Filler Backlash: Insights and Expert Advice from Renowned Cosmetic Surgeon Dr. Ramsey J. Choucair
Today, we are discussing the recent trend known as ”filler backlash.” A sense that facial fillers, whether fillers off-the-shelf such as Restylane or Juvederm-type products, or fat are becoming less desirable. So, let’s explore this in a more detailed fashion.
For sure, fillers provide a valuable benefit in restoring lost volume in the aging face. That’s a fact that remains true. What has changed is the overuse of fillers, especially when the ease of filler injection is applied to aging features that more appropriately require surgical rejuvenation.
This backlash or “filler fatigue” arises when fillers are used to treat aging issues that are better suited for surgical approaches. Currently, fillers are injected by multiple providers and the majority of injectors are not plastic surgeons that have a unique and broad perspective regarding the various techniques to rejuvenate the aging face.
Aesthetic judgment is the most important factor in knowing when to restore volume, what specific filler to consider, and when to recommend alternative rejuvenation techniques such as surgery. Trying to overfill loose skin to avoid surgery is unfortunately a very common error in judgement
And when fillers are indicated, they are often overused, creating distortion or an “over-injected caricature” that is well recognized in society. These unnatural appearances are characterized by excess puffiness or “pillow face”, distorted lip contours and cartoonish animation or “chipmunk cheeks”. These facial abnormalities are opposite from the goals of natural aesthetic enhancements.
Additionally, attempting to match youthful facial volume or fullness to the same volume in an aging face is another example of poor aesthetic judgement. Restoring volume that’s lost from aging remains a reasonable goal, however, determining whether volume restoration is indicated, how much volume is beneficial, and what product or type of volume restoration requires aesthetic judgment.
Another factor to consider is the surprising longevity of fillers. Injectable fillers persist for much longer than originally thought. This lengthy duration is especially concerning in the lower eyelid where even hyaluronic acid fillers may last for several years. It may be very difficult to dissolve or remove excess filler and these attempts may result in unnatural, irregular appearances.
Additionally, we are finding that part of the “backlash to fillers” is a delayed inflammatory change, especially in the lower eyelid. There may be late swelling or puffiness many years following the injection. Therefore, a cautious approach is now taken for filler injections to the lower eyelid tear trough.
But as they say, “you should not throw the baby out with the bath water!” Fillers such as Restylane or Juvederm and autologous fat remain valuable options for restoring a more youthful appearance when volume restoration is needed.
What matters is the judgment of when, how, and where to consider volume restoration. This remains the primary reason that I continue to personally perform all fillers and Botox in my practice. Although there are competent nurses who regularly perform injections, as an experienced plastic surgeon routinely performing facial rejuvenation surgery, it’s the “judgment” of what to do that matters most. On many occasions, an expertly performed surgical procedure creates the most natural, youthful rejuvenation. And isn’t that the ultimate goal?
I hope this short overview of the ‘filler backlash’ is helpful. The reason for the backlash is simply poor aesthetic judgment. It’s not the filler. It’s typically the judgment of the individual who is injecting the filler.
