How to Use Filler Without Looking Like You Use Filler
Vanessa Granda
Ask a dozen doctors about hyaluronic acid filler—its merits, drawbacks, appeal—and you’ll get a dozen different takes. But on one point, most experts will likely agree: Deservedly or not, filler has a PR problem. Public enthusiasm for the injections has cooled in recent years, as we’ve watched some familiar faces grow puffy, peculiar, and eerily indistinguishable. As we’ve learned how “temporary” gels can, to an extent, linger for years or decades. As we’ve witnessed these once-breezy treatments distort our personal perceptions and collective beauty standards.
In the last two years, Allure has reported on the origins of filler fatigue, the ubiquity of undereye-filler-gone-wrong, the tissue expansion that occurs in overfilled faces, the demand for “natural” alternatives to hyaluronic acid, the rise in filler reversals, and the phenomenon of injectables complicating facelifts. On social media, doctors are debating these topics ad nauseam. Filler support groups are cropping up across the internet. (One, called Flawed Fillers & Botched Botox, has nearly 95,000 members.) Celebrities are dissolving and disavowing injectables. MRI scans of filler-engorged faces are going viral.
Meet the experts:
Kami Parsa, MD, is a board-certified oculoplastic surgeon in Beverly Hills
Haideh Hirmand, MD, is a board-certified plastic surgeon in New York City
Nazanin Saedi, MD, is a board-certified dermatologist in Philadelphia
Corey L. Hartman, MD, is a board-certified dermatologist in Birmingham, Alabama
Umbareen Mahmood, MD, is a board-certified plastic surgeon in New York City
Michael Somenek, MD, is a double board-certified facial plastic surgeon in Washington, DC and New York City
Doris Day, MD, is a board-certified dermatologist in New York City
Catherine Chang, MD, is a board-certified plastic surgeon in Beverly Hills
Karan Lal, DO, is a board-certified dermatologist in Scottsdale, Arizona
One widely shared post from Kami Parsa, MD, a board-certified oculoplastic surgeon in Beverly Hills, shows a 3D MRI of a 33-year-old who had 12 syringes of filler injected over a six-year span. According to volumetric analysis, the filler not 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. Parsa’s July 2024 post had accrued more than 11 million views on TikTok alone. His message to followers: “If overused, these products, due to their longevity and proinflammatory nature, will lead to patients actually looking older with time.”
But it sometimes seems there’s no such thing as bad press in aesthetics. Despite it all, the American Society of Plastic Surgeons recorded an 8% jump in hyaluronic acid filler treatments between 2022 and 2023. The spike not only contradicts the sweeping anti-filler sentiment on social media, but calls into question much of the intel I’ve collected from derms and surgeons over the past few years. So, what’s really going on?
“[My patients] often have in hand ‘what happened to this celebrity?’ photos as examples of what they do not want.”
Asked what she makes of the disconnect, board-certified plastic surgeon Haideh Hirmand, MD, says she suspects the statistical uptick in filler use would be even greater if not for the heightened hesitation she sees around injectables. In her New York City office, younger patients are typically the ones expressing fear and reluctance about filler. Not only is this group more tuned-in to the filler firestorm online, but they’ve actually witnessed, in the flesh, filler’s untoward effects. “They’ve seen what’s happened to generations ahead of them,” she explains. “How older people can look a little weird, or how they all look the same in some bizarre way.”
Nazanin Saedi, MD, a board-certified dermatologist in Philadelphia, has also noticed the “plague of bad filler and complications” on social media influencing her patients. “People come in saying, ‘I don’t want to have migration’ or ‘I don’t want to have 28 vials of filler collecting in my face,’” she says. As a result, some are lessening their reliance on injectables by incorporating lasers and tightening devices into their routines. (More on that ahead.)
Treatment-seekers in Birmingham, Alabama have not forsaken filler, according to board-certified dermatologist Corey L. Hartman, MD, but “there is an increased awareness of filler that’s poorly placed,” he says. “No one wants to look like a Muppet or have the dreaded ‘pillow face.’” Similarly, Umbareen Mahmood, MD, a board-certified plastic surgeon in New York City, tells me that her patients are “still very interested in using injectables to look refreshed and to counteract the effects of aging,” but more than ever, they’re worried about looking overdone: “They often have in hand ‘what happened to this celebrity?’ 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. Those who aren’t huge fans of filler and use the stuff sparingly—as a last resort, in some cases—tend to attract like-minded patients. The opposite also holds true. While the former group sees patients abandoning filler, the latter says they’re injecting more than ever. Every anecdote is informed by experience, but also tinged with a bit of bias.
