My Lips Started Thinning at 40, so I Tried Keyhole Lip Filler—Here's My Review

I turned 40 last year, and while I have no qualms about aging, I do miss the collagen of my 20s. It’s this overall depletion and age-related bone loss that led me to consider injectables. First, it was under-eye fillers, and then, I had a liquid facial at 39. (This involves micro-injections of filler and Botox in specific areas of my face to ensure a natural look that still had movement and didn’t look stiff or overdone—I highly recommend it.)

Despite being meticulous about my health and well-being, there are some things you can’t control through diet and exercise alone, and collagen depletion is one of them. Our genetics, environmental stressors, and the natural aging process can all contribute to collagen loss. Trust me. I have tried all of the collagen ingestibles to rectify this, too (I prefer the plant-based options like Moon Juice and The Beauty Chef), but nothing can restore depleted collagen, bone loss, or fat quite like filler. And you don’t need much to see a significant difference!

Outside of my under eyes, the one place where it was the most noticeable was my lips, and this year on my 40th birthday, they just seemed thinner than usual. (This is because the collagen and hyaluronic acid production start to slow down in your late 20s and 30s.) Now, I have tried lip filler before, but it was always very subtle, and this time I was ready for something with a bit more volume, something that could also restore some definition, too, because your lip pigment also starts to fade as you age. (I’m seriously considering seeing the famous Brow Jelly to bump up the color.)

I was first introduced to the keyhole lip filler while browsing Bell Yoo's, MSN, FNP-C, Instagram.

The board-certified nurse practitioner at Facile Dermatology + Boutique in West Hollywood is a renowned master at lip filler, and I knew immediately upon seeing this image that I wanted to try it out for myself. But as with many buzzy medical trends, I wasn’t sure if this keyhole look would suit me or if my lips were suited to the treatment. 

Facile has stringent COVID-19 rules it follows in accordance with government recommendations, so I felt comfortable booking an appointment with Yoo to chat through the procedure. As a side note: if you're sticking to at-home treatments currently, I'd recommend this DIY facial that gives professional results.

It turns out, keyhole lip filler isn’t right for my lip anatomy (more on that later), but thanks to her unique lip-filler technique, we were able to achieve a very similar result. Read on to learn more about my experience with lip filler, what keyhole lip filler is, what filler is used to achieve it, how much it costs, and what to expect during and after treatment, including the recovery time. Feel free to DM me @skinlexicon if you have any questions!

What are keyhole lips? 

The keyhole lip injection technique is when filler is placed strategically to create a small gap between the top and bottom lip, so it resembles an actual keyhole. Yoo believes this buzzy look is trending because it gives the lower lip a more full and pouty appearance while still remaining natural.

Who is a good candidate for lip filler and keyhole lip filler?

Lip filler is for anyone who desires more volume, hydration, symmetry, and/or definition in their lips. However, if your preference is keyhole lips, Yoo does caution that certain lips may be more difficult to get the exact keyhole shape since everyone's natural anatomy is different. “Everyone has a different lip shape, so your result may not look the same as another person's,” she informs me.

This was the case for my lips. I was not a candidate for the keyhole look, but as you can see from my photos, Yoo was able to achieve a very full but natural pout that gave the impression of a keyhole, which I actually prefer. “As long as the patient goes into the procedure with reasonable expectations, most are very happy with the result and feel instantly more confident,” says Yoo. “Getting lip injections is not painless, but everyone always says it was worth it when I hand them the mirror after.” Now, that I can agree with wholeheartedly.

How does lip filler work? 

Lip filler is made of an injectable hyaluronic acid, a naturally occurring substance in our bodies that restores volume and hydrates. There is also some lidocaine mixed into the syringe to reduce discomfort.

Are lip-filler injections painful?

I would be lying if I said it doesn’t hurt, and on a scale of one to 10, I would say it’s around five to six. I have a pretty high pain threshold, but lips are also high on the chart of sensitive body parts, with around a million nerve endings, so you definitely feel the pinch of the needle. Thankfully, I was numbed all over before the needle came anywhere near my face, but that doesn’t mean it is completely pain-free. 

Yoo’s technique is also very unique. She is very deliberate with strategic micro-injections that focus on the outer lip lines. This means more injections overall, but the end result is a more even, full, and defined pout, which is definitely preferred and worth any discomfort. I hadn’t ever experienced this style before, so I asked Yoo to explain her lip-filler approach: “I like to use a combination of techniques depending on the patient's lip tissue and goals. For example, if I want vertical height, I will use a 'tenting technique,' where I enter the needle from the vermillion border. If I want more projection or volume, I will use a lateral-threading technique. Each patient is unique, so it is important to customize the treatment. Most importantly, I like to respect the natural lip anatomy while volumizing so the patient does not end up with ‘duck lips.’”

For me, the pain wasn’t as strong during the process as it was a couple of hours post-procedure. My lips were quite sensitive and swollen (which Yoo warned me about), and I did reach for some pain relief to assist with the inflammation and discomfort. I would say that my lips were quite sensitive for at least a week after, but it certainly didn’t prohibit me from doing any of my normal activities—eating, drinking, talking—I just did them with a little more care!

What is the keyhole lip injection technique?

Some people have a natural keyhole pout, which can be easily made more noticeable with filler injections. For those without a natural keyhole pout, Yoo may place a string of floss or a stick in the center of the lip during the injection and purposely leave a gap to try and change the lip shape.

How long does lip augmentation take?

