Health

DIY ‘Needle-Free’ Lip Fillers Are Still Injections—And Still Dangerous

The hyaluron pen is easy to buy, but medical professionals say that accessibility belies serious risks.
Katie Way
Brooklyn, US
March 2, 2021, 1:00pm
A woman applies pink lipstick.
Photo by Antonio_Diaz via Getty Images

At first glance, the hyaluron pen looks a lot like a curling iron: a stubby wand with a thick handle, with a body cast in black or a metallic jewel tone, with gold accents to match. It’s perfect for sliding into a vanity drawer or nestling in a catch-all with makeup brushes, flat irons, eyelash curlers on a bathroom counter. On TikTok, Instagram, and YouTube, there’s plenty of footage featuring women casually lining the device up to their lips (and occasionally, their cheeks and chins) and letting the pen’s pressure technology inject whatever they want underneath the surface of their skin. 

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But the hyaluron pen isn’t just a beauty instrument—it also likely falls under the FDA’s definition of a medical device, because it’s designed to inject substances beneath the skin’s surface using “pressure technology.” The design for the pen does not appear to be proprietary, meaning any beauty brand can slap its packaging onto the product or sell it wholesale. While pressure technology has been FDA-approved for use with certain specific medications, experts say that people who use hyaluron pens to shoot filler into their lips and faces are opening themselves up to a slew of potential health woes. 

Online, fans describe the hyaluron pen as a “non-invasive,” “painless,” no-needle filler solution. According to medical professionals, however, these descriptors gloss over an ugly truth: the hyaluron pen can put users at risk of infection, as well as permanent damage to their faces or vision. “It's absolutely a false sense of security, the fact that it is considered needle free,” Whitney Bowe, a dermatologist and expert injector, said. “Shooting a bolus of hyaluronic acid filler or a skincare product into the skin… Even though there's no needles, there's nothing safe about that.”

Unlike injection by needle, the hyaluron pen, which is available under several different brand names, delivers its contents imprecisely, injecting it into the lip tissue like buckshot. “It uses pressurized air to deliver filler into the skin, but there's no way to control the amount or depth of what you're introducing, so it may not even go where it's meant to go,” said Shelby Hall, an advanced registered cosmetic nurse who founded Skinfidelity, a medical spa in Ontario, Canada. Bowe said that diffuse delivery is the opposite of what a safe, subcutaneous (that’s below the skin) delivery system looks like, and that’s doubly true when it comes to the delicate tissue, also known as “mucosa,” that makes up our lips. 

“When we use injectable syringes and certain needles in the office, they actually have been studied in FDA trials in a way that they deliver the product in a very safe and very specific manner,” Bowe said. “There's a lot of science that goes into developing the exact needle, or cannula.” Reached for comment, the FDA pointed VICE to its list of approved dermal fillers, which does not include the hyaluron pen. While the FDA would not speak directly to the case of the hyaluron pen, the spokesperson clarified that dermal fillers are class III medical devices subject to the FDA's approval, which would mean marketers of the hyaluron pen are treading legally questionable territory by suggesting it is an adequate, or even superior, substitute for FDA-approved injectables.

The pen’s popularity in the realm of beauty content stretches back into the late 2010s, with YouTubers touting the device and instructing their subscribers on how to use it. Stacy Snook, a cosmetologist and former spa owner who films beauty and wellness content for her channel Gorgeously Aging, said she first came across the pen after watching lip filler before and after videos on YouTube. She said she spent time Googling the device and eventually decided to take the plunge and try the hyaluron pen for herself. 

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“I had some lip filler done at a Med Spa to restore some of the volume lost in my lips due to aging, and was curious to hear about the experiences of other women,” Snook said. She said she was happy with her results.

Unlike the FDA, Health Canada, the country’s medical policy authority, banned the device in September 2019. But the move was lost in the undertow of news about the pandemic. Over the last year, when many people have taken to experimenting with cosmetic modifications out of opportunism or boredom, influencers have started plugging the hyaluron pen as a safe, inexpensive, at-home alternative to pricier injectables.

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Hall, who has been in the cosmetic industry for seven years and injecting patients for around six, said the hyaluron pen came across her radar when she watched colleagues in her field train to use it, both before and after the Canadian ban. “It's wrong on so many levels for [the hyaluron pen] to be in the hands of people that have no idea the dangers and risks of what they’re doing,” Hall said. “Because they aren't medical professionals, they don't understand the implications of using a device that pushes something under the skin.”

