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Skincare can sometimes feel overwhelming, whether it’s finding the right products, ingredients, or treatments. There’s a lot out there, but not always for people of African, Hispanic, Middle Eastern and Eastern South Asian descent.

That’s why I set out to educate myself and others so that we can all feel beautiful in our skin. Hello and welcome to the Skin Report.

I’m Dr. Simran Sethi, an internal medicine doctor, mom of three and CEO and founder of Renew MD Medical Spas and Skin by Dr. Sethi.

Two weeks ago we broke down everything you need to know about BBLs from risks to alternatives to surgeon requirements. If you’re interested, you can find episode 36 in the description below.
This week we’re talking on another popular aesthetic procedure. Lip fillers. Listen to this episode to find out how they work, what they’re made of, and much more.

From Instagram to TikTok to just everyday life, lip fillers seem to be everywhere, only growing in popularity. In 2022, the American Society of Plastic Surgeons released the insights and trends report on cosmetic surgery. It revealed that fillers were the second most sought out after minimally invasive procedures from 2021 to 2022.

In 2021 alone, more than 1.8 million filler procedures were done in the US according to theAesthetic Society.

In my practice, lip fillers are definitely the most requested filler injection and makeup as high as 75% of all fillers we inject.

Now the most popular minimally invasive procedure was Botox, which we discussed in-depth in episode 26. I highly recommend listening to that episode as we go in depth on the topic, including amount of units I would inject in different areas of the face.

I bring up Botox as sometimes people can confuse Botox and fillers. So before we go any further, I’d like to differentiate the two. As we discussed in our Botox episode, Botox is a neurotoxin that when injected into facial muscles, stunts the muscles to prevent movement and the formation of wrinkles, the effects last around three months before the muscle regains movement.

Botox is meant to train the muscles to not move, but still make you appear natural. The muscles that are trained to not move are usually ones we move when we’re not aware we are moving, like when we frown while reading or driving.

By stopping this continuous motion wrinkles in areas like the forehead and around the sides of the eyes are prevented. Fillers, on the other hand do as a name suggests. They fill spaces. Fillers are a gel-like synthetic compound that is injected under the skin into parts of our face or body to at loss volume or enhance an area.

You can get lip fillers to plump up your natural shape or help restore volume that is lost through lack of moisture or through aging.

When we age, our facial features start to lose volume, making them appear tired or saggy, such as our cheeks. This laxity with aging is due to the loss of certain skin proteins such as collagen and elastin.

Our lips can suffer a similar fate. With less collagen and elastin molecules, our lips can start to appear thinner, so whether you want to enhance your features or add back volume, lip fillers can be a great option, but water fillers made of. In our BBL episode, we talked about how Cardi B recently got her silicone butt implant removed and regrets getting them done.

The FDA does not allow silicone injectables as it is a permanent material our bodies cannot dissolve, with the risk of migrating to other parts of the body and causing infection, pain, stroke, and even death.

Fillers including lip fillers are not made of silicone and therefore are not permanent. This is especially important to understand because if a provider is offering a permanent filler, it is unsafe and illegal. Though these are getting more rare in the US, we still see cases of silicone injections being performed in non-medical settings or other countries.

Beyond the safety and legal concerns, they’re just not a great option. From an aesthetics point of view, as we age or undergo weight fluctuations, we don’t want any kind of permanent substance or implant in our face or lips that will not naturally fit our facial structure over time. In essence, our faces and features change over time, but silicone fillers do not.

I still see patients who have had silicone fillers injected in other countries, and now years later are looking to get them removed because they’re no longer suiting their face. Safe and legal fillers are made from different gel-like substances with the most popular being hyaluronic acid or HA fillers.

In fact, HA fillers have been extensively studied and shown to have mild to moderate side effects compared to other injectables. For lip filling I have two favorite filler products that are both HA fillers, and are manufactured by the same company. I largely use a Juvederm family of fillers in my offices because they have the largest amount of clinical data supporting their products, and have an array of filler types to use in different parts of the face and body.

For example, I like using a product called Juvederm Vollure or Juvederm Volbella for lips as they’re very silky but create a beautiful, soft enhancement.

Additionally, they’re also less likely to migrate, which we will discuss in a bit.

Juvederm Vollure has been shown to last around 18 months when injected in the face, but in the lip I found that it lasts around 12 to 14 months as Ellis are more mobile and can break up the HA faster. I use Juvederm Vollure in patients who need more lip shaping as it is a little tougher in consistency than Juvederm Volbella.

I like to use Juvederm Volbella in patients who already have full lips but would like them to be more plump. Volbella creates a soft enhancement without looking overdone.

Lip fillers and other fillers gradually dissolve on their own as the lips are very mobile, the filler dissolves faster than the fillers use in the cheeks or nasal labial folds. Furthermore, lip fillers are softer than the ones used in other parts of the face, which makes them more susceptible to dissolving faster.

Lip fillers and any HA fillers can also be dissolved using an enzyme called hyaluronidase. This is very handy if the patient is experiencing an adverse reaction from the filler or just does not like the result.

If you like your lip filler, I find that usually coming back for more filler around the six-month or10-month mark is a great time to redo it as most of it has naturally dissolved. If you’re a smoker or regularly drink from a straw, you will also dissolve or break down your lip filler faster.

When we return, I’ll go over some questions to ask your provider and some red flags to watch out for.

As we just said, dissolvable HA fillers are safe and a great option to plump up the lips, but beyond the type of filler, there are a few things to look for in your provider.

Always ask to see their works before and afters, as this will give you a sense of that practitioner’s skill and personal style. Injecting lip fillers or fillers in any part of the face and Botox are a form of artistry and require the practitioner to thoroughly understand facial anatomy, the anatomy of aging, and have the skill to inject in a way that the patient looks like a naturally enhanced or refreshed version of themselves.

