Yo-yo lip filler, a dangerous plastic surgery trend, is blowing up

In 2018, Kylie Jenner announced that she “got rid” of all her filler, in a comment that sent the world spiralling. How do you get rid of filler? We asked. Is Juvéderm dead? We pondered. In the days, weeks, and months since, privately getting your lips filled and publically having them dissolved (and then filled again and maybe even dissolved again – like a yo-yo) has become something of a Hollywood trope. But the popularity of lip fillers remains steady, even as celebrities become increasingly open – if not downright sanctimonious – about their decision to have them removed. 

Fillers come in several types, which can be injected in various areas of the body to soften facial creases, diminish lines, or plump lips, for example. Different products are used to treat different areas, but the most common temporary lip fillers (and the only ones that can be dissolved), are hyaluronic acid-based. “(Hyaluronic acid products) are natural polysaccharides that appear in the body,” says Dr Alan Matarasso, a board-certified plastic surgeon and past president of the American Society of Plastic Surgeons (ASPS). Depending on the product, fillers can last anywhere from 6 to 18 months and will deflate naturally.

Hyaluronic acid-based lip fillers are dissolved by injecting a product called hyaluronidase. This naturally occurring enzyme helps to quickly break down hyaluronic acid in the body. The effect is rapid, though some patients may need more than one treatment to achieve the desired results. Hyaluronidase is an effective tool, but Dr Matarasso is careful to note that it’s not without its potential drawbacks. With or without filler, our bodies already contain their own native hyaluronic acid. When injected into the lips, the dissolving enzyme can’t distinguish between the filler’s hyaluronic acid and the body’s native hyaluronic acid. Because of this, the de-puffing process can sometimes cause irregularities, and the effect can be more dramatic than patients might expect. In addition to toning down overfilled lips, hyaluronidase serves another crucial function for dermatologists and plastic surgeons. “You want to have that hyaluronidase not only for Mrs Jones or Mr Jones, who doesn’t like the way the lip looks, but God forbid they have a problem with the injection,” says Dr Matarasso. 

Erin* (not her real name) got her lips plumped for the first time aged 21. She started small, but the initial swelling – which went down after a few days – left her hungry for more filler. She went back one month later. “I said, ’I want big. Do as much as you can. Fill them up.’” She says she walked out of the appointment looking like Farrah Abraham in the now infamous photo from 2015. The experience left Erin spooked and afraid to inject anything else into her body, even the dissolving agent. Instead, she waited over a year for her overfilled lips to deflate naturally. They didn’t. So she finally went in to get the filler dissolved with hyaluronidase. The results weren’t what she expected. “I’d gotten so used to my proportions with bigger lips, but then I started to panic after taking them out. I thought they looked so small, they looked deflated. I started feeling like I was having a physical identity crisis.” 

Erin’s emotional response to finally getting rid of the lips she’d disliked for so long brought her back to the doctor’s office. Again and again. She soon found she was chasing the same unrealistic ideal in the form of lips that didn’t make sense for her face. “The lip is like a sausage,” says Dr Matarasso. “It can only be filled so much before it doesn’t look right.” Erin experienced this first-hand when too much filler left her with what she describes as a blown-out lip line. But still, this double-edged sword effect hasn’t stopped her from consistently re-filling and dissolving her pout in the years since. 

There are currently no statistics on the use of hyaluronidase for dissolving filler, so it’s difficult to say how often people are opting out of their injections. But the practice is certainly seeing an uptick. Dr Matarasso chalks this up to a combination of several factors, first and foremost: the procedure’s heightened popularity. With growing demand comes an influx of improperly trained and unqualified injectors. Hence, an increased need to correct bad injections. In the US, rules regarding who can legally inject filler vary by state. In the UK, fillers are far less regulated, making it absolutely vital to check that you’re being treated by a qualified medical professional – underscoring the existence of the dissolving agent as a medical necessity. It’s vital that you check your provider’s credentials before going in for an injection. UK consumers can consult Save Face, a national register of accredited practitioners.

