Face, Lips


by Antonello Tateo, Plastic and Reconstructive Surgeon

Face, Lips


This is a false myth that needs to be debunked. But it is worth remembering that even false myths possess an element of truth: they can teach us about incorrect or inadequate procedures.

The practice of hyaluronic acid-based treatments is becoming more and more widespread, and as often occurs, with popularity come inaccuracies and fake news. Is it true that following treatment, lips empty out and become thinner than before? Let us attempt to answer this by going slightly more in-depth.

How long does it take for hyaluronic acid to be reabsorbed?

It is common knowledge that over the course of time hyaluronic acid is reabsorbed by the organism. The time it takes for this process to occur after lip treatment ranges from not less than 5-6 months to a year. This variable time scale depends on several factors: from the kind of gel used to the area of the lips where it is applied; from wear and stress owing to movement and external agents – the sun for example. And this time varies from individual to individual.

But is it possible that the volume of the lips can be even less than it was prior to commencement of treatment after the reabsorption of the gel? This is the impression of some patients after having undergone treatment.

In some cases, this perception can be reinforced by a psychological reaction. Once one is used to having fuller and better-defined lips, when the effect wears off it can lead to frustration.

However, this perception can also be symptomatic of the treatment not having been carried out correctly.

When the filler is too stiff.

If a filler that is too stiff, the immediate effect is the perception of lips with a marked increase in volume, and the patient can easily be fooled into thinking that the effect will last for a long time.

But the reality is that the opposite is more probable. By compressing the tissue excessively, the gel compromises its vitality and trophism. Excessively high levels of rigidity impede the gel from integrating with the surrounding tissue. Especially over an extended period of time, this situation can lead to a reduction of the natural volume of the lips and to a relaxation of the mucus and overlying skin.

It is important for the filler to possess the correct properties.

An optimal gel needs to possess the correct elastic properties, be able to integrate with the surrounding tissue, and it must be administered in such a way that the tissue is not excessively compressed.

If these conditions are observed, then the tissue can be preserved and at the same time fibrosis and inflammation can be reduced.

Picture a sponge: it is capable of absorbing a certain limited quantity of water whilst the excess will run off. The same can said of lip treatment with gel based on hyaluronic acid. That which can be integrated into the tissue will not damage it and will offer stable volume. The remaining portion will enhance volume to begin with, but will be destined to disappear rapidly, especially when the treatment is repeated, resulting in deterioration of the tissue – both qualitatively and quantitatively.

The correct procedure to construct a new labial structure and form is that which proceeds gradually, step by step without excess. Though it may seem counterintuitive, on smaller lips reduced quantities of gel should be used whilst in larger ones increased quantities should be employed.

How can a correct approach be identified? By protracted reabsorption time.

Unlike the cases mentioned at the beginning, many people who undergo treatment experience a stabilisation of shape and volume over time. To the extent that the specialist might gradually delay the frequency of subsequent treatments and diminish the quantity of gel required to obtain the desired effect.

This occurs when the gel has the correct physical and structural properties; when the tissue expansion has been programmed accurately and gradually; when the gel has been optimally absorbed into the surrounding tissue; when the injection technique is optimal, meaning that the post-treatment inflammatory reaction is minimal; and when physiologically the tissue has produced collagen and the correct trophism has been restored.

To conclude: is the claim of the title true or false?

It is false. However, as you will have gathered and as mentioned at the beginning, false myths also have an element of truth. Some advice? Avoid shortcuts and excess and entrust a specialist with your treatment. Time will vindicate your choices.

Plastic and Reconstructive Surgeon