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Lip Filler for Black Women and Naturally Full Lips

Who was actually in the lip filler studies, what the labels say about darker skin and scarring, and questions to ask about your own goals.

This guide covers two separate questions. The first is what the research says about lip filler in darker skin. The second is what it says about treating lips that are already full. The two don't always go together: Black women have a wide range of skin tones and lip shapes, and plenty of readers with darker skin or full lips aren't Black. Read whichever sections apply to you.

Lip filler studies describe people by Fitzpatrick skin type, a scale from I to VI of how skin responds to sun. In this guide, “darker skin” means types IV to VI. Skin type is not the same as race or ethnicity, so where the studies also report race, we give those numbers too.

Quick Answer

Darker skin:
Included in all four FDA lip studies, but in small groups
Black participants:
Between 1 and 21 people per study, in studies of 213 to 270 people
Already-full lips:
Barely studied: 3 people in one study started with lips rated Marked
Scarring and dark marks:
One label flags a higher risk with darker skin; small studies found few problems
Last Updated:
Reading Time:
8 to 10 minutes
Written by:
the Find Lip Fillers editor
Sources:
listed below
Purpose:
General Education Only

Your Goals, Your Call

Nobody else gets to decide what your lips should look like. What the research can tell you is how much it has looked at lips that are already full, and the answer is: very little.

Juvederm Volbella XC

Most people needed lips rated Minimal, Mild, or Moderate to join. The study also allowed people with skin type V or VI whose lips were already rated Marked or Very Marked, if they wanted treatment to the body of the lip. In the end, 3 of the 168 people treated with Volbella (1.8%) started with Marked lips, and none with Very Marked.

Restylane Silk

Most people needed both lips rated thin or very thin. People with skin types IV to VI needed only one. By the blinded evaluator's rating, 11 of the 177 people on Silk (6%) started with an upper lip rated Full or Very Full; the summary doesn't say which groups they were in.

So the studies say little about results in lips that are already full. That makes your own conversation with a provider more important. Questions worth asking:

What, if anything, would you change about my natural lip shape, and what would you leave alone?

If I want shape or balance rather than more size, how would you approach that?

How would you keep my lips in proportion with the rest of my face?

Can you show me examples of patients whose lips were already full before treatment?

Who Was in the Lip Filler Studies

These are the four lip studies behind FDA approval, with the numbers taken from each FDA summary or product label. Percentages are of the treated group unless stated.

Juvederm Ultra XC

  • Treated: 157 people (plus 56 controls whose treatment was delayed).
  • Darker skin in the treated group: 25 people, 16% (types IV: 6, V: 16, VI: 3).
  • Race and ethnicity, as the label groups them: 13 African American (8.3%), 8 Hispanic (5.1%), 1 Asian, 133 Caucasian (84.7%).
  • Finding: subgroup analyses by skin type found "no increased safety risks" for any group.
  • Limit: the label doesn’t give the size of each subgroup it analyzed. Only 19 treated people had type V or VI.
  • Funding: the label doesn’t say who funded the study.

Juvederm Volbella XC

  • Treated: 168 people (plus 56 controls treated with Restylane-L).
  • Darker skin in the treated group: 47 people, 28% (types IV: 26, V: 11, VI: 10).
  • Race: 15 African-American (8.9%), 3 Asian, 2 American Indian or Alaska Native, 144 Caucasian (85.7%). Ethnicity: 12 Hispanic or Latino (7.1%).
  • Finding: no significant difference between Volbella and the control filler in any skin-type group. In types V and VI, 3 of 21 people treated with Volbella (14.3%) had a device-related side effect after their initial treatment (including any touch-up).
  • Limit: the type V/VI group was 21 people on Volbella and 7 on the control filler.
  • Funding: the FDA summary says the applicant, Allergan, performed the study.

Restylane Silk

  • Enrolled: 221 people (177 on Silk at the start, 44 whose treatment was delayed).
  • Darker skin: 52 of the 221 people enrolled, 24% (the FDA summary mostly describes them as types IV and V).
  • Race: 1 Black or African American participant, out of 221. Ethnicity: 43 Hispanic or Latino (19%).
  • Finding: "no unique adverse events" in people with darker skin. After their first Silk treatment, 24 of 50 (48%) had bruising and 20 of 50 (40%) had lip swelling, similar to the study overall.
  • Limit: 50 people with darker skin were treated, and only 1 person in the whole study was Black.
  • Funding: the FDA summary says the sponsor, Valeant Pharmaceuticals North America/Medicis, performed the study.

Restylane Kysse

  • Treated: 183 people (plus 87 controls).
  • Darker skin in the treated group: 36 people, 20% (types IV: 23, V: 10, VI: 3).
  • Race: 7 Black or African American (3.8%), 1 Asian, 1 American Indian or Alaska Native, 173 White (94.5%). The label doesn’t report Hispanic or Latino ethnicity.
  • Finding: an "exploratory" safety analysis by skin type was consistent with the study overall.
  • Limit: 13 treated people had type V or VI, and the label calls the analysis exploratory.
  • Funding: the label doesn’t say who funded the study.

