The Conversation Before the Needle: What Nobody Tells You About Getting Natural Lip Filler

By Alice Henshaw, RN, NMP -  Founder and Medical Director, Harley Street Injectables

I turn people away from lip filler at least once a week.

That probably sounds like a strange way to open an article written by someone who has built her career (and her clinic) around injectable treatments. But if there is one thing I have learned in over a decade of practising aesthetic medicine on Harley Street, it is that the most important part of any lip filler treatment has nothing to do with the syringe. It happens in the conversation beforehand. The bit that nobody writes about. The bit that, quite frankly, determines whether you will walk out looking like yourself or looking like someone else entirely.

Every guide you will find online about natural lip filler will tell you roughly the same things: choose hyaluronic acid, go to a qualified practitioner, start small, follow your aftercare. And all of that is true. But it barely scratches the surface of what actually goes into getting a result that makes people say "you look amazing" rather than "you've had your lips done."

I want to talk about the stuff that happens before I pick up a needle. The questions I ask. The things I look for. The moments where I have to be honest with someone about what they actually need versus what they have come in asking for. Because that conversation (awkward, vulnerable, sometimes surprising) is the real foundation of natural lip filler. And I do not think anyone is talking about it properly.

Why I Started Thinking About Lips Differently

I did not start my career in aesthetics. I started in cardiothoracic and ICU nursing at Auckland Hospital in New Zealand, looking after patients who were critically unwell. That might seem like a world away from lip filler on Harley Street, but it taught me something I carry into every consultation: how to listen to what a patient is really telling you, even when they do not have the words for it.

In intensive care, patients often cannot articulate what is wrong. You learn to read faces, body language, micro-expressions, the gap between what someone says and what they mean. When I moved to London in 2014 and began working in aesthetics full-time, I realised that the same skill applied. A client walks in and says, "I want bigger lips." But what they often mean is, "I feel invisible," or "I have lost something I used to see in the mirror," or "My confidence has taken a hit and I do not know how to fix it." If I just hear "bigger lips" and start injecting, I have missed the entire point.

Over the years I have developed what I think of as a reading of the person, not just the lips. It is not a clinical protocol you will find in a textbook. It is the accumulated experience of thousands of consultations where I have had to figure out not just what to inject, but whether to inject at all.

The Question I Always Ask (That Has Nothing to Do With Lips)

Before we talk about shape, volume, or product, I always ask a version of the same question: What is it about your face right now that is bothering you?

Not "what do you want done to your lips?" That question invites a shopping list. My question invites a story. And the story is where the gold is.

Sometimes a client comes in fixated on their lips when the real issue is that they have lost volume in their cheeks, which has changed the proportions of their entire lower face. Sometimes they are frustrated by fine lines around their mouth that lip filler alone will not fix, they might actually benefit more from a skin-quality treatment like Profhilo or a Lip Flip with Botox to relax the muscles pulling the upper lip inward. And sometimes (and this is the one that requires real honesty) they have seen something on Instagram that simply will not translate to their face.

I have built my entire practice on this principle: what you need and what you are asking for are often two different things. My job is to close that gap with honesty, not just compliance.

What "Natural" Actually Means (It Is Not What You Think)

Let us deal with the word "natural," because it gets thrown around in this industry without much precision.

Most people assume natural lip filler means "not much filler." And yes, volume restraint is part of it. But I have seen half a millilitre look overdone on one person and a full millilitre look beautifully subtle on another. Volume alone does not determine whether a result looks natural. What determines it is how well the filler integrates with the architecture that is already there.

Natural, to me, means three things.

It respects your existing anatomy. Your lips exist in a relationship with the rest of your face: your nose, your chin, your cheekbones, your skin quality. I think of the face as a composition rather than a collection of separate parts. When I assess someone for dermal filler, I am looking at the whole picture. How does the upper lip sit relative to the nose? Is there enough chin projection to balance fuller lips? What is happening with the perioral area (the skin around the mouth)? These relationships matter enormously, and ignoring them is how people end up with lips that look "done."

It moves with you. Your lips are not static. You talk, you laugh, you eat, you kiss. A natural result has to look good in motion, not just in a still photograph taken at a flattering angle with good lighting. This is why product selection matters so much. I predominantly use Restylane Kysse for lip work because of its flexibility and stretch, it moves with the lip tissue rather than sitting rigidly within it. But the product is only as good as the hands using it.

It does not announce itself. The compliment you want is "you look really well" or "there is something different about you, I cannot put my finger on it." Not "great lips." If people are noticing the treatment rather than noticing you, something has gone wrong.