Regardless, pretty much every expert I interviewed agrees that filler abuse—injecting too much gel over time, choosing formulas that are ill-suited for the areas being treated, or putting products in the wrong layer of the face—is warping not only our reflections, but society’s image of filler. And it’s hardly fair to condemn a treatment based solely on bad outcomes. “It’s kind of an ignorant and irresponsible position to take,” says Michael Somenek, MD, a double board-certified facial plastic surgeon in Washington, DC and New York City, when in reality, “hyaluronic acid fillers are still a very relevant part of aesthetic practice.”
As our understanding of filler deepens and our preferences evolve, doctors are changing how they approach these products, so we might enjoy the benefits of injectables without suffering the pitfalls. Because, at the risk of sounding like some lame med spa meme, you can use filler without looking like you use filler. Here’s how.
In this story:
Choose an experienced, natural-looking injector
Allure routinely urges readers to seek out board-certified dermatologists and plastic surgeons for injectable treatments—and, from a safety POV, this is a great place to start. These doctors should at least possess appropriate medical credentials and a firm grasp on facial anatomy. But board certification doesn’t guarantee vast experience with injectables, a strong understanding of filler composition and behavior, or, frankly, any sense of taste. (That last one is crucial, because “anyone can pump a face full of filler, but it takes a discerning eye and a subtle touch to deliver undetectable results,” notes Dr. Hartman.) One’s board-certification status also conveys nothing about how clued-in a doctor is to the latest injectable findings and best practices.
Beyond proper licensing and certification, what should you look for in an injector? Experience, for starters: The person sticking a needle in your face should be handling filler nearly every day and have the before-and-afters to show for it. They should also have a track record for safety, including a fridge full of hyaluronidase (to dissolve problematic filler) and the know-how to manage all kinds of complications, from lumps to swelling to blocked arteries.
“If your injector looks weird, chances are, you’ll wind up looking weird too."
Your injector should be product-savvy—know their Versa from their Volbella, their Redensity from their Refyne—and offer a dizzying array of fillers, knowing that each gel has unique properties, serves a different purpose, and creates a distinct effect. They should be able to tell you not only what product they’re injecting and why, but where they’re placing it—deep on bone or more superficially—and their rationale for doing so. (Anatomy and desired outcome usually dictate depth. Though, in certain spots, like the cheeks and under the eyes, doctors almost always inject deep to effectively hide the filler and prevent a swollen look.)
Ideally, the person charged with maintaining the health, beauty, and character of your face should offer treatments other than filler—lasers that eradicate brown spots and redness, microneedling for firming, chemical peels to smooth and brighten—because injections cannot address every concern. When doctors view filler as a cure-all—attempting to “camouflage” bulgy eye bags or “lift” sagging faces—patients generally wind up overfilled. If you’d benefit from a procedure that your injector doesn’t offer—be it deep laser resurfacing, fat grafting, a blepharoplasty—they shouldn’t hesitate to refer you to a specialist. “I’m never trying to compete with a facelift,” says New York City board-certified dermatologist Doris Day, MD. “I tell my patients, if you have a facelift in mind, these are great doctors to go to.”
Lately, there’s increasing chatter among aesthetic doctors on social about the true impact of volume loss on the aging face, with some surgeons arguing that deflation has been overemphasized—and, thus, fillers overused—when, in fact, tissue laxity and descent tend to be greater contributors. And according to Dr. Parsa, “if we replace volume without addressing other components of aging, then we are stuck with a puffy, overfilled face.”
“I’m never trying to compete with a facelift. I tell my patients, if you have a facelift in mind, these are great doctors to go to.”
Finally, responsible injectors say “No” when patients ask for unnecessary or ill-advised tweaks—the big one being just one more syringe. “Filler blindness is an epidemic, and injectors who will not deny patients’ requests for more filler are only contributing to it,” says Dr. Mahmood.
That “blindness” or dysmorphia can affect doctors as well as patients, so when you meet a potential injector, notice their appearance. “Every day, people comment on how natural I look,” says Dr. Saedi. “If you go to someone who’s totally overfilled, that’s a quick out.” Indeed, a practitioner’s face reflects their filler philosophy and style. “If your injector looks weird, chances are, you’ll wind up looking weird too, because that’s their aesthetic,” says Catherine Chang, MD, a board-certified plastic surgeon in Beverly Hills.
Book a consultation, and do not set foot in an injectable bar
How can you possibly find someone who checks all these boxes? Ask friends and colleagues who look good for recommendations; scour online reviews; and peruse doctors’ social media (skeptically, as it may all be an illusion). Once you have a name or two, the best way to determine if they’re up to snuff is to meet with them. Treat the consultation as a fact-finding mission only. “Do not have a procedure done the same day as your consultation,” advises Karan Lal, DO, a board-certified dermatologist in Scottsdale, Arizona. “Go home, do more research, and think things over—the cost, the risks—so you don’t make a decision you’ll regret.”