A study focused on darker skin (Taylor 2019)

Researchers pooled 72 people with skin types IV to VI from two “pivotal” lip studies of hyaluronic acid fillers (the main studies used to support approval). About 69 of the 72 were women (95.8%).

  • At 3 months, 85% of those assessed had at least a 1-point improvement in lip fullness. The abstract doesn't say how many people were assessed.
  • Injection-site reactions were generally mild or moderate and cleared within 2 weeks.
  • The most common side effects were a lump at the injection site, in 19.4% (about 14 people), and bruising, in 12.5% (about 9 people).

Limits: the abstract doesn't name the two studies, so some of these people may also be counted in the figures above. It doesn't report race. We couldn't access the full paper to check who funded it. The authors themselves note that people with darker skin are underrepresented in lip filler research.

Scarring and Dark Marks: What the Evidence Says

The labels and the studies point in different directions, so here they are side by side.

What the labels say

  • Restylane Kysse: people with abnormal wound healing or “dark skin (Fitzpatrick Type IV-VI) may be more prone to develop hypertrophic scarring and keloid formation.” It also says pigmentation changes and scarring may occur after filler.
  • Juvederm Ultra XC: safety in people prone to keloids, hypertrophic (raised) scarring, or pigmentation disorders “has not been studied.”

What the studies found

  • The FDA lip studies: no increased or unique side effects reported for darker skin, in the small subgroups described above.
  • Grimes 2009: see below. Few pigment problems and no raised scarring, but not in the lips.

Grimes 2009: a larger study, but not of lips

Two studies followed 279 people with skin types IV to VI for 24 weeks after filler in the nasolabial folds, the lines from the nose to the corners of the mouth. This was not a lip study.

  • 160 people received one of three higher-concentration hyaluronic acid fillers (Juvederm Ultra, Ultra Plus, and 30). There was no hypertrophic scarring, and no more lightening or darkening of the skin than in white (Caucasian) participants.
  • 119 people received one of three lower-concentration fillers (Hylaform, Hylaform Plus, and Captique). There were no keloids and no hypertrophic scarring, and 3 cases of mild darkening.

Limits: the abstract doesn't break participants down by race, and we couldn't access the full paper to check who funded it.

What this means for you: the studies are small, and one label still flags a higher risk. If you have had keloids, raised scars, or dark marks after cuts, acne, or other skin injuries, tell your provider before treatment.

Questions to Ask a Provider

Have you treated people with my skin tone and lip shape? Can I see examples?

How do you reduce the risk of bruising and dark marks with skin like mine?

I have a history of keloids or dark marks after injuries. Does that change your plan, or whether you would treat me?

Which filler would you use, and do you know whether its studies included people with skin like mine?

What would you do if I developed bruising or darkening that didn’t fade?

A 2023 review of cosmetic procedures in darker skin describes injection approaches some providers use to lower the risk of bruising and dark marks, so it's reasonable to ask what your provider does.

Verify provider credentials through your state's licensing board (in Colorado, the DORA database). Our guide on how to find a lip filler provider has more questions for a consultation.

Frequently Asked Questions

Is lip filler safe for darker skin?

The research doesn't give a simple yes or no. In the four FDA lip studies, people with darker skin (Fitzpatrick types IV to VI) were analyzed as a subgroup, and the documents report no increased or unique side effects for them. Those subgroups were small: for example, 21 people with type V or VI received Juvederm Volbella XC, and 36 people with types IV to VI received Restylane Kysse. A 2019 analysis of 72 people with darker skin from two lip studies found that injection-site reactions were generally mild or moderate and cleared within 2 weeks. At the same time, the Restylane Kysse label says people with "dark skin" (its term for types IV to VI) may be more prone to raised scars and keloids. Go over your own skin and scarring history with your provider.

Can lip filler cause keloids?

The Restylane Kysse label says people with abnormal wound healing or "dark skin" (types IV to VI) may be more prone to hypertrophic (raised) scarring and keloid formation. The Juvederm Ultra XC label says safety in people prone to keloids, hypertrophic scarring, or pigmentation disorders has not been studied. A 2009 study of 279 people with darker skin, treated in the folds beside the nose rather than the lips, reported no hypertrophic scarring with any of the fillers and no keloids with the three lower-concentration fillers. We found no lip study designed to measure keloid risk. If you have had keloids before, tell your provider.

Can lip filler cause dark spots?

The Restylane Kysse label says pigmentation changes may occur after filler injections. In a 2009 study of people with darker skin, treated in the folds beside the nose rather than the lips, there were 3 cases of mild darkening among 119 people treated with lower-concentration fillers, and no more lightening or darkening than in white participants among the 160 treated with higher-concentration fillers. The Juvederm Ultra XC label says safety in people with pigmentation disorders has not been studied.

I already have full lips. Can filler still help with shape?

