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Is lip augmentation the most popular treatment of the 21st century?

Is lip augmentation the most popular treatment of the 21st century?

It is not uncommon knowledge that non-surgical cosmetic treatments are becoming the norm for an increasing number of people, and lip augmentation has become part of the regular beauty routine for millions of women. Aesthetic practitioners simply cannot keep up with the demand, thus, it is imperative that aesthetic nurses have a sound knowledge and understanding of the changes in culture and societal trends as well as consideration of the psychological aspects surrounding lip augmentation.


A major part of this cultural emphasis started in the ’50s, when Marilyn Monroe reached the height of her fame and Barnes (2015) suggests that Monroe represented a transition in our cultural thought about women and sex. From an injection perspective, in around 1900, surgeons tried injecting paraffin into the lips without success (Heidingsfeld 1906). Later, in the early 1960s, liquid silicone was used for lip augmentation, but was abandoned thirty years later due fears about the effects of silicone on general health (Duffy 1998).  Then in around 1980, injectable bovine collagen was introduced to the cosmetic surgery market and became the standard against which other injectable fillers were measured (Klein 1983).

Lips and sexuality

The anthropological history of the female body and sexuality suggests that full lips signal sensuality (Barnes 2015). This is similar to how some studies in African tribal cultures demonstrate higher levels of attractiveness in those with a higher hip-to-waist ratio. One 2010 study by Pallett et al (2010) supports this as researchers experimented to see whether there was a facial golden ratio, i.e., an ideal facial feature arrangement. It found that a woman who had large lips suggested a strong mating potential. The researchers also established that people were rated as most attractive when the vertical distance between the eyes and mouth was about 36 percent of its length, and the horizontal distance between the eyes was about 46 percent of the face’s width.

Lips and youth

Cosmetic surgery continues to grow in popularity, perhaps stimulated by the impressive physical rejuvenations exhibited by media figures and/or the spate of provocative television shows illustrating the “miracle” of drastic surgical self-transformation (Sansone, & Sansone 2007). Although precepts of lip beauty have cultural and ethical variations, full lips with well-defined curvatures are characteristic of youth and beauty (Samizadeh, 2015).

Social media

Psychologist Dr Michael Carr-Gregg in Glyde, C (2015) comments that social media is the main contributory factor for the growing rise in lip augmentation. He cites Instagram as one of the big risks of growing up in 2015 and has counselled countless teenage girls on how to foster better self-esteem. He comments; “Instagram feeds this cult of body hatred. I have not seen one female teenage client this year who is happy with the way she looks.” Furthermore, latent teenage insecurities manifest differently in contemporary culture. These are major challenges the next generation of aesthetic practitioners will face, and it could be well argued that a far more rigorous curriculum of training and education is required for practitioners in light of the above.

Body dysmorphic disorder (BDD) and the importance of psychological screening

Body dysmorphic disorder (BDD) is a psychiatric disorder characterized by preoccupation with an imagined or slight defect in appearance which causes clinically significant distress or functional impairment. A majority of individuals with BDD have poor insight, believing they have an actual deformity for which cosmetic treatment is needed. Those with BDD frequently seek cosmetic treatments to fix perceived “defects” rather than psychiatric interventions. Crerand et al (2010). Just as it is for those interested in surgical cosmetic procedures, assessment for psychopathology should be a part of the pre-treatment evaluation for patients seeking nonsurgical cosmetic rejuvenation (Krader 2012). This was based on the findings of a pilot study including 35 patients seeking nonsurgical aesthetic medical procedures that found that appreciable proportions of this population suffered psychologic distress, low quality of life and a moderate to high probability of  (BDD). However, formal psychological screening is typically not done in patients requesting nonsurgical rejuvenation, based on the premise it may be less important for procedures that produce appearance changes that are generally modest and temporary. These findings on the psychosocial profiles of patients requesting non-surgical cosmetic enhancements suggest that practitioners may be remiss in omitting an evaluation for psychopathology in this population. However, further study is needed to determine the impact of nonsurgical cosmetic procedures in patients with pre-existing psychopathology. Regardless, this research does suggest that aesthetic practitioners should at least undertake a brief screening to identify psychosocial issues preoperatively.