The way a doctor talks about filler during consultation, how they analyze your face, and the suggestions they make will reveal their injectable education and ethos, so pay attention, because plenty of injectors are still practicing like it’s 2008—recommending double-digit syringes in one session, insisting that filler disappears at six or 12 months, and pushing frequent touch-ups. Much of the bad intel on how long fillers last is rooted in old clinical trials, which followed subjects for a limited period of time and then used those time frames to approximate the durability of the products being tested.
Again, MRI studies have largely debunked those estimates by proving that hyaluronic acid, especially in the midface, can stick around for years, with some types of gel outlasting others. This isn’t necessarily a bad thing, but your doctor should be transparent about filler longevity and thoughtful about repeat injections.
The principle of “do no harm” should extend to the aesthetic and psychological damage that can occur when doctors over-inject.
Some physicians actually struggle to deprogram patients from these ingrained filler falsehoods when aiming to hone smarter habits. Dr. Lal tells me about a patient whose previous med spa injector encouraged him to top off his jawline filler every eight months—even though the specific gels lining the patient’s mandible have a two-year indication. “He was like, ‘No one ever told me they last two years.’ And I was like, ‘They last two years on paper, but in reality, they’re probably lasting much longer,’” Dr. Lal explains. “Getting filler is not like getting a physical—you don’t need to do it every year.”
In Dr. Lal’s experience, such antiquated filler customs are still fairly standard in injectable bars and med spas (particularly those unaffiliated with board-certified aesthetic physicians), where you’re not exactly encouraged to go home and sleep on a consultation; where you’re rarely told you’re not a candidate for filler. First-name-only injectors with questionable credentials commonly work on commission, cashing in on every syringe they sell. “That is a true business, not a medical office—their job is to make money,” Dr. Lal tells me. “My priority, as a doctor who upholds the Hippocratic Oath, is patient safety. It’s very different when you have a medical license to worry about.”
Dr. Hirmand also spoke at length about filler safety, adding that the principle of “do no harm” should extend beyond physical injury to include the aesthetic and psychological damage that can occur when doctors over-inject and “create crazy-looking people,” she says. All too often, she adds, financial gain overshadows ethics, particularly when providers charge by the syringe.
Bring pictures to your appointment
Some doctors will ask to see old photos before injecting filler to get a sense of your original anatomy and face shape. “Even if it’s a young person, I’m going to ask them to bring in photos, so I can see the proportions they were born with and how they’ve changed over time,” says Dr. Hirmand. She typically asks for high school yearbook portraits as a starting point, and then, ideally, pictures from every decade after. “I use the photos not to make a 60-year-old look the way she did in her 20s, but as a tool of investigation,” she explains. They allow her to see: Did you always have thin lips or slightly sunken tear troughs or this particular curve to your cheeks? When enhancing a face with filler, or restoring what’s been lost, maintaining one’s hallmark features—the things that make you, you—will keep you looking authentic and undone.
Never try to lift your face with filler
During your appointment, “be very clear about what you’re experiencing in the mirror and what you think you might want to have done, so we can assess the feasibility [of your request],” Dr. Hirmand says. Some goals, like lifting saggy jowls (the holy grail!), simply cannot be achieved with filler—and blindly pursuing them is futile at best. At worst: “Thoughtlessly shoving product in the face to try to hold it up,” adds Dr. Day, “that’s when people get filler fatigue.”
It’s your doctor’s job to manage expectations and respect the very real limitations of injectables. When filler isn’t the answer, you might consider other noninvasive procedures (see below), more powerful surgical interventions, or doing nothing at all. In certain scenarios, notes Dr. Hirmand, “you’ll look better if you don’t do anything [for a perceived issue] than if you do something.”
Start slowly and build gradually
The best injectors use the least amount of filler to get the job done. Dr. Hartman, for instance, “performs conservative injections, paying careful attention to how the tissue behaves [throughout the procedure], and adding more product later, if necessary,” to ensure the face looks natural at rest and in motion.
While there’s no magic number of cc’s that will satisfy every individual, for first-timers, especially, Dr. Somenek typically recommends starting with one or two syringes, depending on the degree of volume loss. “I always say, ‘Let’s wear that for a couple of weeks—let the swelling go down, let the filler integrate into your tissues,’” he tells me. “I think that keeps people in check and prevents them from looking overfilled.”
