In a world of mask-wearing, will lip fillers reign as the UK's most popular filler procedure? (2023)

Post-Covid-19 we’ll experience “a total beauty reset,” trend forecaster Clare Varga, head of WGSN Beauty, tells Bazaar. Aesthetically-speaking, one aspect will be the diverted attention towards areas on display when wearing masks in public, she feels.

“With the lower half of the face covered, the eyes will take on a new importance, with focus on the eyes and brows and bold eye looks used to express individuality.” Cue sales of eye make-up soaring, but as clinics look set to open­ in the coming weeks – while obeying Covid-secure guidelines – what of tweakments?

The post-lockdown look

Dr Nyla Raja, founder and medical director of Medispa Clinics in London, Cheshire and Liverpool, points out that “the enforced ‘detox’ has allowed patients to reflect and recognise the benefits of the treatments that really work and are worth investing in”. She thinks it’s not necessarily the thought of mask-wearing, but other issues which are giving rise to her clinics “receiving a marked increase in enquiries for the upper face”.

Firstly, without regular muscle relaxing treatments (i.e. Botox), “dynamic and static wrinkles, especially in the upper face, have become much more prevalent,” she says. But there are other reasons we may notice changes in the facial structure more post-lockdown. Prior, many people doubled-down on injectables with non-invasive treatments, such as collagen-stimulating facials utilising radiofrequency, which helps maintain smoother, tighter looking skin. In addition, our off-the-record warmer spring hasn’t helped retain results: “We’ve had increased exposure to UV light, which is well known to cause the degradation of collagen”.

Plus, as Dr Raja explains, there’s simply the natural ageing process at play, as ever. “As we get older, our facial bones – including our eye sockets, nose and upper jaw – continue to change. For example, the eye sockets enlarge and the angle of the bones beneath our eyebrows decrease, forming wrinkles in the upper face.” Her approach is to tackle all this with a combination of non-surgical tweakments including advanced ultrasound energy treatments such as Ultherapy, along with injectable skin boosters. “Profhilo and Volite will become favourites to kick-start the skin’s collagen production and get the glow back,” she says of hyaluronic acid injectables which work on the condition of the skin.

What does this mean for the UK's most popular dermal filler procedure, the lip job? Dr Sophie Shotter, founder and medical director of Illuminate Skin Clinics, says she doubts we’ll see much of a decline in lip filler requests given our ‘new normal’.

“Most of my patients have treatments for themselves rather than for anyone else – it’s about how they feel when they look in the mirror rather than being about how other people perceive them” – mask or no mask.

“My feeling is that treating the lip area will be as popular as ever – be it for volume, shape or for fine lines around the mouth.” However, she adds that eye treatments are already incredibly popular in her clinics. “I probably treat as many patients for peri-orbital treatments as I do peri-oral. I suspect that if people are prioritising, they will choose eyes over lips, and then do lips at a later date, but they won’t forego them altogether.”

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The big lip dilemma

Beyond popularity, masks pose another problem when it comes to lips: how injectors can safely work on them when a patient isn’t wearing a face covering. Founder of Esho Clinics, Dr Esho – known as ‘the lip doctor’ – says it’s a real cause for concern. “Lips are definitely one of the more high-risk areas to treat on the face due to the area’s vast blood supply,” he explains. Risks include infection, bleeding and tissue necrosis, “but now in a Covid-19 world they pose an additional risk of transmission of the virus through the air between patient and injector.” Despite the presence of PPE, he says this is a real worry for many.

“When treating the upper face, the risk is reduced as the patient can still effectively wear their mask while having Botox and filler injections given anywhere higher than the nose.” Therefore, he expects these to be the first injectable procedures to return when clinics re-open. “But, below this point the mask comes off, and the risk of virus spread, despite the injector wearing PPE, isn’t truly known.”

With 10 years of practice, having performed several thousands of lip filler procedures, Dr Esho has looked at ways to reduce risk in this treatment, while acknowledging that it will never be risk-free, “which should always form part of the consent process”.

If you’re considering lip filler, Dr Esho reveals how his clinics (in London, Newcastle and Dubai) and clients will participate in practices to stay as safe as possible:

Virtual lip assessments

“Before an appointment, as much assessment of the lips and the dynamics of the peri-oral area should be done via video as well as standardised photos. This will help practitioners build an accurate plan of treatment, which can be shared with patients.”

‘Mask on, mask off’

“The mask should remain on the patient until the point of cleaning and prepping the area to reduce droplet spread. It should then be placed on the patient immediately post-procedure (once they have seen their results). The best masks in this sitting are FFP2/FFP3 masks, and should be worn by both patient and injector wherever possible.”

Decontamination

“Cleaning of the treatment area pre-Covid was always crucial, as lips are a high-risk area for infection. But now, with the more we understand about how the virus colonises the nasal and cavity, additional cleansing of these areas with nasal swabs and mouthwash will be a prerequisite for the pre-procedure preparation.”

Ventilation

“A lip filler procedure can last from five to 15 minutes, so, despite wearing PPE, this is a long time for an injector to be close to a patient without social distancing. Reducing droplet spread during this time is crucial and there are a number of devices now being brought in to help this. Some clinics have opted for specific filters for patients to place in their mouths, while others have used suction devices to sit in front of the patient’s face during the procedure to promote extraction. We have opted for Radic8, an airflow extraction system that filters and kills viruses throughout the air in the entire clinic.”

Post-care: Delayed onset reactions

“One of the rare but known complications of dermal fillers is something known as ‘delayed onset nodules’. This is where an immune reaction is triggered within the body, causing the filler to form hard and painful lumps. With Covid being a new virus, we don’t know what effects it could cause in patients with dermal fillers yet, but it’s crucial to make this part of the consent process and follow up with patients - not just at two weeks-post treatment, but further down the line, to collect data and ensure the safety of all patients.”

Ultimately, as Dr Esho admits, “these procedures are ‘wants’, not ‘needs’ – and patient and injector safety must always come first”.

The new risk could mean that the way your cosmetic procedures are carried out are simply different, as proposed above, or it could mean postponing lip fillers for the foreseeable.

Pass the eye cream and mascara.

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