Fillers have come to be seen as magic wands, and injectors, fairy godmothers granting wishes. Higher cheekbones? Poof! A stronger jawline? Shazam! Plumper lips? Presto change-o!
But this notion of ask-and-you-shall-receive injectables isn’t without limits. Generally speaking, reputable providers will refuse any ask they deem to be unsafe or unrealistic. “We have to know when to say no,” says Jessica Henderson Rhee (aka @jessicathelipqueen), a physician assistant in Red Bank, New Jersey. “Oftentimes, when I do say no, the patient goes down the street and gets [their lips] done somewhere else—and you know what? Nine times out of 10, they end up back in my chair, [asking] me to fix it.”
Ahead, injectors share the specific lip-filler requests they’re sure to deny—plus the importance of respecting the powers of these potions.
1. Making overfilled lips even bigger
Outsize, attention-seeking lips are a hallmark of Instagram Face—but many of today’s most in-demand injectors have grown weary of the look. “I always deny lip-filler requests for anything resembling a blow-up doll,” says Henderson Rhee. “There comes a point where the lips are just maxed out—there is no possible way to add more filler without making the lips look fake,” she adds. Unfortunately, “patients usually don’t see it and just want more and more.”
According to Dr. Janelle Vega, a board-certified dermatologist in Coral Gables, Florida, there are certain telltale signs of an overstuffed pout. For starters, “the normal contours of the lip have been obliterated,” she says. The lip roll—or slightly raised rim of the vermilion border—becomes very swollen, and the flesh-toned skin above it puffs out, sometimes appearing even more projected than the actual lip itself. “There’s often a complete loss of any lip markings, including the natural texture of the lip,” she adds. Overdone lips typically have a stretched-smooth surface, which “can look odd and almost bluish in color.”
This sort of filler-induced distortion is more than skin-deep—and can make it impossible for injectors to safely navigate the vascular anatomy of the lips. “Normally, the upper labial artery, which supplies blood to the upper lip, courses about three millimeters deep to the surface of the lip—but when lips are overfilled, all bets are off as to where this will lie,” says Dr. Vega. And when key anatomical landmarks go missing, the risk of vascular occlusion jumps up.
Augmenting overfilled lips is “the most common thing I have to say no to,” says Dr. Kay Durairaj, a board-certified facial plastic surgeon in Pasadena, California. “I’m constantly having to remind people about the longevity of fillers—that there’s still retained gel in the lips when you’re coming back at regular intervals. They feel like the exciting swell has gone down, and they want it back—they love that feeling of euphoria that comes with having their lips freshly done—but there’s still a lot of filler in those lips, and it’s almost ready to migrate out.”
Joshua Davis, a registered nurse in Brentwood, Tennessee—better known as @ToxJosh to his 40,000 followers—describes the aftermath of lip-filler migration as the “Marge Simpson mustache.” He commonly sees it in patients who bounce between injectors and wind up with multiple fillers layered over one another. In such scenarios, “it’s better to dissolve it all out [with hyaluronidase] and start fresh,” he says. “I always say no to placing my work over bad filler.”
When patients come in with this never-enough mentality, he says, “it’s important to get to the root of why they’re wanting such big lips,” noting that body dysmorphic disorder (BDD) is real in cosmetic medicine. “You can almost get addicted to this,” adds Dr. Darren Smith, a board-certified plastic surgeon in New York City. “When someone who already has fairly large lips wants to go bigger, we really need to listen to them and see if what they’re asking for is in line with reality or if there’s a hint of dysmorphia there.”
2. Modeling lips after unrealistic inspiration photos
Inspo pics can help convey a desired mood or showcase a specific feature, injectors say—but they become problematic when patients expect copy-and-paste results.
“This happens every single day,” Dr. Durairaj says. “Patients pull out their phones and show me these lips that are so luscious and sexy—and [would look] absolutely out of place on their face.” In creating a lip that works for them, “it’s fun to be able to echo the little features they see [in photos],” she says, but staying true to someone’s innate proportions and personality is key.
“Some lips just cannot look like other lips—and we have to have an up-front conversation and set realistic expectations,” adds Davis. “If it’s safe and achievable, I’ll give it to you—if it’s not, I’ll work within the confines of your natural lips.”
Pushing lips beyond their natural-born capacity, however, is never a good idea. “When patients come in with pictures of lips that are so far off from what they have to start—these are the requests that are generally more apt to lead to complications,” says Henderson Rhee. Trying to go too big too fast or inject more filler than the lips can handle can cause the filler to migrate above the lip or leave the lips firm and lumpy.
3. “Devil lips” and other Instagram fads
“Modifying people beyond the natural limits of human form—that’s something I’m never going to do,” says Dr. Smith. He’s turned down multiple requests for what he calls “wavy lips,” with scalloped edges cast by “depositing little balls of filler” along the top and bottom borders.
The effect is reminiscent of the Russian “devil lips” trend, which quickly flooded Insta before being called out as more Photoshop than filler.
In California, a new look is fueling unreasonable lip-filler requests. “I’ve had a lot of patients asking for what I describe as Bratz doll lips, where the upper lip has a little overhang of filler—almost like an exaggerated lip-liner effect that projects off the face,” explains Dr. Durairaj. What most people don’t realize, she adds, is that “it’s really smoke and mirrors—a lot of makeup, contouring, overlining—and [the effect] is hard to mimic precisely with filler alone.”
4. Injecting hyaluronic acid filler around silicone
“I don’t use silicone, and I try to avoid injecting around silicone in the lips,” Dr. Durairaj tells us. Silicone is a permanent, irreversible, and controversial substance, with a tendency to drift and harden over time. “So often, these patients develop lumps and nodules, and they want help camouflaging the nodular area with a soft hyaluronic acid gel filler—but that’s always an invitation to create a flare up of inflammatory problems around a quiet silicone fragment.”
5. Augmenting lips on an otherwise unmaintained face
The reach of the ripe-lipped influencer transcends generations, it seems. But when asked to treat aging lips in isolation, some injectors will respectfully decline.
“Once in a while, I’ll get a request for lips to be done on an older person who has not maintained any of their face yet is suddenly inspired to get their lips done,” says Dr. Durairaj. The outcome would likely look “awkward,” she says—a plump, juicy lip offset by crepey skin and sagging features. She’ll typically encourage these folks to first rebuild their facial foundation with filler—correcting sunken under-eyes, restoring fallen cheeks—before enhancing the lips.
Age aside, when the lips become the focal point of the face, warns Dr. Vega, “they can detract from other beautiful features, creating an imbalance—and, perhaps, even draw attention to the lower part of the face, which, if not optimally corrected, may be a bad thing.”
