Are Lip Fillers Permanent? Here Is What You Need to Know.

Most people can recognize filled lips that look unnatural. Not only can they be obviously large, but also disproportional, with an upper lip as large as or larger than the bottom lip. These lips can also have a translucent quality and/or a “duck-lipped” exaggerated projection.

It is reasonable to be concerned about whether the effects of fillers are permanent, especially considering the recent explosion of articles in wellness and beauty media about the potential persistence of hyaluronic acid fillers, which have been considered temporary.

This blog post seeks to evaluate the evidence behind more recent concerns about the longevity of hyaluronic acid fillers, summarize the science behind hyaluronic acid fillers broadly, and discuss ways to achieve a long-lasting, more natural-appearing rejuvenation of the lips.

Hyaluronic Acid Filler is (1) Chemically Bound and (2) Broken Down Slowly by the Body

Hyaluronic acid filler dissolves in the body in much the same way our body’s own, natural hyaluronic acid dissolves. This process simply occurs more slowly because of how the manufactured hyaluronic acid filler products are chemically bound. The differences in chemical bonding explain the different properties, i.e., rheology of these products. Timing likely depends on the:

• Product
• Volume injected
• Depth of injection
• Location of injection

Thicker hyaluronic acid filler products injected at higher volumes more deeply in areas with little movement likely last longer.

Are Lip Fillers Permanent?

Hyaluronic acid fillers may persist longer than previously believed in some instances. It is important to emphasize that there is a propensity for the media to be an echo chamber, amplifying stories with little context or appropriate analysis that are likely to generate attention. Furthermore, there is also a propensity for plastic surgeons to “ride” this wave of media coverage for their own exposure. I feel the discussion about the longevity of hyaluronic acid filler is one of many examples of this.

How the Presence of Lip Filler is Identified.

There are two ways that clinicians identify persistent hyaluronic acid filler in the face:

• Physical exam i.e. actually examining the patient.
• Imaging (e.g., Magnetic Resonance Imaging [MRI] and Ultrasound [US])

A skilled, experienced clinician who pays attention to the patient generally has a good sense of whether enough filler persists to still cause some fullness where the volume was added. However, especially when most of the filler has dissolved, this can become difficult if not impossible to visualize or even feel. Imaging can provide a more precise answer as to the location and amount of filler that remains in the face. Unfortunately, an MRI, while the best imaging modality to evaluate for the presence of hyaluronic acid filler, is expensive and time-consuming to perform. Ultrasound is much less expensive and easier to perform. However, it is more difficult to distinguish hyaluronic acid filler from surrounding tissue compared with MRI.

What Studies Reveal About Lip Filler Life Span

My review of the medical literature identified two case reports and one study evaluating the long-term presence of hyaluronic acid filler in the face (1, 2). The papers were produced by the same author, which means the breadth of the research is very limited. Also, these studies consist of a limited number of patients in a series without randomization or controls.

The studies utilized MRI. One case report identified hyaluronic acid filler in the cheek at 27 months (2 years and 3 months) after treatment without evidence of filler migration. A follow up study looked at 33 patients who received different types of filler at different volumes at least 2 years prior. Every patient was found to have residual filler at least 2 years after their last treatment. 12 of these 33 patients had fillers 5 or more years after their treatment. One patient had evidence of persistent filler 15 years after their last treatment.

Why Lip Fillers Typically Do Not Last as Long in the Lips

I believe many surgeons would agree that they feel hyaluronic acid filler can persist in the face longer than the reported 6 to 18 months that most manufacturers of hyaluronic acid filler report. This is not based on rigorous research, but our day-to-day experience using the products. I have noticed that hyaluronic acid filler products tend to last longer in areas with little-to-no movement like the cheeks and tear troughs and less time in areas with significant movement like the lips.

Permanent Lip Fillers vs Temporary Fillers: What Patients Should Know

What the above-referenced studies do suggest is that a more comprehensive, longer-term imaging study – preferably using MRI – would be worthwhile. Also, consideration should be given to being more conservative about the frequency and/or amount of refills or “top offs” administered because the persistence of small amounts of hyaluronic acid filler in the face coupled with too frequent administration of the product may contribute to the “pillow face” phenomenon.

Treatment Options Beyond Lip Fillers for Long-Lasting Results

An experienced and well-trained physician can evaluate patients based on the bigger picture and offer a range of options, surgical and non-surgical. For example, in many instances, a surgical lip lift can achieve desired results in the lips in a permanent, more-natural appearing manner. It can also facilitate more conservative volumes of filler in the lips geared to enhancing the results of the lip lift rather than being an end to itself.

Final Thoughts on Lip Filler Longevity

In summary, additional research is essential to confirm what we suspect is true about the rate of dissolution of hyaluronic acid filler in the face. It is equally important to emphasize that there is a disconnect between the sometimes-sensational way the media portrays issues such as this and what we experience as physicians. Healthy curiosity and skepticism, balanced with a calm humility, are in order. Moreover, less consideration of this may need to be given to hyaluronic acid filler products placed in areas with a great deal of movement, where it is noticed to dissolve more quickly, such as in the lips. Finally, hyaluronic acid filler is only one of multiple treatment options to achieve your aesthetic goals for the lip.

References

1. Master M, Azizeddin A, Master V. Hyaluronic Acid Filler Longevity in the Mid-face: My review of 33 Magnetic Resonance Imaging Studies. Plast Reconstr Surg Glob Open. 2024 Jul 15;12(7):e5934.
2. Master M, Roberts S. Long-term MRI Follow-up of Hyaluronic Acid Dermal Filler. Plast Reconstr Surg Glob Open. 2022 Apr 13;10(4):e4252.