Injectables / Rejuvenation Dermatology Calgary South

Lip filler, judged by proportion

Hyaluronic acid lip augmentation adds hydration, definition or structure to the lips. Done conservatively it reads as a well rested mouth. Done heavily it reads as filler. Dr. Paul Kuzel is a Royal College certified dermatologist, and he treats the lip as anatomy with a blood supply rather than as a volume target.

Book a consultation Call (403) 286-6888

What it is

A gel that holds water, placed in a specific layer

Hyaluronic acid is a sugar molecule your body already makes. It sits in skin, cartilage and connective tissue, and it binds water. The fillers used in lips are hyaluronic acid that has been cross linked in a laboratory so it holds its shape and lasts months instead of days. Once it is placed, it draws in a small amount of water and stays where it was put until the body gradually breaks it down.

The important part is not the brand. It is the gel. Softer, less cohesive gels spread through tissue and add suppleness without much projection. Firmer, more cohesive gels resist tissue pressure and hold a shape, which is what creates definition on the vermilion border or projection in the body of the lip. Two products with the same brand name on the box can behave completely differently, so product selection follows the plan rather than the other way around.

Hydration

Softness and suppleness

A soft, low cohesivity gel placed in small amounts through the body of the lip makes it feel and look better hydrated. It smooths the fine vertical texture of the lip surface. It does not add much size and it does not create a defined edge.

Structure

Definition and projection

A firmer gel placed at the wet dry border, along the vermilion border or in the philtral columns creates shape: a clearer edge, a restored cupid's bow, or more forward projection on profile. It is also the placement that shows most obviously if it is overdone.

Product families

Juvederm, Restylane, Revanesse

Dr. Kuzel carries all three families. Each includes several gels with different firmness, lift and water binding behaviour. Which one is used depends on the lip in front of him, not on a house preference.

6 to 12 monthsTypical duration of hyaluronic acid in the lips, though it varies widely
2 to 4 weeksBefore swelling has fully settled and the result can be judged
ReversibleHyaluronic acid filler can be dissolved with hyaluronidase

Who it suits

Good candidates, and the ones we decline

Lip filler is a small treatment with a large visual footprint. The face notices the mouth. That is why candidacy matters more here than the volume of gel used.

Often a good fit

  • Lips that have thinned with age, where the upper lip has lengthened and the vermilion has rolled inward.
  • Naturally fine lips where the goal is modest definition rather than a change of character.
  • Asymmetry that bothers you, where a small amount on one side balances the other.
  • A flattened cupid's bow or philtral columns that have lost their edge.
  • Smoker's lines and fine vertical texture, where a soft gel is one part of a broader plan.
  • Patients who want an outcome that does not announce itself.

Often not a good fit

  • Active cold sore, infection, or broken skin anywhere on or around the lips.
  • Pregnancy or breastfeeding, where these treatments are not offered.
  • Old filler that has migrated above the border. That usually needs dissolving first, not more product on top.
  • A request for a size that the surrounding anatomy cannot support without looking obvious.
  • Autoimmune or connective tissue disease that is active or poorly controlled, which needs discussion first.
  • Anyone hoping filler will fix a concern that is really about tooth position, gum show or jaw structure.

Why overfilling reads as obvious

Lips look natural because of ratios and edges, not because of volume. A normal upper to lower lip ratio sits near one to one and a half or one to two, and the vermilion has a crisp border with a slight ridge above it. When too much product goes in, or when it is layered session after session, three things happen. Product spreads above the vermilion border and creates a pale shelf between lip and skin. The philtral columns get blunted and the cupid's bow flattens. On profile the upper lip projects past the lower lip, which no lip does naturally.

Repeated overfilling also stretches the tissue itself. That change does not fully reverse when the filler is dissolved, which is one of the strongest arguments for treating conservatively and spacing sessions out.

What happens

The appointment, step by step

  1. Consultation and assessment

    Dr. Kuzel looks at the lip at rest, in animation and on profile. He reviews your medical history, medications and supplements that increase bruising, any history of cold sores, and any previous filler including where and when. If you have had filler elsewhere and cannot recall the product, say so. It changes the plan.

  2. A plan you agree to before anything is injected

    That includes which gel, which zones, roughly how much, and what will deliberately be left for a second visit. Staging is normal and is often the better choice.

  3. Numbing

    Topical anaesthetic is applied for about twenty minutes. Most hyaluronic acid gels also contain lidocaine, so the area becomes more comfortable as the treatment progresses. A dental block can be used in some cases.

  4. Injection

    Placement uses a fine needle, a blunt cannula, or both, depending on the zone. Product is delivered slowly, in small aliquots, with low pressure. Slow and low is not a comfort preference. It is the technique that reduces the chance of forcing product into a vessel.

  5. Shaping and review

    The lip is gently moulded, then reviewed with you sitting upright and in a mirror. Ice is applied. The whole appointment usually takes forty five minutes to an hour, most of which is assessment and numbing.

  6. Follow up

    A review at two to four weeks, once swelling has resolved, is when the result is actually assessed. Small adjustments, if any are needed, happen then.

Afterwards

Swelling, bruising and the risks that matter

Lips swell more than any other area that gets filler. Expect it and plan around it.

