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Where Not to Inject Lip Fillers?

Medically reviewed by Jacob Sanchez, CRNA

Lip fillers are among the most popular cosmetic treatments today, offering a quick and effective way to enhance the appearance of the lips. However, as with any aesthetic procedure, proper technique and understanding of facial anatomy are critical to achieving safe and desirable results. 

While skilled practitioners focus on where to inject fillers, it’s equally important to understand where not to inject lip fillers to avoid complications and unnatural outcomes.

Why Knowing “Where Not to Inject” Matters

Injecting lip fillers might seem straightforward, but the lips are a complex structure with intricate blood vessels, muscles, and connective tissues. Poorly placed injections can lead to:

  • Vascular complications such as occlusion or necrosis.
  • Unnatural appearance, including lumps, bumps, or distorted shapes.
  • Long-term damage to the surrounding tissues.

Understanding the “no-go zones” isn’t just about aesthetics it’s about ensuring safety and achieving a natural, balanced look.

1. The Vermilion Border (When Overfilled)

The vermilion border is the line where the colored part of the lips meets the skin. This is a key area to enhance when creating definition, but overfilling or improper placement here can lead to serious issues.

Why Avoid Overfilling the Vermilion Border?

  • Duck Lips Effect: Over-injection in this area can cause the lips to project unnaturally forward, creating an artificial “duck lips” appearance.
  • Asymmetry: Slight misplacement along the vermilion border can lead to uneven lip contours, which are highly noticeable.
  • Risk of Migration: Filler in this region may spread into the surrounding tissue, causing puffy or unnatural-looking areas above the lips.

Instead of heavy injections, subtle enhancements at the vermilion border can provide a more elegant, natural look.

2. The Cupid’s Bow (Improper Technique)

The Cupid’s bow, the curved “M” shape at the center of the upper lip, is one of the most delicate and defining features of the lips. While shaping this area can enhance lip symmetry, excessive or poorly placed filler can ruin the aesthetic balance.

What Happens When Fillers Are Misplaced Here?

  • Flattening of Natural Curves: Overfilling can cause the Cupid’s bow to lose its natural peaks and valleys, creating a “flat” upper lip.
  • Blocky Appearance: The upper lip may look overly wide and disproportionate to the rest of the face.
  • Lack of Subtlety: A heavy-handed approach can turn a delicate enhancement into an obvious, artificial alteration.

To achieve the best results, fillers should be placed sparingly and with precision to enhance, not distort, this central feature.

3. Directly Into Blood Vessels

This is a critical point: never inject fillers directly into blood vessels. The lips are rich in blood supply, with major vessels such as the superior labial artery and inferior labial artery running through the area.

Risks of Injecting Into Vessels

  • Vascular Occlusion: Blocking a blood vessel can stop blood flow, potentially leading to tissue necrosis (death of the tissue).
  • Blindness: While rare, accidental injection into an artery that connects to the ophthalmic artery can lead to permanent vision loss.
  • Severe Swelling or Bruising: Injecting into vessels can also cause hematomas or prolonged swelling.

To avoid these risks, practitioners use techniques like aspirating before injecting and relying on anatomical knowledge to steer clear of these critical vessels.

4. Too Close to the Corners of the Mouth

The corners of the mouth, also known as the oral commissures, are delicate areas where fillers can do more harm than good if improperly placed.

Why Are the Corners a Risky Area?

  • Pillowing Effect: Overfilling near the corners can create small lumps or bulges, giving the lips an uneven appearance.
  • Drooping Mouth Corners: Incorrect placement can accentuate a downward pull, making the face look sad or aged.
  • Filler Migration: This area is prone to migration, where filler shifts out of place over time.

Instead, focus on adding volume to the body of the lips, and avoid heavy filler placement at the edges.

5. Too Deep Within the Lip Tissue

The lips have multiple layers, including skin, muscle, and mucosa, and injecting too deeply can result in undesirable effects.

Consequences of Deep Injections

  • Lumps or Nodules: Uneven distribution of filler may create hard lumps that can be felt or seen.
  • Tissue Damage: Injecting into deeper layers increases the risk of damaging the delicate structures within the lips.
  • Unnatural Movements: Deeply placed filler can interfere with normal lip movement, leading to a stiff or restricted feel.

Skilled practitioners focus on placing fillers in the correct plane for smooth and even results.

6. Inside the Wet-Dry Border of the Lips

The wet-dry border is where the outer lips meet the moist, inner mucosa. While fillers are sometimes placed here for volume, excessive or improper injection in this area can lead to complications.

Risks of Wet-Dry Border Injections

  • Overhydration Appearance: Excess filler here can make the lips look overly puffy or “swollen.”
  • Filler Migration: This area is prone to filler shifting into the inner lips, causing irregular shapes.
  • Discomfort: Injections here can sometimes lead to increased swelling and tenderness.

A subtle approach, with minimal product, is essential to avoid overcorrection.

7. The Philtrum Columns (If Overfilled)

The philtrum columns are the vertical ridges that connect the upper lip to the base of the nose. Adding definition here can enhance the lips’ overall appearance, but overfilling is a common mistake.

Problems With Overfilling the Philtrum

  • Unnatural Protrusion: Excess filler can create a “ridge” that looks disproportionate.
  • Unbalanced Features: Over-enhancing the philtrum can throw off the harmony of the entire lip structure.
  • Obvious Results: Heavy filler use here often looks artificial, drawing attention for the wrong reasons.

Refining the philtrum requires careful placement to maintain the lips’ natural elegance.

The Importance of Choosing a Qualified Injector

Avoiding these high-risk areas requires not just anatomical knowledge but also the skill and artistry of an experienced injector. Here are some key reasons to choose a qualified professional:

  • Anatomical Expertise: Trained practitioners understand the complex network of blood vessels, muscles, and tissues in the lips.
  • Technique and Precision: They know how to achieve natural-looking results while avoiding complications.
  • Emergency Preparedness: In the rare case of a filler-related complication, a qualified injector will know how to respond effectively.

Always research your provider’s credentials, look at before-and-after photos, and prioritize safety over cost.

Table: Areas to Avoid When Injecting Lip Fillers

Area Risks Key Considerations
Vermilion Border Duck lips, asymmetry, filler migration Avoid overfilling; aim for subtle definition
Cupid’s Bow Flattened curves, blocky appearance Enhance gently to preserve natural shape
Blood Vessels Vascular occlusion, blindness, severe bruising Never inject directly; use aspirating techniques
Corners of the Mouth Lumps, drooping corners, filler migration Avoid heavy injections near edges
Deep Lip Tissue Lumps, stiffness, tissue damage Focus on the correct injection plane
Wet-Dry Border Swelling, filler migration, overhydration look Use minimal product to avoid overcorrection
Philtrum Columns Unnatural ridges, unbalanced appearance Subtle enhancement to maintain harmony

Conclusion

Injecting lip fillers is both an art and a science. While adding volume and shape can transform your appearance, knowing where not to inject is equally critical to ensure a safe and natural result. The delicate structures of the lips demand precision, skill, and a deep understanding of anatomy.

If you’re considering lip fillers, consult with a licensed and experienced practitioner who prioritizes your safety and satisfaction. By avoiding high-risk areas and focusing on a personalized approach, you can achieve beautiful, balanced lips without compromising your health or natural beauty.

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Medically reviewed by

Jacob Sanchez, CRNA

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