Very few people with already-full lips were in the lip studies. The Juvederm Volbella XC study allowed people with skin type V or VI whose lips were already rated Marked or Very Marked to join if they wanted treatment to the body of the lip, but only 3 of the 168 people treated started with Marked lips, and none with Very Marked. So the studies say little about results in already-full lips. Ask a provider what they would change, what they would leave alone, and why.

Why do the studies describe skin type instead of race?

Lip filler studies group people by Fitzpatrick skin type, a scale of how skin responds to sun, because skin type is linked to scarring and pigmentation questions. Skin type is not the same as race or ethnicity. The four FDA lip documents also report race, and the numbers of Black participants were small: 16 of 213 people in the Juvederm Ultra XC study, 21 of 224 in Volbella, 1 of 221 in Restylane Silk, and 9 of 270 in Restylane Kysse.

Sources

  1. JUVÉDERM Ultra XC Directions for Use. AbbVie (manufacturer prescribing information).
    Supports: lip study of 157 treated people and 56 delayed-treatment controls; treated group skin types IV 6, V 16, VI 3; African American 13, Hispanic 8; subgroup analyses by skin type found no increased safety risks for any group; safety in people prone to keloids, hypertrophic scarring, and pigmentation disorders has not been studied; the document doesn't say who funded the study
  2. JUVÉDERM VOLBELLA XC: Summary of Safety and Effectiveness Data (P110033/S018). U.S. Food and Drug Administration.
    Supports: study performed by the applicant, Allergan; 168 treated and 56 controls; entry rule for skin type V or VI with Marked or Very Marked lips; 3 of 168 treated started Marked, none Very Marked; treated group skin types IV 26, V 11, VI 10; African-American 15, Hispanic or Latino 12; device-related side effects in types V/VI in 3 of 21 treated and 1 of 7 controls; no significant subgroup differences
  3. Restylane Silk Injectable Gel: Summary of Safety and Effectiveness Data (P040024/S072). U.S. Food and Drug Administration.
    Supports: study performed by the sponsor, Valeant Pharmaceuticals North America/Medicis; 221 people, 52 with skin types IV to VI; 1 Black or African American participant; 43 Hispanic or Latino; people with types IV to VI needed only one thin lip to enroll; no unique adverse events in types IV to VI; bruising in 24 of 50, lip swelling in 20 of 50
  4. Restylane Kysse Instructions for Use. Galderma (manufacturer prescribing information).
    Supports: people with abnormal wound healing or "dark skin" (Fitzpatrick IV to VI) may be more prone to hypertrophic scarring and keloid formation; pigmentation changes and scarring may occur; 183 treated and 87 controls; treated group skin types IV 23, V 10, VI 3; Black or African American 7; exploratory subgroup safety analysis consistent with overall results; the document doesn't say who funded the study
  5. Taylor SC, Downie JB, Shamban A, et al. Lip and Perioral Enhancement With Hyaluronic Acid Dermal Fillers in Individuals With Skin of Color. Dermatol Surg. 2019;45(7):959–967. Peer-reviewed journal (abstract).
    Supports: 72 people with skin types IV to VI pooled from two pivotal studies; 85% had at least a 1-point improvement in lip fullness at 3 months; injection-site reactions generally mild or moderate and resolved within 2 weeks; injection-site mass 19.4% and bruising 12.5%; people with skin of color are underrepresented in lip studies
  6. Grimes PE, Thomas JA, Murphy DK. Safety and effectiveness of hyaluronic acid fillers in skin of color. J Cosmet Dermatol. 2009;8(3):162–168. Peer-reviewed journal (abstract).
    Supports: 279 people with skin types IV to VI treated in the nasolabial folds, not the lips; higher-concentration fillers (160 people): no hypertrophic scarring and no increase in pigment changes compared with white participants; lower-concentration fillers (119 people): no keloids or hypertrophic scarring, 3 cases of mild hyperpigmentation
  7. Desai M, Gill J, Luke J. Cosmetic Procedures in Skin of Color: Clinical Pearls and Pitfalls. J Clin Aesthet Dermatol. 2023;16(3):37–40. Peer-reviewed journal (review).
    Supports: describes injection approaches some providers use with darker skin to lower the risk of bruising and pigment changes; no funding was provided for the article

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Lip Filler and Cultural AppropriationDo Lip Fillers Look Fake?How to Find a Lip Filler Provider

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Important Legal and Medical Disclaimer

Educational Content Only: This guide provides general educational information and does not constitute medical advice. It does not address any individual's specific health situation and should not be used as the basis for any medical or treatment decision.

Professional Consultation Required: Always speak with a licensed physician and a qualified cosmetic provider before making decisions about treatment. This content does not establish a doctor-patient relationship.

Verify Provider Credentials: Verify provider credentials through your state's licensing board (in Colorado, the DORA database) before scheduling any procedure.

No Guarantees: Treatment outcomes and risk levels vary by individual. Always review informed consent documentation carefully before proceeding with any cosmetic treatment.