Is there any non-surgical procedure (such as RF, ultrasound, laser) that can restore volume around the lips without fillers?

Hello and thank you for your question.  Volume loss in the lips can be addressed with a Nano-Fractional Radio Frequency technology call the Venus Viva™ .  Viva delivers a specified amount of energy that triggers collagen and elastin production.  Multiple treatments are required for optimal results and, since the physiologic process of cellular renewal is a slow one, full results take several months.  We also use the Viva to shrink pores, smooth out acne scars and lift lax skin.  A topical anesthetic is used for comfort but there is little to no downtime.  If the wrinkles and puckering are your biggest concern, this treatment will be ideal for you.  If, however, you want the actual fullness of your lips restored/augmented, fillers will be needed (even if in small amounts).  If done correctly, there should be no concern of tissue embolism or necrosis.  In addition to technology such as the Viva, we also use ThermiSmooth in our office to soften lines around the mouth.  The two can even be used together.  Patients find it reassuring that they are investing in their own collagen/elastin producing abilities rather than having it injected from an outside source.  I often use very small amounts of Botox in the lips lines as well to reverse and prevent further wrinkling.  Ideally in correcting the signs of aging, a multi-pronged approach will yield the best results.

Thank you for your question. You’re asking if there is a non-surgical laser or radiofrequency treatment that can restore volume around the lips without fillers because you expressed a concern about potential necrosis and embolism. 
I can give you guidance as to how I counsel my patients with similar concerns during consultation. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years, and I have witnessed an evolution of technologies and development of products to help people look their best. You also mentioned you had a facelift in 2010, so it’s not necessarily about sagging but to restore these areas.
I can give a little perspective about the benefits of non-surgical treatment and some understanding about the relative risks of necrosis and embolism. These situations are terrible and occur very rarely. I can give you some ideas on how we can avoid these things. You’re 58-years-old, and although I don’t see a photo, I can say that a lot of our patients when they come for a treatment want to see results that are not subtle. The challenge with radiofrequency devices or non-ablative devices is you’re treating the skin which is barely 2 millimeters in thickness. The reason why you’re dealing with issues such as wrinkles or volume loss, is mostly due to bone loss. 
As we get older, we lose bone volume, fat, and soft tissue which are many layers several millimeters thick, and may milliliters in terms of volume loss. One of the unfortunate challenges for patients is lasers and radiofrequency technologies can be very effective, but only play one part in helping restore volume.
In my practice, I have developed a lot of methods and techniques to minimize the potential for these problems such as embolization. No doctor wants to ever experience that, and certainly don’t want to have a patient experience that. There’s a method that we do called structural volumizing where I use cannulas. Cannulas are special instruments that are blunt, which makes them unlikely to pierce a vessel. The problem with embolization and necrosis is the material being injected ends up going inside a vessel inadvertently, and that’s because when you use a needle, depending on the technique and the placement, there’s a possibility you can pierce a vessel. We know this from liposuction because the cannulas actually roll past vessels, and cause minimal bleeding during liposuction by the same concept. When you use cannulas and placement, it’s not impossible to pierce a vessel, but it’s less likely.
It would be worthwhile to talk to doctors you meet with, and understand what the outcome will be. You’re asking, “Is it possible?” of course, it is possible. We have technologies in our practice using lasers and radiofrequency to help improve skin quality, tighten the skin, and stimulate collagen. You can actually do it using various lasers, but the limitations are how much collagen and soft tissue can you generate, and can you do the same as fillers.  From my experience, you can’t even come close because fillers can be really effective, and you often need a fair volume to achieve significant results, and that volume has to restore structure.
I think  you shouldn’t just close your mind to the use of fillers. Speak to doctors to learn about the techniques employed. There is a lot of finesse and art to doing this, and the instruments we have available make this a less risky procedure. We do a lot of injectables in our practice so I’m constantly improving people’s cheeks, jawlines, lips, the folds around the mouth, marionette lines and nasolabial folds. This is something we do all day, every day, and it really is a pleasure to employ more advanced techniques that use these types of instruments such as cannulas to minimize the risk - not only the risk of embolization, but minimizing bruising, and allowing people to quickly recover so that they don’t have much swelling so they are able to go back to normal life as quickly as possible. 
It’s important to understand what the limitations are of these new, modern thermal energy devices, and understand what kind of outcome would be satisfactory before you move forward. Unfortunately, a lot of people are very disappointed with the results of thermal energy devices because their expectations and the way it was presented to them didn’t match the expectation and the results. Realistically speaking, I think there’s a role for fillers even without looking at a photo, and understand there are different ways to place these fillers to create these results, and minimize the risks. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Filler is really the only reliable, non-surgical way to restore volume around the lips. It is very safe. Skin necrosis is extraordinarily rare and can be treated to prevent a permanent problem. I would recommend seeing an experienced injector. If you just want to improve the wrinkles without filler, then a laser resurfacing like Halo or full field erbium would do a wonderful job of smoothing the skin, but they won't increase the volume of the lips.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers