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Ask a dozen doctors abouthyaluronic acid fillerits merits, drawbacks, appealand youll get a dozen different takes.
Vanessa Granda
As weve learned how temporary gels can, to an extent,linger for years or decades.
As weve witnessed these once-breezy treatments distort our personal perceptions and collective beauty standards.
On social media, doctors are debating these topics ad nauseam.
“The key to any soft tissue filler treatment is proper placement of the filler—a comprehensive approach and an eye for detail come in handy,” says Dr. Hartman. Here, one of his patients before (left) and after pan-facial filler, including in the nasal labial folds, chin, and cheeks. Courtesy of Dr. Hartman
Filler support groups are cropping up across the internet.
(One, calledFlawed Fillers & Botched Botox, has nearly 95,000 members.)
Celebrities are dissolving and disavowing injectables.MRI scansof filler-engorged faces are going viral.
Another of Dr. Mahmood’s patients before (top) and after lip filler. Courtesy of Dr. Mahmood
According to volumetric analysis, thefillernot only persisted, but more than doubled in size from water absorption.
(Most fillers are made from hyaluronic acid, a sugar-based humectant that binds water.)
At last look, Dr. Parsas July 2024 post had accrued more than 11 million views on TikTok alone.
“Nothing is worse than too much filler,” says Dr. Hartman. Here, one of his patients before (left) and after tear trough filler, as well as deeper pan-facial injections—including in the chin, temples, and cheeks—to frame the face without interfering with facial movements “so a more natural appearance is achieved,” he says. Courtesy of Dr. Hartman
But it sometimes seems theres no such thing as bad press in aesthetics.
So, whats really going on?
[My patients] often have in hand what happened to this celebrity?
One of Dr. Hartman’s patients before (left) and after natural-looking pan-facial filler, including in the nasolabial folds, prejowl sulcus, and chin. Courtesy of Dr. Hartman
photos as examples of what they do not want.
In her New York City office, younger patients are typically the ones expressing fear and reluctance about filler.
Theyve seen whats happened to generations ahead of them, she explains.
(More on that ahead.)
No one wants to look like a Muppet or have the dreaded pillow face.
photos as examples of what they do not want.
No one wants to look like a Muppet or have the dreaded pillow face.
I should note, when speaking to injectable trends, doctors viewpoints are often skewed by their personal tastes.
The opposite also holds true.
While the former group sees patients abandoning filler, the latter says theyreinjectingmore than ever.
Every anecdote is informed by experience, but also tinged with a bit of bias.
And its hardly fair to condemn a treatment based solely on bad outcomes.
These doctors should at least possess appropriate medical credentials and a firm grasp on facial anatomy.
Beyond proper licensing and certification, what should you look for in an injector?
If your injector looks weird, chances are, youll wind up looking weird too."
(Anatomy and desired outcome usually dictate depth.
Im never trying to compete with a facelift, says New York City board-certified dermatologistDoris Day, MD.
Im never trying to compete with a facelift.
Every day, people comment on how natural I look, says Dr. Saedi.
If you go to someone whos totally overfilled, thats a quick out.
Indeed, a practitioners face reflects their filler philosophy and style.
How can you possibly find someone who checks all these boxes?
Treat the consultation as a fact-finding mission only.
Some physicians actually struggle to deprogram patients from these ingrained filler falsehoods when aiming to hone smarter habits.
He was like, No one ever told me they last two years.
Getting filler is not like getting a physicalyou dont need to do it every year.
First-name-only injectors with questionable credentials commonly work on commission, cashing in on every syringe they sell.
My priority, as a doctor who upholds the Hippocratic Oath, is patient safety.
Its very different when you have a medical license to worry about.
All too often, she adds, financial gain overshadows ethics, particularly when providers charge by the syringe.
Some goals, likelifting saggy jowls(the holy grail!
), simply cannot be achieved with fillerand blindly pursuing them is futile at best.
Its your doctors job to manage expectations and respect the very real limitations of injectables.
The best injectors use the least amount of filler to get the job done.
I think that keeps people in check and prevents them from looking overfilled.
Courtesy of Dr. Hartman
Lips can easily betray a filler fanatic.
(Is there a bigger giveaway?)
They value hydration, structure, and symmetry over volume.
And they tread lightly along the lip line: The vermillion border is unforgiving, Dr. Somenek says.
Judicious lip filler can look natural.
Here, one of Dr. Mahmood’s patients before (top) and after lip filler.
Courtesy of Dr. Mahmood
Another of Dr. Mahmood’s patients before (top) and after lip filler.
Only 10-15% of patients coming in fortear trough fillerare reportedly good candidates.
You wont find me using more than .2 to .5 ccs under the eyes, Dr. Hirmand adds.
Thats very little filler, but nobody needs more than that around the eyes.
Nothing is worse than too much filler, says Dr. Hartman.
I do so much more laser than filler, because I think it gives more bang for your buck.
Devices arent everything either, mind you.
But when injectors do their jobs well, you look better and were invisible, says Dr. Day.
As it turns out, though, theres another enemy of good filler: the pursuit of perfection.
When you have a go at make someone look too perfectthats when things get weird, says Dr. Chang.
Which is why I dont chase lines, ever.
You only end up distorting the face.
I dont chase lines, ever.
You only end up distorting the face.
Remember, its normal, itshuman, to have creases, hollows, shadowshigh points and lows.
When one part is out of whack, thats when you’re able to tell something was done.
We dont have standing filler appointments, says Dr. Chang.
Patients just call if they think they want a little more, but thats pretty rare.
They know that being slightly underdone looks so much better than being overdone.
Its initial oomph fades as it flattens out and weaves its way into your tissues.
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