Hyaluron pens are available for sale, and marketed for cosmetic use, on digital marketplaces like Poshmark, LightintheBox, and Amazon for as little as $63.99. This availability is exactly what worries Hall. “I think curiosity kills the cat with a lot of this DIY stuff,” Hall said. “Because you can get it easily, you can do at home, it's like, ‘OK. let's try it.’ But I would strongly suggest doing some research before you put anything inside your body.”

Snook said she decided to make videos about her experience with the pen precisely because of the uptick in interest in at-home injectables. “Given the circumstances with COVID over this past year, I felt it was the perfect time to empower responsible DIYers and those interested in educating themselves to the options available to them, including the hyaluron pen,” Snook said. According to the American Med Spa Association, some companies seem to have picked up on the cottage industry of administering these injectables, and offer hyaluron pen training courses for people looking to start their own hyaluron pen business—appealing, given the low price of the pen itself.

Bowe disagreed with Snook: the device scares her. What worries her isn’t the at-home results like Snook’s, the kind women are proud to show off. She said she thinks more about the before and afters that don’t make it to the internet. “When  you see that immediate result, it can be really impressive,” Bowe said. “But what you're not seeing is the complications down the road. If you're a kid in your home, and you're trying to build your social media platform as being a beauty influencer, you're not going to go online and be like, ‘Wow, actually, I have this infection that developed on one side, or ‘My lips actually came out asymmetrical and they don't look good,’ or, ‘Now I'm having stinging and burning and weird symptoms, and I'm not sure if what I did was OK.’”

Bowe said the pens could be specially dangerous in the hands of amateurs with no background in cosmetic injections—and no legal means of obtaining dermal filler for at-home use without a prescription or medical license (though the empty pens can be acquired without one). A 2019 investigation by OneZero found that there are several online marketplaces that cater to DIY injectable needs, but Bowe has also seen people resort to other methods. 

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“I actually saw [another clip on TikTok] where a young woman was using a very similar device, but with a hyaluronic acid serum,” Bowe said. “Taking a skincare product that's developed and formulated to be used topically and injecting it into her lips using this at-home device, with non-sterile technique… I was prepared to respond to that on a day when I wasn’t in the office, but she had already taken it down.” 

Healthcare attorney and founder of American Medical Spa Association Alex R. Thiersch noted in MedEsthetics that the FDA “has not approved any needle-free injector for use with hyaluronic acid fillers,” and that because needle-free injectors are medical devices, practitioners must legally hold “the same type of professional license required to inject using a needle and syringe.” Sounds rigorous? It is—for a reason. “There's a lot of training involved with understanding the anatomy and understanding injection technique, so that you can minimize risks,” Bowe said. “You're dealing with blood vessels, you're dealing with nerves, you're dealing with anatomy that can have very serious repercussions if procedures are not done properly.”

Those risks range from the aesthetic to the medical. Bowe warned that imprecise injections can cause filler to ball up, forming insightly bumps in the lips, and more pressingly, they can also restrict blood flow. “There are very important blood vessels and nerves that flow through the different layers of both the mucosal lip as well as the skin surrounding the lip,” she said. If those blood vessels are compressed by incorrectly placed filler, known as vascular occlusion, patients risk tissue necrosis: cell death due to irreversible trauma. 

Other injection sites make Bowe even more nervous, like the nasolabial fold, where the nose meets the cheek and laugh lines are at their most pronounced. “Press right at the corner of your nostril,” Bowe said. “If you inject right there, that’s something called the facial artery, and if you accidentally get in that artery, you can go blind.”

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Hall takes issue with another aspect of the device, especially in a professional setting—the possibility for cross-contamination between patients. “The device is an open-ended device because it uses pressurized air,” Hall said. “After impact, there's microscopic blood particles, like splashback, that go up into the device. So, every time this device is used in between people, you’re spreading blood and bodily fluids—that’s how you contract communicable diseases, anything from herpes to HIV to hepatitis.”

These dangers, however, are not what ultimately deterred Snook. She has since stopped using the hyaluron pen, but “[I] do credit it as an important stepping stone in my learning process,” she said. Instead, she feels she’s simply progressed past it on her DIY beauty journey. “I have seen several doctors, who I respect, express concerns regarding the hyaluron pen,” Snook said. “I see those concerns as valid. I've expressed similar concerns in videos since my first hyaluron pen video was posted.” Ultimately, Snook said she’d still recommend the hyaluron pen for use on lips, not the cheeks or chin. 

That kind of distinction, though, would likely be lost on someone who came across the hyaluron pen in a 15-second clip and used that snippet to inform their choices. “You're not going to hear about or see the negative consequences, because a lot of these people are trying to become influencers,” Bowe said. “I think you’re getting a very biased presentation.”

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