The Anatomy Nobody Explains to You

I could write an entire article on lip anatomy alone, and maybe I should, but here is what I think every person considering lip filler deserves to understand.

Your lips are not just two cushions of tissue sitting on your face. They have structure: a border (the vermilion border), a body (the fleshy part), columns that run from your nose to your upper lip (the philtral columns), a Cupid's bow, commissures at the corners, and a complex web of muscles underneath that control everything from smiling to speech.

When I treat lips, I am considering all of these landmarks. I am thinking about where the light catches, where shadow falls, how defined the border should be relative to the body of the lip, and whether the Cupid's bow needs sharpening or whether that would look too sculpted on a particular face.

There is a widely cited "golden ratio" for lips (roughly one-third upper lip volume to two-thirds lower lip) and it is a useful starting point. But I treat it as a guideline, not a rule. Some faces look more harmonious with a slightly fuller upper lip. Some ethnic backgrounds naturally carry more volume in the upper lip, and imposing a rigid ratio on them would erase their individuality rather than enhance it. This is where experience matters more than formulas.

I think the single biggest mistake in lip filler (the one that creates the look everyone dreads) is over-treating the border at the expense of the body. You have seen it: that harsh, drawn-on outline that looks like someone has gone around the lips with a fine-tip pen. A crisp border can be beautiful, but it has to be proportional to the softness and volume of the lip itself. When the border is overdefined and the body is under-supported, you get what I call "all frame, no painting."

The Practitioner's Dilemma: When to Say No

This is the part of my job that does not get discussed nearly enough.

The aesthetics industry has a commercial incentive problem. If someone walks in wanting treatment and you turn them away, you have lost revenue. In a sector that ranges from highly regulated medical clinics to unregulated beauticians offering filler at a discount, the pressure to say yes is enormous.

At Harley Street Injectables, I have always operated on a different principle: the best treatment I can give someone is sometimes no treatment at all. Or a different treatment from the one they came in for. Or a plan that starts with skincare and comes back to injectables in six months.

I have had clients show me reference photos of lips that belong to a completely different face shape, skin type, and age group. My job in that moment is not to recreate the photo. It is to understand what the client loves about that photo; is it the fullness? The shape? The way the lips sit against the skin? and then translate that feeling into something that works for their face.

Sometimes this conversation is uncomfortable. Nobody enjoys being told that what they want is not what they need. But I would rather have an honest conversation at the consultation stage than a distressed client two weeks later. And almost without exception, when I explain my reasoning, clients are grateful. They came to me because they trust my judgment. If I just did whatever anyone asked without pushback, I would not be doing my job,  I would be a vending machine.

This is also, incidentally, why so much of our business comes from referrals. When someone has a genuinely good experience (one built on trust rather than just a transaction) they tell their friends. And their friends arrive already understanding that we operate differently.

The First-Timer's Experience: What Actually Happens

If you have never had lip filler and you are considering it, I want to walk you through what a consultation and treatment actually look like in practice; not the sanitised version from a brochure, but the real one.

The Consultation

You will sit down with me or one of my team and we will talk. Not about lip shapes or millilitres, about you. What has brought you in. What you have been thinking about. What worries you. I will ask about your medical history, any medications you are taking, whether you have had cold sores (this matters,  the herpes simplex virus can be reactivated by trauma to the lip area, so we may prescribe antivirals beforehand). I will look at your face from multiple angles, often asking you to smile, talk, and move your mouth so I can see how your lips behave in motion.

Then we will talk about what is realistic. If you have come in with very thin lips expecting a dramatic transformation in one session, I will be straight with you: the tissue can only accept so much filler safely and aesthetically. Trying to go too big too fast is how you end up with that sausage-like, overstretched look that takes months to resolve. I always recommend starting conservatively (sometimes as little as 0.5ml) and building gradually. You can always add more. You cannot un-inject.

The Treatment

I apply a topical numbing cream and let it take effect, usually about twenty minutes. Most modern fillers also contain lidocaine, so the discomfort decreases as we go. I use a combination of techniques depending on what we are trying to achieve: sometimes a needle for precision work along the border and Cupid's bow, sometimes a cannula for body volume where it offers a smoother, more even distribution.

The whole treatment takes about thirty minutes. You will have some swelling, sometimes quite a bit on the first day, and possibly some bruising. I always tell clients not to judge their results until at least two weeks have passed, because the swelling can make everything look much bigger than it will once it settles.

The Follow-Up

This is where a lot of clinics fall short, and it is something I feel strongly about. I do not consider a treatment finished when you leave the chair. My team and I are available for questions, concerns, and follow-ups in the days and weeks after your appointment. If something does not look right once the swelling has resolved, we address it. If you want a touch-up, we schedule one. This ongoing relationship is fundamental to how I practise,  it is not a one-and-done transaction.

