Allure investigates the effect filler has on the soft tissues of the face, even after you stop injecting it.
In some cases, “I don’t think you ever get 100% back to having no filler in your face,” says one expert.
In our three-part series, The Filler Files, Allure explores our relationship with facial filler. It’s still one of the most popular nonsurgical cosmetic procedures, yet more of us are looking to dissolve our filler than ever before.
What does this mean for our lips, our cheeks, and our approach to injectables?
If you clicked on this headline, you likely have some relationship with hyaluronic acid fillers — the injectable gels, like Juvéderm and Restylane, that millions rely on to contour, plump, and smooth their features.
Whether you’re a diehard fan or a casual acquaintance, you’ve probably wondered how these sugar-based substances behave inside the body and what actually happens when we decide to quit them after years of routine touch-ups.
In posing these questions to dermatologists and plastic surgeons, we discovered that there’s a frustrating dearth of formal studies investigating hyaluronic acid fillers over the long term — how and when they break down,
the ways in which they change over time, and their effects on the quality of our skin and elasticity of our tissues, both during peak injectable use and long after we’ve sworn off the stuff.
Given the paucity of hard data, much of what our experts shared is anecdotal — insights informed by their decades of experience injecting and dissecting the human face. Reliable intel, nonetheless.
In the interest of not burying the lede, we’ll start here: If you’ve been getting filler religiously for years, what happens when you stop will hinge on one critical factor: your average dose at each appointment.
“People who are getting a syringe or two every 12 months — doing a little bit for specific points of volume replacement — they have a much easier time than those who are receiving 5 to 10 syringes every six months, because they’re not getting to a place of overinflation and tissue distortion,” says Jessica Weiser, MD, a board-certified dermatologist in New York City.
And make no mistake: Countless men and women are walking around with gluts of filler under their skin. While Dr. Weiser’s self-imposed limit for a single session is “two or very rarely three syringes,” she believes she is somewhat of an outlier among injectors.
“There are tons of doctors doing 10 syringes at a time,” she tells us. Some of the other physicians we spoke to confirmed that they commonly encounter patients who’ve received 20 or even 50-plus syringes of hyaluronic acid over a one- to two-year span.
When “patients come in with too much filler in their faces, it can be almost disfiguring,” says Lara Devgan, MD, a board-certified plastic surgeon in New York City.
The problem can be more than skin-deep, affecting both the look of the face and its functionality. It’s so common that there’s a term for it: “filler fatigue.”
Board-certified ophthalmologist and oculoplastic surgeon Mitesh Kapadia, MD, describes the overfilled face as “an epidemic” for which a growing number are now seeking a cure — namely, hyaluronic acid-melting hyaluronidase, a synthetic version of an enzyme found in the body.
You’ve no doubt seen celebrities, like Courteney Cox and Amy Schumer, talking openly about being displeased with the look of their outsize cheeks or lips and having their filler dissolved with this injectable solution.
They’re hardly alone. According to The Aesthetic Society’s most recent trend report, their members performed 57% more filler reversals in 2021 than they did the year before.
Indeed, a common refrain among cosmetic providers is that they’re spending more time dissolving filler than injecting it.
What’s behind the about-face? “People are realizing that they’re not looking better, but looking odd,” says Elizabeth Houshmand, MD, a board-certified dermatologist in Dallas.
It may be an old photo or a well-meaning family member that helps them see the error of their ways. Or a complication will clue them in, as they notice their filler migrating or swelling.
Often, though, they can’t pinpoint the exact problem, Dr. Weiser says; they just know “that things feel strange.”
Sometimes, people break up with filler not because they’re overfilled, per se, but because they’re over filler — the look, the upkeep, the headaches — and this too is a form of fatigue.
The filler becomes oppressive, a burden. “Especially when they’ve been through bad injectables and dissolving, they just don’t want to deal with it anymore — they’re done,” says Jonathan Cabin, MD, a board-certified facial plastic surgeon in Arlington, Virginia.
In other cases, the filler has just exhausted its usefulness, no longer able to obscure insecurities in a natural-looking way and compelling once-loyal users to pursue a more powerful solution, like surgery.