Heart-shaped, keyhole and Devil lips: good or bad lip filler trends?

If you have been watching Instagram Reels or TikTok lately, it is very likely that you will have come across various lip filler trends.

Some you may have heard of and some you may not, but the question for aesthetic clinicians is should you be providing treatments to conform to these fashions and trends, or should you be steering your patients away from these sometimes-unnatural options for lip shaping and augmenting.

In this blog, Dr Tim discusses current trends for lip filler procedures including heart lips, Hyaluron pens or no-needle lip fillers, keyhole lips, and Devil lips.

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What are heart-shaped lips?

The heart-shaped lip look achieved with dermal fillers reflects a natural lip shape. You achieve it by trying to intentionally create or over-emphasise the shape. Dr Tim credits Dr Bob Khanna with pioneering this look and method. It is performed using dental flow that is hooked between the lower teeth and pulled over the top of the lower lip, whereupon filler is injected on either side of the dental floss.

This does mimic a natural lip shape, and you would simply be enhancing its existence; ethically you are creating a shape that fits with the norms of a beautiful lip. For that reason, Dr Tim believes that it is something aesthetic clinicians could provide to a certain cohort of patients.

However, he does have reservations about the technique, and the need to use dental floss. Based on his mental model on how filler products work, he explains that when you are injecting into a quadrant of the lip, the product does not flow easily to the other side of the quadrant, therefore he doubts whether injecting in the same place without the dental floss would create a vastly different result, certainly, with a little palpation, he suspects that you would probably get a very similar result. The key to the use of dental floss may therefore all be in the compelling marketing for this technique and aesthetic outcome. This creates a clearer image for patients to understand the method and to ask for the look they seek.

There is no harm in this technique and the outcome on the right patient; with conservative use of lip filler, you can create a nice, pleasing heart shape.

It is safe to use a hyaluron pen for lip filler treatments?

A hyaluron pen is used for a no-needle ‘injection’ of lip filler. Dr Tim has first-hand experience of trying one of these devices back in 2011 when he was one of the first clinics to be offered a chance to try the innovation. He used it on his receptionist and apologises that it left her horribly bruised and did not achieve a very nice aesthetic result. He never offered it to any of his patients.

No-needle injection pens were widely promoted and sold to aesthetic clinics at the time. It sounded like a great idea, even Dr Tim notes that he thought it was going to work and he loved the idea of being able to inject dermal filler without causing any swelling or needle-type injuries, but sadly it turned out not to be true.

Patients, and practitioners are attracted to the concept as it seems a compelling idea if you are afraid of needles but want to have your lips filled. Unfortunately, without a needle for product placement, the problem is that it is replaced with a high velocity jet of filler that is less targeted than would be achieved with a needle (or cannula).

Similarly, the amount of energy that you need to exert on a drop of hyaluronic acid filler gel to fire it through the skin is quite significant, thus it causes trauma to the capillaries, leading to bruising.

The lack of control means that it also results in filler at different levels within the tissue – sometimes going deeper, but often leaving it very superficial, which results in lumps at the surface of the lip that require massage. Unlike when using a needle, you will have no control over the finer details of the lips to shape the vermillion border, contour, and keep balance – volume is about all it can do.

This is not a trauma-free or pain-free option for lip filler – you cannot fire a gel though someone’s lip at a high energy without causing trauma (pain), bruising and swelling – no matter how it is marketed.

What are keyhole lips?

Keyhole lips are like heart-shaped lips, but the idea is that the aesthetic injector is trying to create a little space between the lips that can be seen when the lips are resting, like a keyhole.

The first time Dr Tim saw this lip filler trend, he admits he was somewhat confused, and unsure of the reasons why this look was regarded as beautiful. Delving a little deeper, he has concluded that the association with very full lips is what makes this look intriguing and desirable. If a patient’s lips were full during their youth, they are more likely to have a lip structure that is so strong that it leaves a little area that does not close properly, which will be replicated with adding volume to the lips again with dermal filler.

He has reservations about this technique and the desire to create a hole or empty space in between the lips when the lips are meant to sit neatly together. Although the desire for fuller, more voluptuous lips is associated with this hole, and can appear sexy to some, it can also be a little odd, so be careful if you attempt this look.

If a patient already has that shape to their natural lip, whereby there is a small hole in between the upper and lower lips, then you could say that they might be able to have the keyhole lip look, as an enhanced feature. However, Dr Tim does not think that it is a good goal in the consultation, and he would be advising his patients to think more broadly about the shape, volume, and details of their lips to achieve the best aesthetic result, rather than focusing on the desire for a little hole, which might just be a happy side effect, rather than a primary treatment goal.

Devil lips?

The trend for so-called Devil lips was a viral phenomenon a couple of years ago and appears to involve aggressively injecting the lips with vertical injections to create additional peaks in the lip border.

If this is true, Dr Tim finds it interesting that it shows how powerful a vertical injection is at averting the lip, but obviously it is not compatible with being a medical injector and is more in the realm of body modification. He would not recommend any aesthetic clinicians perform this type of procedure as he believes it is unethical.

You can find Dr Tim Pearce on Instagram if you want to drop him a comment or question to discuss aspiration or other patient safety techniques for performing dermal fillers.

Aesthetics Mastery Show

Dr Tim shares his views on the latest lip filler trends and discusses whether they’re safe to perform, or whether you should be steering your patients away.

Further resources

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Dr Tim Pearce eLearning

Dr Tim Pearce MBChB BSc (Hons) MRCGP founded his eLearning concept in 2016 in order to provide readily accessible BOTOX® and dermal filler online courses for fellow Medical Aesthetics practitioners. His objective was to raise standards within the industry – a principle which remains just as relevant today.

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