Effectiveness and safety of hyaluronic acid fillers used to enhance overall lip fullness: A systematic review of clinical studies

J Cosmet Dermatol. 2019 Apr;18(2):436-443. doi: 10.1111/jocd.12861. Epub 2019 Jan 12.


Background: The majority of aesthetic treatments today are nonsurgical or minimally invasive aesthetic procedures. Soft-tissue augmentation with hyaluronic acid (HA) is one of them. Lip fullness and definition are key aesthetic factors associated with attractiveness, which is the reason that lip augmentation with HA fillers has become so popular.

Objective: To provide a systematic review of published medical literature on the effectiveness and safety of different HA fillers used to enhance overall lip fullness.

Methods and materials: The literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Twenty-two studies were included in the qualitative synthesis, 9 of them with level of evidence (LOE) 1b (randomized controlled trials), 1 with LOE 2b (individual cohort study), and 12 with LOE 4 (case series, poor-quality cohort, and case-control studies). A total number of subjects included in all studies were 3965.

Results: Hyaluronic acid fillers turned out to be an effective and safe treatment. The assessment methods (especially for efficacy) varied greatly from one study to another. Observed responses to the treatment in studies using different lip fullness scales varied between 71% and 93.2%. The most common adverse events were local reactions at the injection sites (swelling, contusion, bruising, pain, redness, and itching).

Conclusion: Based on the results of the studies included in this systematic review, HA fillers are effective and safe to use. The majority of included subjects were satisfied with the result and their looks.

Keywords: efficacy; filler; hyaluronic acid; lips; safety.

Publication types

  • Systematic Review

MeSH terms

  • Clinical Studies as Topic
  • Cosmetic Techniques / adverse effects*
  • Dermal Fillers / administration & dosage*
  • Dermal Fillers / adverse effects
  • Humans
  • Hyaluronic Acid / administration & dosage*
  • Hyaluronic Acid / adverse effects
  • Injection Site Reaction / epidemiology*
  • Injection Site Reaction / etiology
  • Lip / drug effects*
  • Rejuvenation


  • Dermal Fillers
  • Hyaluronic Acid