There’s an intriguing trend emerging across top injectors’ Instagram accounts: lip augmentations that, at first glance, appear utterly…unaugmented. The absence of a striking size shift actually stops us mid-scroll, compelling us to take a closer look. That’s when we see it—the lip line is crisper in the “after”; the Cupid’s bow, sharply defined. The upper lip is more outturned and pouty but almost imperceptibly so. The left and right halves suddenly seem a more perfect match. A supple smoothness has replaced preexisting cragginess.
The common thread linking these lips is a sort of undone quality. They look youthful and healthy, cared for but not obsessed over. Call it the lip-aug equivalent of beach hair or no-makeup makeup, if such a thing were to exist.
“There are so many lips that you see every day in life that you don’t even realize have been treated, because they are just that good,” Dr. Corey Hartman, a board-certified dermatologist in Homewood, Alabama, wrote in a recent IG post describing the uptick in demand for what he calls “a more subtle lip enhancement … that focuses on contour, hydration, and shape.”
While “subtle is the new dramatic” has become a ubiquitous slogan among aesthetics doctors—one that could certainly apply to injectables of all types—the tagline perhaps most aptly fits the lips. “Patients are gravitating toward a more natural fullness,” says Dr. Sarmela Sunder, a board-certified facial plastic surgeon in Beverly Hills, California. “Ten years ago, lip fillers were about subtlety. Then the pendulum swung all the way to the overdone ‘Instagram’ lips. Now I feel like we’ve settled into a happy medium, where there’s more interest in shape, border definition, soft hydration—the subconscious cues of healthy, youthful lips.”
In Dr. Hartman’s corner of the world, patients have always favored a more conservative lip look, he says. Recently though he’s seen this understated aesthetic reflected in a widespread way across social media—which he speculates may have something to do with the current mood of our country. Amid a pandemic and social unrest, flash feels not only irrelevant but inappropriate. “There’s this desire to get back to something natural-looking,” Dr. Hartman reiterates. Lip injections, in his opinion, have become more “about making someone whole—restoring what they’ve lost rather than changing them in a big way.”
Even in Miami, where modesty is hardly the rule, “I don’t want to look fake” is typically the first thing board-certified dermatologist Dr. Janelle Vega hears from potential lip filler patients. Happily, “lip fillers have so many benefits beyond sheer augmentation,” she notes. Ahead, leading injectors reveal how they can subtly fine-tune the lips with filler.
Crisp contours and improved projection
Young lips stand at attention, all pert and flush. But over time, their borders tend to flatten and slouch. This lack of crispness, our experts say, frequently drives patients to lip injections.
“As we age, fat loss occurs all over—within the body of the lip, along the border, and in the skin around the lips, creating changes in the contour of the upper and lower lips and contributing to the formation of ‘bar codes’ or ‘smoker’s lines’ around the mouth,” explains Dr. Vega. Along with dwindling fat, we see our collagen and elastin levels drop off, our lip muscles thin out, and our upper jawbone gradually recede—all of which negatively impact pout and projection.
Some of these changes occur earlier than you may think. “At 22, our collagen production peaks,” Dr. Hartman tells us. “Every year after that, it decreases by 1%.” The inevitable loss of firmness is perhaps most evident along the upper lip line. Ideally, your top lip should jut out the tiniest bit—a millimeter or two—over your lower lip on profile view, says Dr. Vega. Barring some serious self-scrutiny, however, you may not visually register its slow collapse. More often than not, “people start to notice that the pop they used to get when they put on lipstick is no longer there,” adds Dr. Hartman. “And that’s really what we’re trying to recreate—we want to get that area back to what it was, without making someone look cartoonish.”
Strengthening the lip line and perking up the Cupid’s bow should take precedence over pure plumping, Dr. Hartman notes, since adding volume in the absence of contour can lead to an unnatural outcome. When striving for definition, injectors place fine threads of a hyaluronic acid (HA) filler along the borders of the lips. (Only temporary and reversible HA fillers should ever be used in the lips.) Dr. Hartman says that Restylane Kysse is his current go-to for lips, because it’s versatile, is long-lasting, and doesn’t swell quite as much as other HAs.