  • First 24 to 72 hours: the most swelling. Lips can look considerably larger than the intended result, and can feel firm and tender.
  • Day 3 to day 7: most of the swelling settles. Bruising, if present, is usually at its most visible early in this window.
  • Week 2 to week 4: small lumps and firmness typically soften as the gel integrates. The result at four weeks is the result.
  • Bruising can last up to two weeks. Fish oil, high dose vitamin E, ibuprofen and alcohol all make it more likely, so pausing those beforehand where medically safe is sensible.
  • Do not book lip filler in the week before a wedding, a photo shoot or a holiday. Two to three weeks of margin is the minimum.
  • Cold sores can be reactivated by injection. If you get them, tell Dr. Kuzel, because antiviral prophylaxis started before the appointment is straightforward.

Vascular occlusion, and why hyaluronidase matters

The superior and inferior labial arteries run through the lip, most often in a deep submucosal plane near the wet dry border, and their exact position varies from person to person. If filler is injected into one of these vessels, or if enough volume is placed to compress one, blood flow to that area of tissue is blocked. This is called vascular occlusion. It is uncommon, it is the most serious risk of lip filler, and left untreated it can cause tissue death and permanent scarring.

The warning signs are recognisable: pain that is out of proportion to the procedure, immediate blanching or a white patch, then a dusky, mottled or purple discoloration with slow capillary refill. It can appear during the injection or over the hours afterwards.

Hyaluronic acid is the only filler category that is directly reversible. Hyaluronidase is an enzyme that breaks the gel down, and in a suspected occlusion it is injected promptly and generously into the affected territory, often repeated. That is the reason to have this treatment done by a physician who recognises the signs early, keeps hyaluronidase on site, and is reachable after hours. It is also why permanent and semi permanent fillers are not used in lips here.

Other risks include infection, delayed inflammatory nodules, lumps that need dissolving, asymmetry, product migration over time, and rarely a granulomatous reaction. Any sudden vision change, severe pain, or spreading discoloration after filler is an emergency. Call the clinic and seek care the same day.

Read more about hyaluronidase and dissolving filler, or see cheek filler if support in the midface is part of what you are considering.

Questions

What patients actually ask

How much does lip filler cost?
Cost depends on which product is used and how much of it, and that is only clear once the lips have been assessed in person. For that reason pricing is quoted at consultation rather than published as a single figure. Cosmetic injectable treatments are not covered by Alberta Health Care Insurance. If dissolving old filler is needed first, that is a separate appointment with its own fee.
Does it hurt?
Most people describe it as uncomfortable rather than painful. Topical anaesthetic is applied first, and most of the gels contain lidocaine, so the lip becomes progressively number during the treatment. A dental block is available in some cases. Pain that is severe or out of proportion during or after the injection is not normal and should be reported immediately, because it can be an early sign of vascular occlusion.
How long do the results last?
Hyaluronic acid in the lips typically lasts six to twelve months. Lips are constantly moving and have a rich blood supply, so filler often breaks down faster there than in areas like the cheeks or temples. The range varies with the product, the amount used, your metabolism and your activity level, so no specific duration can be promised.
Will my lips look obviously done?
That depends on the plan and on the restraint used, not on the product. Lips look obvious when the ratio between upper and lower lip is wrong, when product sits above the vermilion border, when the philtral columns are blunted, or when the upper lip projects past the lower on profile. Dr. Kuzel treats conservatively and often stages a result across two visits for that reason. If the outcome you are asking for cannot be achieved without those signs, he will tell you before treatment rather than after.
Can lip filler be reversed?
Yes. Hyaluronic acid filler can be dissolved with hyaluronidase, an enzyme injected into the treated area. It usually works within days, and it can be repeated. It is used both for results a patient is unhappy with and urgently for suspected vascular occlusion. It is not perfectly selective, so it can temporarily affect some of the hyaluronic acid your own tissue makes, and allergic reactions are possible though uncommon.
How much swelling should I expect?
Significant swelling in the first 24 to 72 hours is normal, and lips can look considerably larger than the intended result during that window. Most of it settles within seven days, and the lips are usually settled enough to judge at two to four weeks. Bruising is common and can take up to two weeks to clear. Leave at least two to three weeks before any event.
What is vascular occlusion and how likely is it?
Vascular occlusion happens when filler blocks a blood vessel, either by entering it directly or by compressing it. It is uncommon but it is the most serious complication of lip filler, and untreated it can cause tissue death and scarring. Warning signs are pain out of proportion, blanching, and then dusky or mottled discoloration. It is treated urgently with hyaluronidase. This is a large part of why the treatment should be done somewhere that recognises it early and has hyaluronidase on hand.
I have filler from somewhere else. Can I just add to it?
Sometimes, and sometimes not. If previous product has migrated above the vermilion border or created a shelf, adding more gel on top usually makes it more obvious rather than less. In that situation the honest recommendation is often to dissolve first, let the tissue settle, and rebuild from there. Bring whatever record you have of what was used and when.

Next step

Start with a consultation

Every plan starts with an assessment in person. Dr. Paul Kuzel, MD FRCPC, is a board certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.

Dr. Paul Kuzel, MD FRCPC
Rejuvenation Dermatology Calgary South
10201 Southport Rd SW #102, Calgary AB T2W 4X9
(403) 286-6888

Book a consultation Call (403) 286-6888

Related pages: hyaluronidase, cheek filler, under eye filler, temple filler.

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