A new method of injecting fillers to plump up one’s pout has been making waves on social media of late – that of needle-free lip augmentation. This sans needle treatment utilises a pen-like device to ‘shoot’ the filler into the lips with pressurised air: lip perfection without the injection, if you will. Yet is this procedure safe? What risks does it carry? And what is the final result? Dr Riekie Smit answers the questions that are on everyone’s lips.
While the concept of a needle-free lip procedure sounded very alluring to people at first, the initial hype and excitement that surrounded this innovation dissipated almost as soon as it began. This was largely due to the lack of similar results compared to that of the traditional syringe and needle method in lip augmentation.
Beautiful voluptuous lips are very in-vogue right now, thanks to the Kylie Jenner’s and Angelina Jolie’s of the world. There’s most certainly a number of patients out there who covet the perfect pout but are holding back due to their fear of needles – or the price tag a lip augmentation carries.
In fact, it’s this very needle and pricing concern that boosted the trend in the international markets (especially the United Kingdom and the United States) – but unfortunately ended up with disastrous consequences. So, in a way, it’s probably better that South Africa is slightly behind global aesthetic trends, as we can learn from the mistakes of others.
What is this ‘emerging technology’ of needle-free lip fillers?
Lip fillers are traditionally performed by doctors with sterile injectable products that are inserted with either a needle or a cannula into the specific areas that need to be treated.
The needle-free devices, however, are in the form of a pen-like mechanism that applies jet injection technology to force the filler with pressurised air through the surface into the more superficial layers of the lips. These tools actually resemble an ear-piercing device that shoots out with a quick click, which then ‘pushes’ the filler into the lips without the need for a needle.
These devices have been popular in the beauty market as the premise is that no skill is required – nor is the need for anatomical knowledge of blood vessels (because the area is more superficial).
Initially, the marketing was focused on this method being a ‘safer alternative’ to fillers, yet not surprisingly, turned out to be quite the opposite (to say the least).
In a recent online article published on Refinery29.com, the British consultant dermatologist, Dr Emma Wedgeworth, shared her thoughts on these new pen lip filler treatments:
“We are only just beginning to learn about the complications of these devices because they are relatively new to the market. The devices claim that the hyaluronic acid is only delivered to the top layers of skin – and therefore are relatively safe… but the high pressure at which the product is delivered can cause complications. Problems include blocked blood vessels, resulting in reduced blood flow to the skin of the lips. This in turn causes significant damage to the skin, as well as bruising, swelling and lumpiness” said Dr Wedgeworth.
A global dilemma
Needless to say, Britain is not the only country being flooded with complaints about the use of the device for lip augmentation. Indeed, our local shores have experienced its fair share of handling complications due to these new trendy pens.
So what went wrong?
The huge problem that medical specialists have with these products is not only its lack of evidence and safety but especially the misleading advertising of the treatment. Several training providers and companies are marketing this as a pain-free, complication-free, and bruise-free treatment. However, an overwhelming amount of evidence proves this to be completely incorrect – not only locally, but also abroad.
The British platform, Save Face (a site that supports safe non-surgical cosmetic treatments), have received over 70 complaints so far this year… all related to no-needle filler procedures. They report that patients are very unhappy with these treatments misleading the public, as it purports to be pain-free and bruise-free – yet their experience tells a completely different story. Patients have revealed that, in reality, the treatments are not only very painful but also brings significant swelling and bruising with it.
Why does this happen?
The reason for this extensive swelling and bruising is due to the extrusion force being much higher than what a doctor needs from using a needle.
This is to compensate for the fact that no needle is applied. Furthermore, the ultra-high pressure needed to force the product through intact skin causes significant tissue and small blood vessel damage. It’s no wonder then that action will result in severe swelling and bruising.
It must also be noted that while the treatment really makes the lips look plumper, it’s certainly not long-lasting. This leads to the patient feeling very discontented, as their mild saving in cost means more recovery time – along with a disappointingly short-lived outcome.