Hydration and smoothness
Since all HA fillers attract and hold water—creating some amount of swell, for better or worse—injectors commonly capitalize on their powers of hydration to give lips a dewy, moisturized-from-within smoothness and sheen. “As we get older and lose volume, some of us may develop lines around our mouth and on our lips,” says Dr. Camille Howard-Verovic, a board-certified dermatologist in New York City. “Adding a small amount of hyaluronic acid superficially can help your lips to look plump and hydrated.”
In the mucosal body of the lips, volume loss reads as shriveling—and a shot of HA can reinflate the lips slightly so they look less raisin-y. But then there’s the skin over your top lip—what doctors call the upper cutaneous lip—which is where those aforementioned barcode lines eventually dig in, serving as estuaries for bleeding lipstick. “The upper cutaneous lip is the area between the bottom of the nose and the vermilion border, which houses the philtrum and the Cupid’s bow and all those anatomic landmarks that define a good lip,” says Dr. Hartman. As it succumbs to age and gravity, this area starts to elongate and droop, causing the top lip to turn under and hide, he says. The columns of the philtrum—the vertical groove between the nose and upper lip—lose their edge, developing an undefined, blunted appearance.
For older folks, addressing the upper cutaneous lip in addition to the mucosal lip is the only way to rejuvenate the area in a harmonious way and avoid a glaring mismatch. “When someone has this loss of architecture of the whole mouth region, we have to volumize the entire area,” Dr. Hartman says. To do so, “you want to create a plane [of HA filler] that goes right under the skin and smoothes out the lines and provides a lattice of support, without creating too much volume,” he explains. He’ll then sharpen the philtral columns with a small amount of gel, acknowledging that “a subtle philtrum is always better than a philtrum that’s too done.”
Lip symmetry and proportion
When tweaking the structure of the lips, injectors often notice slight asymmetries—some that patients were born with and others that have emerged with age. While we tend to think of symmetry as a strictly left side/right side scenario, Dr. Vega points out that “for some patients, it’s about creating a better upper-lip-to-lower-lip ratio for their face.”
Such proportional irregularities are common and totally normal, of course, yet they’re oftentimes what bring patients—women of color, in particular—into Dr. Hartman’s office. “We’re starting to see Black women, Latino women, women of different ethnicities, who are realizing these procedures can be for them,” he says. (He credits the inclusive ad campaigns recently put forth by major filler manufacturers with welcoming more people of color into the filler fold.) While Black and brown women typically have naturally full lips, he adds, many will “start to see some asymmetry, especially on the border of the upper lip, where one side just doesn’t sit up as nicely as it did before.” A few strategic drops of HA can restore shape without imparting bulk.
Minor corrections are key, where symmetry is concerned. In the process of “chasing symmetry,” warns Dr. Howard-Verovic, “people can end up overcorrecting, with too much volume.” Echoing her sentiment, Dr. Vega adds, “Exact perfection and symmetry are never the goal—but when asymmetry is distracting for a face, correcting it can be a game changer.”
Volume replacement and subtle enhancement
Adding volume to the body of the lips—boosting the pillowy part within the borders—isn’t an all-or-nothing proposition. For the most part, “people still want full lips, but they prefer not to look obvious or dramatic,” Dr. Sunder says. To that end, doctors aim to augment or replenish the lips—put back the poutiness time has stolen—by placing filler selectively and judiciously rather than indiscriminately inflating all over, to sausage-like effect. “You always add some volume to the lips when you do filler—that is a fact—but injecting in the right place allows you to achieve a more beautiful lip without creating a disharmonious appearance,” notes Dr. Vega.
While the specter of overdone lips has left some patients hesitant to try lip injections, our doctors say that many more come in, mourning the loss of fullness they once had and wishing for a discreet refresh. For these people, choosing the right HA is everything. Dr. Hartman finds that Juvéderm Volbella works well “to subtly restore what was there and smooth out the lines around the lips,” but, he stresses, it’s not going to deliver overt volume or heft. For patients craving a bit more oomph, he may upgrade to a slightly thicker gel, like Juvéderm Vollure. As a rule, he always avoids brawny volumizers, like Juvéderm Voluma, in the lips, because such products don’t allow for subtlety or nuance—two critical underpinnings of the modern lip enhancement.
With every tweak our experts have discussed, they’re carefully “adding a very small amount of volume, to highlight the defining structures of the lip,” Dr. Howard-Verovic summarizes. “It’s really about appreciating and enhancing something you find beautiful about yourself—and finding the right doctor to help you achieve that goal.”