{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T16:53:19Z","timestamp":1777049599511,"version":"3.51.4"},"reference-count":17,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T00:00:00Z","timestamp":1775174400000},"content-version":"vor","delay-in-days":92,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Hyaluronic acid (HA) is widely used for lip augmentation; however, the safety and performance of injection techniques and instruments (needle vs cannula) remain unclear. The aim of this study was to evaluate the safety of HA injection techniques for lip augmentation and to assess patient satisfaction, injected volume, and associations with technique, instrument, and HA product. A systematic review was conducted accordance with PRISMA 2020 and registered in PROSPERO (CRD420251123328). PubMed\/MEDLINE, Embase, Cochrane Library, LILACS, SciELO, and Scopus were searched from January 1, 2010, to August 16, 2025, for studies involving adults undergoing HA lip augmentation. Eligible designs included randomized and nonrandomized clinical trials, cohort studies, and systematic reviews. The primary outcome was safety, defined by type and timing of complications. Secondary outcomes included patient satisfaction, injected volume, and associations with technique, instrument, and HA product. Risk of bias was assessed using RoB 2 and ROBINS-I, and findings were synthesized narratively. Sixteen studies including 3692 patients were analyzed. Most protocols used 1 to 2\u2005mL per session, commonly employing linear retrograde techniques with serial puncture, fan patterns, or microdeposits. Adverse events were mild and transient, including edema, ecchymosis, tenderness, and nodularity, with no reported cases of vascular occlusion or vision-threatening events. Needle-only and combined needle plus cannula approaches showed comparable safety profiles. Patient satisfaction was high in most patients. HA lip augmentation appears effective and generally safe when performed by experienced injectors. Current evidence does not support a single superior technique, instrument, or HA formulation. Standardized studies are needed to define best-practice protocols.<\/jats:p>\n                  <jats:p>Level of Evidence: 3 (Risk) \u00a0<\/jats:p>","DOI":"10.1093\/asjof\/ojag059","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:58:35Z","timestamp":1775044715000},"source":"Crossref","is-referenced-by-count":0,"title":["Hyaluronic Acid Injection Techniques for Lip Augmentation\u2014Comparison of Linear, Retrograde, and Microdeposit Approaches: A Systematic Review"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7041-7382","authenticated-orcid":false,"given":"Victor Rene","family":"Miranda Cerna","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"2026042412212331900_ojag059-B1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003332","article-title":"A safe and effective lip augmentation method: the step-by-step \u03a6 (phi) technique","volume":"9","author":"Keramidas","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026042412212331900_ojag059-B2","doi-asserted-by":"publisher","first-page":"4554","DOI":"10.3390\/jcm11154554","article-title":"Lip lifting efficacy of hyaluronic acid filler injections: a quantitative assessment using 3-dimensional photography","volume":"11","author":"Rho","year":"2022","journal-title":"J Clin Med"},{"key":"2026042412212331900_ojag059-B3","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1097\/DSS.0000000000001282","article-title":"Randomized, evaluator-blinded study comparing safety and effect of two hyaluronic acid gels for lips enhancement","volume":"44","author":"Hilton","year":"2018","journal-title":"Dermatol Surg"},{"key":"2026042412212331900_ojag059-B4","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.79325","article-title":"Lip volumization with hyaluronic acid: comparative ultrasonographic evaluation of cannula and needle techniques in a multicenter study","volume":"17","author":"Gonzalez","year":"2025","journal-title":"Cureus"},{"key":"2026042412212331900_ojag059-B5","doi-asserted-by":"publisher","DOI":"10.3389\/fsurg.2021.681028","article-title":"Hyaluronic acid is an effective dermal filler for lip augmentation: a meta-analysis","volume":"8","author":"Czumbel","year":"2021","journal-title":"Front Surg"},{"key":"2026042412212331900_ojag059-B6","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1093\/asj\/sjae086","article-title":"9-Point injection technique for lip augmentation and lip corner lifting using sonographic imaging of the labial artery pathway","volume":"44","author":"Kim","year":"2024","journal-title":"Aesthet Surg J"},{"key":"2026042412212331900_ojag059-B7","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1093\/asj\/sjae149","article-title":"Lip augmentation with saypha LIPS lidocaine: a postmarket, prospective, open-label, randomized clinical study to evaluate its efficacy and short- and long-term safety","volume":"45","author":"M\u00fcller","year":"2025","journal-title":"Aesthet Surg J"},{"key":"2026042412212331900_ojag059-B8","doi-asserted-by":"publisher","first-page":"e168","DOI":"10.1097\/DSS.0000000000002917","article-title":"An objective, quantitative assessment of flexible hyaluronic acid fillers in lip and perioral enhancement","volume":"47","author":"Nikolis","year":"2021","journal-title":"Dermatol Surg"},{"key":"2026042412212331900_ojag059-B9","doi-asserted-by":"publisher","first-page":"S127","DOI":"10.1097\/DSS.0000000000000199","article-title":"A randomized, evaluator-blinded, controlled study of effectiveness and safety of small particle hyaluronic acid plus lidocaine for lip augmentation and perioral rhytides","volume":"41","author":"Beer","year":"2015","journal-title":"Dermatol 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augmentation","volume":"47","author":"Weiss","year":"2021","journal-title":"Dermatol Surg"},{"key":"2026042412212331900_ojag059-B13","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003957","article-title":"Lip reshaping with LOVE approach: a prospective analysis based on two hyaluronic acid fillers","volume":"9","author":"Bertossi","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026042412212331900_ojag059-B14","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2024.1495012","article-title":"Aesthetic lip filler augmentation is not free of adverse reactions: lack of evidence-based practice from a systematic review","volume":"5","author":"Coppini","year":"2024","journal-title":"Front Oral Health"},{"key":"2026042412212331900_ojag059-B15","author":"American Society of Plastic Surgeons"},{"key":"2026042412212331900_ojag059-B16","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.64716","article-title":"Comparing the effects of different injection 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