The Dissolving Conversation

I want to address something that has become increasingly common: clients coming to me who have had filler done elsewhere and want to start fresh.

The rise of hyaluronidase (the enzyme that dissolves hyaluronic acid filler) has been a genuine game-changer for the industry. It means that if you are unhappy with a previous result, or if filler has migrated or been poorly placed, there is a way back. It has also given clients more confidence to try lip filler for the first time, knowing it is reversible.

But dissolving is not a magic eraser. It requires its own expertise. The enzyme does not just dissolve injected filler,  it can also break down your body's natural hyaluronic acid, which means there is a temporary period where the treated area can look deflated. A good practitioner will plan a dissolve-and-refill strategy, typically waiting a few weeks between dissolving old filler and placing new product, to let the tissue recover and stabilise.

I see a lot of clients who have accumulated filler over years, sometimes from multiple practitioners using different products, and the result has gradually drifted from natural to overfilled without anyone noticing the trajectory. The honest thing to do in these cases is often to dissolve everything, let the lips return to their baseline, and start again with a clear canvas. It takes patience, but the results are worth it.

Why Skin Quality Matters More Than You Think

Here is something the Instagram before-and-after photos do not show you: the condition of the skin around your lips affects how filler looks as much as the filler itself.

If you have significant sun damage, dehydration, or fine lines around the mouth - what some people call "smoker's lines" even though they can appear in people who have never smoked -  then lip filler alone will not give you the result you are imagining. The filler might plump the lip body beautifully, but if the surrounding skin is crepey or lined, the contrast can actually make those lines more noticeable.

This is why I often recommend a combined approach. We might pair lip filler with a skin-tightening treatment for the perioral area, or start with a course of treatments to improve skin texture before introducing filler. Polynucleotides are brilliant for improving the quality and elasticity of lip tissue itself, and Profhilo can transform the skin around the mouth, creating a better canvas for filler to sit in.

Thinking about lips in isolation without considering the skin they are set in is like hanging a beautiful painting on a crumbling wall.

The Ageing Lip: A Conversation We Should Be Having Earlier

Most of the content online about lip filler is aimed at younger clients who want more volume. But some of the most rewarding work I do is with clients in their forties, fifties, and beyond who are experiencing age-related changes to their lips.

As we age, several things happen to the lips simultaneously. We lose collagen and fat volume, so the lips literally shrink. The vermilion border becomes less defined, making the lip line appear blurred. The philtral columns flatten, reducing the definition between the nose and the upper lip. And the skin around the mouth develops lines from decades of muscle movement.

For these clients, lip filler is not about creating volume that was never there. It is about restoration … returning the lips to a version of what they used to be. The approach is completely different from treating a twenty-five-year-old who wants slightly fuller lips. We are working with tissue that has changed in texture and elasticity, and the products and techniques need to reflect that.

I often use a combination of a structured filler to rebuild the border and Cupid's bow definition, paired with a softer, more hydrating product in the body of the lip to restore plumpness without rigidity. The goal is lips that look healthy, hydrated, and like they belong on the face, not lips that look treated.

This is an area where I think the industry needs to do better. There is so much focus on the young, volume-seeking client that we do not talk enough about elegant, age-appropriate lip rejuvenation. It is not about trying to look twenty again. It is about looking like the best, most refreshed version of the age you actually are.

Red Flags: How to Spot a Practitioner Who Will Not Give You Natural Results

I am going to be direct here, because your safety and your face are at stake.

They do not do a thorough consultation. If someone is ready to inject you within minutes of meeting you, without discussing your medical history, facial anatomy, or expectations in detail, leave. A proper consultation is not optional, it is where the entire treatment plan is built.

They cannot show you their own work. Any practitioner worth seeing should be able to show you before-and-after photos of their actual clients (with consent, of course). Look for results that look natural and varied, not a portfolio where every client has the same shaped lips. That tells you they are applying a template rather than treating individuals.

They cannot explain what they are using and why. You should know exactly which product is going into your lips, why it was chosen over alternatives, and how much is being used. At our clinic, we use Juvederm and Restylane products: FDA-approved hyaluronic acid fillers from Allergan and Galderma, and I can explain the properties of each and why I have selected one over another for your specific treatment.

They do not have appropriate qualifications. In the UK, anyone can legally inject dermal filler regardless of their medical background. This is a regulatory gap that the industry has been fighting to close for years. At a minimum, your practitioner should be a registered medical professional; a doctor, dentist, or nurse prescriber. At Harley Street Injectables, every injectable treatment is performed by a qualified medical professional, and our clinic is CQC registered, which means we are inspected and regulated to the same standards as medical facilities.

