Lip filler is one of the most requested aesthetic treatments in doctors’ offices these days, but the lips can be a tricky place to inject. I have personally had my lips injected twice—the last time being early 2017, right before my wedding. However, in the summer of 2020, I visited my dermatologist and she noticed my lips looked uneven, which I too, had also noticed, but figured my filler would dissolve eventually and I had bigger fish to fry at the time. I didn’t even consider hyaluronidase injections, as I had never had them done before, but it turns out, that was the answer to restoring a more natural look—albeit smaller than I’d like. Here’s what to know when lip filler doesn’t dissolve within the projected timeframe, and how you can get back to beautiful baseline with help from the pros.
How long is hyaluronic acid (HA) filler supposed to last?
Filler generally lasts six to 24 months, depending on the area. New York dermatologist Melissa Levin, MD says that in areas like the posterior jawline, the cheekbones and the temples, it can last much longer, but in areas that are more dynamic, like the lips or the perioral region, it might dissolve faster. “Also, I think people tend to think it’s just the longevity of the filler, but every day we age and change, so we have to account for that as well.”
Dover, OH facial plastic surgeon David Hartman, MD explains that the HA fillers injectors most often chosen for the lips tend to be smoother and softer, which means it can also dissolve faster than filler in other areas. “Softer varieties, as opposed to the stiffer, less-pliable HA filler that might be used to volumize the cheekbone area, tend to dissolve quicker,” he says. “Also, fillers in the lips are subjected to the almost constant ‘grinding’ movement—from the lips and mouth—and that, too, accelerates the breakdown of the filler. Because of this, I advise my lip filler clients that lip filler tends to last for six to 12 months.”
Why doesn’t it dissolve within that timeframe for some people?
“HA fillers are not only hyaluronic acid,” says Dr. Levin. “Actually, if we were to inject straight-up HA into the skin, it would go away really quickly. They increase the longevity of the filler by crosslinking it, so basically that means putting these bonds in between the HA particles to minimize the degradation process so it lasts longer. It’s interesting because when we biopsy the skin, you’ll actually still see hyaluronic acid filler that was placed years ago that is no longer doing anything clinically meaningful. Meaning it’s no longer hydrating, it’s no longer lifting, but it’s still present in the skin. Everyone’s body is different in how it degrades filler. That’s why some people run through their HA lip filler in six months, and for other folks, sometimes it’s there for years. The tear trough is a classic location where you see filler last for a long time. We not only break down filler with hyaluronidase, an enzyme we have naturally in our skin, but we also have phagocytosis, the process of which our immune cell is monitoring and scavenging and then degrading particles in a different way.”
If there’s a lump of filler in the lip that persists for more than two years, Dr. Hartman advises seeing a board-certified plastic surgeon or dermatologist who can determine what it is. “I would wonder if either the filler used was actually not an HA product after all, and rather some other type of filler, or the lump was caused by a reaction that the patient’s lip had to the filler.” Most commonly, these reactions produce what’s called a granuloma. “Granulomas develop when a specific location of the body is chronically irritated, often by a ‘foreign body’—an object that somehow gets buried in our flesh—or by some other cause of a non-healing wound,” Dr. Hartman adds. “However, I have not yet seen that happen in HA-injected lips, and I have injected HA fillers into lips thousands of times. Studies show that granulomas are much more likely to develop in reaction to injections where non-HA filler is used.”
What is hyaluronidase exactly?
Hyaluronidaseis an enzyme that we have in our bodies that degrades hyaluronic acid. “In the synthetic form, there are two FDA-approved brands that are readily available in the states: one is Hylenex and the other is Vitrase,” says Dr. Levin. These are substances that can be injected into HA-filled areas to dissolve them very quickly. “In minutes actually,” Dr. Hartman explains. “It is an all-or-nothing remedy by and large. I believe lips are more beautiful when they look more natural, so I don’t overfill them. I have used hyaluronidase only once in the last six years.
Dr. Levin says the cost to receive hyaluronidase injections depends on how much filler needs to be taken away, but it can range anywhere from $200 up to $1,000. “And, not all physicians are comfortable injecting hyaluronidase because it’s sort of like you’re managing someone else’s complications without knowing exactly what’s been put in there,” she adds. “I know a lot of offices that don’t even carry it when they do filler, but to me, that is unacceptable.”
How often do patients experience HA filler dissolving unevenly in their lips?
“I don’t think anyone has done a study on this, but I do correct and take away a good amount of filler nowadays,” says Dr. Levin. “I think it’s because more people are getting filler now and we have a more sophisticated and evolved understanding of aging and beautification. I think there’s a lot for us to learn. I always teach the residents that softening and taking away filler are more advanced techniques than just filling lips. I do think we’re going to see this more and more. And there are other hyaluronic acid fillers on the market in other countries that we have no idea about that may be linked with other types of fillers that we’re not so familiar with.”
If someone comes in with leftover filler in their lips, do you remove it in one appointment and then refill the lips in another? Or can you do it all in one appointment?
“I have done it in one appointment, but it’s not ideal because it does take a full 48 hours to see the clinical result of hyaluronidase,” explains Dr. Levin, who prefers to inject, have the patient come back a couple days or a week later, then see the result, and then refill. “It’s also really emotional when you take away filler because somebody has gone through the process of getting it and feel like they look better, but then they realize they look kind of weird. For me, it’s a lot of counseling the patient and also understanding what this person in front of you sees as beautiful and what their face normally looks like. The crazy beauty ideals, the whole selfie phenomenon and filters, have made some people look not normal. It’s much more common than people realize.”
Will you switch up the filler you use to avoid the problem happening again?
“Not necessarily,” says Dr. Levin. “There are certain fillers that have more crosslinking that allow for them to last longer. I may not use that filler if the patient has had what we call delayed hypersensitivity to it because they’re probably not reacting to the hyaluronic acid, but rather the crosslinking.”