Are the results the same as lip filler injections?
To answer this, we can start by looking at what constitutes a good result with lip fillers.
There are a number of factors contributing to a successful lip augmentation:
- Good medical and artistic evaluation by the doctor of the proportions of the lips, the face and where the filler is needed most
- Precise injecting into the area that needs fillers, while avoiding incorrect placement
- The depth of filler placement
- Good quality lip filler that has scientific evidence of its safety and efficacy
- Good anatomical knowledge of the lips and blood vessels
- Sterility in the procedure and knowledge of managing complications
Conversely, the pen devices are not specific and precise in placement, as the high extrusion force makes it impossible to be precise to the millimetre (and with lip fillers, millimetres really do count a lot). In addition, the products sold with the pen devices are not medical injectable products with clinical trials supporting their safety. This lack of evidence is the major reason why many countries have banned the use of these pen injectors.
Another negative is the pen injectors extrusion force: it does not allow for the same even distribution of the hyaluronic acid molecules, which most often leads to an uneven and irregular lumpy appearance.
Lastly, the significant swelling and bruising from the procedures may also develop irregularities as the filler particles move or spread to undesired locations.
Complications from lip filler pen treatments
The lips are an extremely sensitive area and have an abundance of rich blood supply (which is the reason lips are red in colour). Many of these blood vessels are not only close to the surface but are also delicately minute. And herein lies the problem: the pressure from lip-filler devices breaks these delicate blood vessels – hence the bruising. Now, if there is one thing a blood vessel doesn’t want, it’s that of fillers. Fillers are gel-like products that will cause a clog in a blood vessel. If there are fillers placed inside a blood vessel, the blood flow stops… and if blood flow stops, tissue necrosis (tissue death) occurs.
There are two instances of how these needle-free devices can cause tissue death on the lips. The first is the filler being able to enter the small vessels easily, then travelling to the larger vessels (ultimately causing tissue death). The second instance is specifically more worrisome for people with delicate skin. In thin skin patients (or those with very superficial blood vessels), the product can directly enter these vessels with the force of the device.
Meanwhile, there have been various reports of vascular complications from these devices in numerous countries – additional proof that this treatment is by no means safer than the traditional method of using a needle administered by a trained medical professional.
Worse case scenarios
The management of a vascular occlusion by fillers is a complicated and long process of dissolving the emboli, treating the dead tissue, re-establishing blood supply, minimising long term scarring -and really -just hoping for a normal lip again one day!
The aspect of sterility and risk for bacterial infections is another topic that requires another page or two, so for now, let’s just summarise that the pen device carries more risks, complications and a higher infection rate than the traditional needle method.
Take home message
While needle-free devices are bad news, it seems there is still a place for them in certain procedures – but at this stage, it’s definitely NOT for fillers. What is really needed here is more research into how this can be applied for cosmetic treatments in a safe and controlled manner. There are certainly interesting developments in the field of transdermal delivery of medicines in many medical industries, yet these are supported with evidence-based medical literature.
For now, it seems that if you want fuller lips, it’s safer to visit your doctor or buy a lip plumping gloss and pout all day!
Written by Dr Riekie Smit – MBChB, MSc Sports Med, Adv Dip Aesth Med
- Dr Smit has a private practice in Pretoria, South Africa. The focus of her practice is aesthetic medical procedures for face, body and skin treatments www.drriekie.co.za
- Honorary secretary of AAMSSA (Aesthetic & Anti-Ageing Medicine Society of South Africa).
- A faculty member of the American Academy of Aesthetic Medicine.
- Chairperson of the Aesthetic Medicine Congress South Africa (AMCSA).
- President member of the International Union of Aesthetic Union.
A2 Disclaimer: This article is published for information purposes only, nor should it be regarded as a replacement for sound medical advice.
This article was written by Dr Riekie Smit and edited by the A2 team EXCLUSIVELY for the A2 Aesthetic & Anti-Ageing Magazine Spring/Sep 2020 Edition (Issue 34).
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