Collier (2015) recently described the phenomenon of “distortion” within the speciality of lip augmentation; a major consideration when consulting and treating patients. There is no doubt that some requests for lip augmentation should not be fulfilled. However, on the one hand it could be argued that who are we to play cosmetic God? In addition, even if we refuse to treat, it is likely that the patient will seek treatment elsewhere. If our professional instinct and ethical mind set during consultation is not to treat, then we should not. Practitioners will be far more respected and preserve their reputation as a result of refusing to treat a “distorted request”. Furthermore, in any distorted work seen in clinical practice, there is an ethical and moral question mark above the practitioner who has administered treatment. We must remember as aesthetic nurses, we are never obliged to treat anyone.

Improving quality of life

Improving quality of life and self-esteem may be part of the motivation of patients seeking these minimally invasive cosmetic procedures. It is important to know whether these goals are achieved in persons with underlying psychopathology or if we should be referring them for professional mental health intervention (Krader 2012). Interesting, Persaud (2010) refers to this group as the “emotionally ambitious”; those seeking to improve their appearance and are interested in getting more out of life. They don’t blindly accept the hand of cards life has dealt them. They want to know how to get new cards, or how to play the ones they have better than before. He goes on to say if this wider background context to why someone is seeking help with improving their looks is not fully grasped by the professional consulted, then disaster can follow.

Male V female injectors

There is absolutely no evidence to suggest that male aesthetic practitioners are better than female aesthetic practitioners and vice versa, and would be sexist to even suggest so. Even so, it is apparent from the author’s clinical experience that more females do seek a female injector for the treatment of lip augmentation. The main reason being that a “woman knows what a woman wants”. However, this is a very small sample of the population and is absolutely anecdotal.


The demand for lip augmentation is certainly not going away anytime soon. In fact, it’s only going to become more mainstream and for many women it’s not necessarily about being influenced by celebrity and media, but more for the fact that lip injections can assist in achieving a subtle result leading to higher self-esteem and confidence. Ultimately, it is age very age dependant. As long as we continue to provide the full care and follow up, whist maintaining standards, we can go to assist and being remembered for helping women in society to achieve confidence for years to come.


Barnes, Z (2015) Accessed 05.11.15

Crerand et al (2010) Surgical and Minimally Invasive Cosmetic Procedures among Persons with Body Dysmorphic Disorder. Ann Plast Surg  65(1): 11–16

Collier (2015) Mastering the Mouth Presentation. 4th Journal Aesthetic nursing Conference CCR London

Duffy, D. (1998). “Injectable liquid silicone: New perspectives”. In Klein, A. W. Tissue Augmentation in Clinical Practice: Procedures and Techniques. New York: Marcel Dekker. pp. 235:267. ISBN 0-585-12910-X

Glyde, C (2015) The alarming trend of teen Botox, fillers and other cosmetic enhancements  Accessed 05.11.15

Heidingsfeld, M. L. (1906). “Histopathology of paraffin prosthesis”. J Cutan Dis 24: 513–521

Krader, C (2012) Accessed 05.11.15

Pallett et al (2010) Golden Ratios for Facial Beauty Vision Res. 2010 Jan 25; 50(2): 149

Persaud (2010) Accessed 05.11.15           

Samizadeh S (2015) Treating the perioral area. Aesthetics 2(5): 51–3

Sansone & Sansone (2007) Cosmetic Surgery and Psychological Issues Psychiatry (Edgmont) 4(12)

Klein, A. W. (1983). “Implantation technique for injectable collagen”. J Am Acad Dermatol 9: 224–228

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