“The lip is like a sausage. It can only be filled so much before it doesn’t look right” – Dr Alan Matarasso, plastic surgeon

While interminable toing and froing may not constitute a full-blown hyaluronidase craze, it’s clear that what was once an emergency measure used to treat injections gone medically wrong, has taken on new meaning as a mode of self-correction for overzealous users. But does the existence of an ‘undo’ button make us all the more fickle when it comes to sizing up (and down)? Where filler is concerned, Dr Matarasso has seen a trend of patients developing a more relaxed attitude to the procedure. The knowledge of a so-called antidote is certainly a factor, as is the technique’s meteoric rise to the status of commodity. “You can walk along the street and see a storefront that does it. You feel like you’re walking into a hair salon, not a medical space.” After all, everyday facades and relaxed settings beg the question: If my injector’s office looks like my salon, can I change my lips as often as I change my hair?

Aesthetic procedures have long catered to the whims of popular culture. Nowhere is this more evident than when it comes to lip fillers. Kylie Jenner’s lips blew up in 2015 and nothing was the same. Hyaluronic acid fillers weren’t new, but Kylie put puffed-up pillow lips on the map. Kylie gets them, we want them. Kylie gets them taken out… you get the picture. 

The thing about trends is that they come and go. “When you go back to the 80s and 90s, there was a procedure called lip reduction. We took big lips and you made them smaller. We rarely, rarely ever see that anymore,” says Dr Matarasso. The enormous lips of 2015 have given way to a less exaggerated, but still huge, ideal. It’s not that people want smaller lips per se, but that the initial big lip bubble has popped. We’re moving in favour of using this technology with greater subtlety, more finesse. Sometimes that’s easier said than done. 

In Erin’s experience, it becomes more difficult to maintain perspective with each subsequent injection. “Your idea of what you actually looked like before is so far gone and it’s been so long that your frame of reference kind of gets really muddy.” A journey that begins with ‘just a little’ can quickly become a route to a different destination.

For celebrities and mortals alike, lip fillers can turn into a treacherous journey down a road paved with bittersweet results. Getting something done, let alone deciding to have it undone, is a vulnerable and personal choice. Brielle Biermann has been open about getting her lips done from day one. Back in 2015, she posted a video of her receiving her first filler injections. Earlier this month, she added to the conversation again when she announced she was getting them dissolved. But Biermann is an exception to the rule. 

It’s not unreasonable for celebrities to want to keep the experience for themselves, and in some cases, that’s exactly what they do – only sharing their filler stories after the fact. In 2017, Courteney Cox proclaimed that she’d had all of her fillers dissolved. “I feel better because I look like myself,” she told New Beauty. Yolanda Hadid shared a similar sentiment early last year. 

There’s something to be said for lip-plumping glosses and Instagram’s removal of cosmetic surgery filters, which fake the pillow lip look for under an hour, instead of months. ‘Temporary’ may be the name of the game, but going all-in on filler can mean getting caught in a cycle of bigger is better – until bigger becomes worse. This is probably why, as a society, we’ve become so accustomed to hearing lip plumping horror stories and tales of triumphant escape. 

An incomplete picture is painted when we only hear about the ones who got away. Millions of people have filler injected every year in the US, yet we hear so much more from the people who’ve given up on enhanced lips than we do from the ones who haven’t. “I feel like maybe there’s a pride in, ‘I’m kind of divorcing myself from, what could be considered, this vain decision,” says Erin (who, for the record, doesn’t consider getting fillers to be a vain decision). This so-called pride builds a culture of judgment and contributes to the stigma around aesthetic treatments that are perceived as vain or ‘fake’. The result is unfair, a sort of damned if you do, damned if you don’t effect. At the end of the day, what you put in or take out of your face is entirely up to you. But if you do choose to get your lips filled, make sure your provider has hyaluronidase on-site, just in case.