Good work is always discreet and your friends and family should compliment you with, “You look great. What are you doing?” Versus “Did you get fillers?”

I always ask my patients if they have an inspiration photo to get a sense of what kind of results they’re looking for with their filler. Most of the time people are very realistic and want only a natural amount of plumpness in their lips, and that’s also my style of injecting.

Once in a while, I will meet patients who want their lips to be much larger than their current size, and I only agree to do the treatment if they agree to a level of enhancement that still looks natural and elegant. Again, when performing lip fillers, I and other reputable injectors want their work to complement their patient’s face and not look artificial.

Yes, there is such a thing as overdoing lip fillers and it can have its own effects. If you get too much filler, your lips will expand way beyond their natural size and stretch the skin around them. This means that you will have to continue getting your lips filled to that size, otherwise you will have a shriveled or wrinkled lip order and vertical lines above the lips.

This is actually the reason why at some point when Kylie Jenner wanted to reverse her lip filler, she couldn’t reverse it all the way because she had so much filler injected that reversing it all the way would’ve made her lips and the skin around them look very wrinkled.

I do want to also mention the cost of lip filler injections in the United States, as this will help you be a safe consumer. A lip filler injection is charged based on the number of one milliliters syringes of filler used, and usually one syringe is used in the lips. This can cost between 700 to $900 depending on the syringe product and the injector’s credentials and experience.

If a filler syringe is costing you $500 or less, I would be very wary of the price as this suggests that the injector is inexperienced, or using a cheaper filler product. I don’t want to make generalizations but feel that in this case it’s important to understand the cost associated with fillers so that you have all the information you need to make an informed and safe decision.

Stick around to see me tackle a popular TikTok about lip fillers, lip filler migration, and the difference between lip fillers and a lip flip.

Social media has been a driving force behind the growing interest in cosmetics. With TikTok. In particular, the hashtag lip fillers has accrued over 510 million views across millions of videos.

Now, you may have heard of filler migration from the internet. Filler migration is relatively rare, but when it does happen, it is most common with a lip filler.

This occurs when the filler moves into another adjacent area to the area injected. For example, when filler migrates to the upper lip, it can give a duck-like appearance to the patient. If filler migration does occur, we can’t dissolve it with hyaluronidase. This will within a few hours to days completely dissolve the migrated filler.

However, there are some factors that contribute to filler migration, which we can avoid in the first place. Those factors include using a tough product that makes it difficult to move or express with the lips, and may move the product into another tissue plane and migrate, injecting too much HA filler or also injector experience.

Another internet talking point I want to discuss is something that came up in a popular TikTok. With lip filler or any lip filler injection, there is a very small chance of infection or an allergic reaction to the filler. Infection from a lip filler can be more common than in other areas, as the mouth has an abundance of bacteria, but even the infection from filler are still very rare.

If an infection does occur, it can be treated with a course of oral antibiotics and the lips will come back to normal. I do want to emphasize that this is precisely the reason why you should always get any injectable performed by a certified physician so that you can get treated if you were to have an adverse reaction, or an infection due to filler. I’ve been injecting fillers in my patients for years and have performed thousands and supervised even more injections and have had only one patient get an infection. It’s rare, but it can be easily managed by a doctor.

You will also have swelling when the filler is first injected. As expected, the swelling will occur immediately on injection, but the lips will actually get more swollen a few hours later and will be at their most swollen state the next morning.

Don’t worry, this swelling is normal and will go down during the course of that second day. If you have excessive swelling, which some people tend to get, you can ask your doctor about taking a short course of an antihistamine like Benadryl, and in some cases I’ve even had to prescribe steroids for a few days to bring the swelling down faster. Again, these are rare but temporary side effects, which can be easily treated if the filler is performed by a certified provider.

Lastly, I want to talk about lip fillers versus lip flip.

A lip flip is a way to inject Botox, not filler, to perk up the upper lip to make the upper lip look fuller. A lot of patients ask if a lip flip is right for them as it is a popular trend on Instagram.

In my opinion, the lip flip is not very effective and is definitely not going to give the upper lip a fuller appearance. The way a lip flip works is by paralyzing the function of tiny muscles that help the upper lip push down, like when you’re drinking and your lips need to make contact with a cup to sip a beverage.

By limiting this function, the upper lip will be pulled upwards by other tiny opposing muscles that elevate the lip. There are two problems here.

First, these muscles are tiny and will not make a noticeable difference in what the lips look like.

Second, and most importantly, if you stop the function of the small muscle group, your lips will have trouble latching onto the surface of a cup while drinking and your beverage will just spill down as if you were drooling. Definitely not the look anyone is going for. For these reasons, I caution my patients against a lip flip if they’re doing it to achieve a fuller upper lip.

Overall, HA fillers can be a safe, effective and adjustable way to plump up your lips while still maintaining a natural appearance and feel.

I hope with this episode you have more clarity on what to expect from lip filler injections. Know that it can look very, very natural if done by an experienced practitioner and know what to look for when you are choosing a provider to enhance your lips.

Thank you for listening, and until next time, love the skin you’re in and celebrate your beauty.

If you’d like to learn more about science-backed skincare or medical aesthetic treatments, please subscribe to and turn on notifications for the Skin Report, so you always know when a episode is up. We have a newsletter that you can sign up for on the skinreportbydrsethi.com so that you can stay up to date on all our new episodes, blogs, products, and more.

Additionally, if you have a skincare question or want you make an episode topic recommendation, please message me at the skinreportbydrsethi.com, which is linked in my show notes and I’ll be sure to answer your question in an episode soon.

We’ve received some great questions so far and I will try and answer them at the end of every episode, so keep them coming.

Transcript by Rev.com