The good news is lip injections only take about 40 to 45 minutes. This includes 10 to 15 minutes for topical numbing, then about 30 minutes for the injection. So it’s all over fairly quickly. Yoo, however, admits that she does like to take her time when injecting because “I focus on the smallest details,” and when it comes to lip filler, you definitely want someone who pays particular attention to every little detail. I appreciated how much Yoo respected my lips and treated them like a work of art.

What type of filler is used for lip injections? 

There are so many different brands and types, but Yoo says the Restylane and Juvéderm ranges of fillers are the most common. Restylane Kysse is the newest FDA-approved filler for lips. Yoo says this is the best lip filler because it is the “perfect combination that allows for both volume and definition. Patients are very happy with the results and find that it lasts longer.” This was my first time with the Restylane Kysse, and I definitely noticed more fullness and definition in my lips than previous lip injections.

What is the downtime?

You can typically expect swelling and bruising to be the worst for at least the first three to five days after treatment. Then, this will gradually go down until the two-week mark. I definitely experienced swollen and sensitive lips for that long. This is why Yoo advises her patients to allow for at least two weeks of downtime when planning to get lip filler.

When will you expect to see results?

Results are immediate. Though, your lips will be swollen immediately after treatment. However, as was the case with my lips, it takes about two weeks to see the fully-healed results. It has been two months since I had the initial treatment, and my lips are really soft with no lumps or sensitivity—no one would ever know. In fact, no one did notice, which was great because having full, natural lips without it being noticeable was the ultimate goal.

Should you expect bruising from lip fillers? 

Yes! Yoo warned me that everyone bruises after lip filler, but I personally have never experienced any bruising, and I’ve had lip-filler injections about four times now.

How long does it last?

Ask any practitioner, and they’ll say filler lasts between six to 12 months, but as Yoo reminds me, longevity varies depending on individual patient metabolism and the volume of filler injected. Since the mouth is a “very mobile area”—we use it constantly to talk, eat, and drink all day—the filler may not last as long in the lips. The more syringes you do, the longer it will last. Now, two months in and after the swelling has completely gone down, I can say that the volume has decreased, but it isn’t visually noticeable. It has settled into a nice, natural, and full shape. 

If, like me, you get to this point and you’re missing that additional fullness, then Yoo suggests a lip flip, which involves Botox injections into your upper lip to relax the muscles and “flip” your lip upward. I’ll be going back in for this procedure soon.

Fillers such as Restylane Kysse (this is what I had) or Restylane Defyne may hold the keyhole lip shape better than other softer fillers such as Restylane Refyne or Juvéderm.

Will I need a follow-up appointment?

It usually isn’t necessary. However, if you feel like there are some corrections that need to be made, Yoo recommends coming in for a two-week follow-up. Since a lot of my swelling had left by that point, I did see Yoo after two weeks and ended up having a little more filler added to my bottom lip to balance out the fullness of my upper lip.

What questions should I ask before getting lip filler?

1: Do I have any important events coming up in the next two weeks? If yes, reschedule. Allow at least two weeks for any downtime—swelling, bruising, etc.

2: Do I have a history of cold sores? If yes, we recommend taking a preventive antiviral medication prior to treatment, which can be prescribed for you.

How do you find a good provider who won't overfill your lips and who gives a natural look?

Look for a provider with consistent before-and-after photos. Also, Yoo advises to look at the provider's face—if their face looks overfilled and unnatural to you, you may not be on the same page in terms of aesthetic goals. She adds, “Ask the provider how often they inject lips. Everyone has a different lip shape and lip tissue, so more experience with a variety of different lips gives the provider a better understanding of how to best achieve your lip goals.”

What are some things that can go wrong with lip filler?

Common side effects are swelling, bruising, tenderness, and lumps in the first two weeks. I experienced all of these symptoms, but it’s very normal and expected with any filler treatment, and they’re only temporary. Yoo says you can reduce your risk of severe bruising and swelling by avoiding blood thinners such as alcohol, fish oil, Advil, and aspirin a week before your appointment. 

According to Yoo, a very rare side effect is a vascular occlusion, which is “when filler occludes a vessel and blocks blood supply to the lip tissue.” She adds, “This may lead to necrosis (tissue death) if not promptly managed. It is rare but possible, so it is important to have a discussion with your provider about this. A good provider knows how to prevent this by using safer injection techniques and also knows how to recognize any warning signs and how to manage a vascular occlusion quickly so there is no permanent damage.”

How much does lip filler cost?
Lip filler ranges from $650 to $900, depending on product type and amount of filler.

What are the major lip-filler myths out there, and what is the truth?

Myth 1: Getting lip filler will give me duck lips.

Fact: A skillful injector will be able to volumize while respecting the natural lip anatomy so that your lips will look like yours—but a more hydrated, plump version. 

Myth 2: One syringe is too much and will give me huge lips.

Fact: One syringe is only 1ml, which is a fifth of a teaspoon. Most of what you see initially after treatment is swelling from injections. Most virgin lips will require at least one to two syringes to see a noticeable result.

In conclusion…

Even though I couldn’t achieve the keyhole lip-filler look, I am very happy with my fuller lips and will definitely be back to do it again. I highly recommend Yoo’s technique, even though it is slightly more painful thanks to more micro-injections. I really can vouch for her layering technique, as the smaller, strategic injections achieve a more defined and voluminous lip line and pout. So if you're interested in lip fillers, do your research, find a practitioner you can trust, and go for it! Oh, and try the Restylane Kysse too. It’s definitely the softest filler I’ve had in my lips.