They never say no. A practitioner who agrees to everything you ask for without any clinical assessment or professional opinion is not acting in your best interest. The best practitioners I know (the ones whose work I genuinely admire) are the ones who turn clients away when it is the right thing to do.

The Emotional Weight of Lip Filler (And Why We Need to Acknowledge It)

There is something I wish more people talked about openly: lip filler is emotional.

It might be a thirty-minute procedure, but the decision to change something about your face (even subtly) carries psychological weight. Some clients feel nervous about being judged. Some worry their partner will not like it. Some are processing grief or a breakup or a milestone birthday and are looking for something that makes them feel more like themselves again. Some have spent years thinking about it and finally summoned the courage.

None of these motivations are wrong. But they all deserve to be acknowledged, not rushed past in favour of getting the consent form signed.

I have always believed that the relationship between a practitioner and a client is built on more than clinical skill. It is built on trust, on emotional intelligence, on the willingness to sit with someone in a moment of vulnerability and make them feel safe. When a client cries in my consultation room (and it happens more often than you might think) I do not see that as a complication. I see it as proof that this matters to them, and that they have come to the right place.

The physical act of injecting filler is something I could teach a technically skilled person in a relatively short time. The ability to understand the human being sitting in front of you, to know when to push gently and when to hold back, to read the difference between someone who is ready and someone who needs more time, that takes years. It is the part of this work that no online course can teach you and no algorithm can replicate.

What I Have Learned From the Clients Who Changed My Mind

I want to end with something personal, because I think it matters.

Early in my career, I was more rigid in my approach. I had strong opinions about what looked good and I was not always brilliant at separating my aesthetic preferences from what a client actually wanted. I remember a client (this must have been 2016 or 2017) who wanted her upper lip slightly fuller than the lower. I pushed back hard because it went against the conventional ratio I had been trained in. She was patient with me. She explained that in her culture, a fuller upper lip was considered beautiful. She showed me photos of women in her family. And she was right. The result, when I finally listened and adjusted my approach, was stunning, and it taught me a lesson I have never forgotten.

Natural does not mean one thing. It does not belong to one face shape or one beauty standard. My job is not to impose my version of natural onto someone else's face. It is to collaborate, to bring my clinical knowledge and my technical skill to the table, and to meet them where they are.

That is the conversation that matters. Not "how many millilitres?" Not "which product?" Not even "what shape?" The conversation that matters is: who are you, what do you want to feel when you look in the mirror, and how can I help you get there safely?

Everything else (the needle, the filler, the technique) is just the means. The conversation is the treatment.

My Philosophy, in Plain Language

After more than a decade in this field, having treated thousands of clients and trained other practitioners in advanced injection techniques as a Key Opinion Leader for Allergan Aesthetics, my philosophy has become quite simple.

Your face is unique. It is shaped by your genetics, your ethnicity, your life, your age, your expressions. The way you smile is yours. The way your lips move when you talk is yours. My job is not to redesign any of that. My job is to work with what is there, to enhance, to refine, to restore, so that you look in the mirror and see a better version of you, not someone else.

I got into aesthetics because I believe that looking good and feeling good are deeply connected. When a client leaves my clinic standing a little taller, smiling a little wider, carrying themselves with a quiet confidence that was not there ninety minutes ago,  that is the best part of my job. It is not the syringe. It is not the product. It is the moment someone reconnects with their own reflection.

Natural lip filler is not a product or a technique. It is a philosophy. It starts with the conversation, it requires honesty on both sides, and it only works when the practitioner cares as much about what not to do as what to do.

If you are thinking about lip filler for the first time, or if you have had it before and it has not gone the way you hoped, I would always recommend starting with a consultation. Not a commitment, just a conversation. Tell me what is on your mind. Show me the photos you have been saving. And let me tell you honestly what I think will work for your face.

That conversation is where every natural result begins.

Alice Henshaw, RN, NMP, is the founder and medical director of Harley Street Injectables, the largest clinic on Harley Street dedicated exclusively to non-surgical aesthetic treatments. A qualified nurse prescriber registered in the UK, Australia, and New Zealand, Alice is a Key Opinion Leader for Allergan Aesthetics, was named Best Aesthetic Injector in London by the GHP Awards, and has been featured in Vogue, Tatler, Vanity Fair, and the Tatler Cosmetic Surgery Guide. She is also the founder of Skincycles, a clinical skincare range stocked at Liberty of London.

To book a consultation, visit harleystreetinjectables.com or call +44(0) 3455 485 658.