many options available today and ensuring that you are making informed choices. 

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