Dr. Mahmood finds that more patients are now electing to do filler in stages, rather than treating the whole face at once—an approach she’s long advocated for—“so they can see how different areas settle and make sure they still look like themselves.” This way, patients can clearly assess the impact that each injection has on the face, she explains, and judge precisely what’s working and what’s not. But not every injector proceeds with such caution: “Not infrequently, I see patients who’ve had several syringes injected by other providers, and they come to me wanting to dissolve it all, because they can’t identify what, specifically, they don’t like—they just know it doesn’t feel like them.”
Stay true to your natural lip size and shape
Lips can easily betray a filler fanatic. (Is there a bigger giveaway?) To keep lips’ shape and proportions in sync with the rest of the face, experts swear by a few key tenets: They augment in a modest and incremental fashion, rarely if ever injecting a full syringe into the tight confines of the lips. They value hydration, structure, and symmetry over volume. And they tread lightly along the lip line: “The vermillion border is unforgiving,” Dr. Somenek says. “If you overdo it, it’s going to give a ducky appearance, which is what people perceive as an unnatural look.”
If the right filler—a soft gel, like Restylane Kysse, that doesn’t draw a ton of water—is dosed conservatively and injected appropriately, it shouldn’t migrate (yielding yet another tell: the filler mustache). Then there are the experts who flat-out dismiss the notion of migration: “Numerous papers have shown that filler can spread a couple of millimeters, but it does not shift dramatically from where it’s initially placed,” Dr. Hartman says. Often, he explains, filler that appears to have spread over the course of weeks or months was simply misplaced at the time of injection.
Go easy on the undereyes
Celebrity undereyes are the new cautionary tale, alerting us to the perils of tear trough filler: stubborn swelling, glaring lumps, that steely-blue tinge. While some injectors are abandoning the procedure, claiming it’s too unpredictable, others insist it can be among the most gratifying of treatments when performed on the right person: someone with hollow tear troughs, no eye bags (whether caused by fat or fluid buildup), and tight skin, who isn’t prone to allergies, immune issues, or fluid retention, says Dr. Parsa.
“If we put under-eye filler in someone who’s not a good candidate, we will make them look worse immediately.”
Only 10-15% of patients coming in for tear trough filler are reportedly good candidates. While the shot may seem like an easy fix, odds are, it won’t serve you well, so don’t push if your doctor turns you down. “If we put under-eye filler in someone who’s not a good candidate—who has fat bags or loose skin—we will make them look worse immediately,” warns Dr. Hirmand.
In folks who qualify, selecting the correct product (classic Restylane is a go-to for many experienced injectors) and using it judiciously can help keep the filler from backfiring (though, in this area, no promises). “You won’t find me using more than .2 to .5 ccs under the eyes,” Dr. Hirmand adds. “That’s very little filler, but nobody needs more than that around the eyes.”
Think outside the syringe
In appropriate patients, Dr. Lal likes to address the surface of the skin before injecting, because in his experience, “sometimes clearing the slate can make the facial contours look so much better, you don’t even want filler,” he says. Using various devices, “we can improve pigment, redness, and texture—we can even reduce your risk of precancers. I do so much more laser than filler, because I think it gives more bang for your buck.”
Dr. Saedi also offers a wide spectrum of devices in her office—from noninvasive BBL (broadband light) to fully ablative resurfacing lasers (which remove the top layer skin)—but says it’s Sofwave, the ultrasound-based skin-tightening machine, that’s become her workhorse for improving skin quality (texture, tone, radiance) in patients over 30. In addition to boosting collagen and elastin synthesis (for a thicker, firmer dermis), the technology has been shown to increase the skin’s own hyaluronic acid content, which translates to glowier skin in six weeks, she notes. “These tightening devices give a nice, small improvement [in terms of tightening], but it’s not incredible, where people are like, ‘Oh my god, you had a facelift!” she says. With Sofwave, “what really makes people happy and earns them so many compliments is that their skin quality is better and they have that nice glow.” (While no device can rival surgery, a lot of doctors prefer Sofwave to older tightening technologies, because its energy is limited to the dermis. Unlike its competitors, Sofwave can't be tuned to the deeper or more aggressive settings that allegedly cause scarring and fat loss below the skin.)
Devices aren’t everything either, mind you. The trick is to treat the face holistically, notes Dr. Day, by incorporating sun protection, skin care, exercise, even Invisalign or veneers, if needed, “to balance out the teeth and support the lips,” she says, rather than depending solely on filler. "For the appropriate woman, I [might also] talk about hormone replacement therapy, and I refer them to doctors who know how to do it." (For these patients, hormone replacement therapy, during perimenopause and menopause, may increase the skin’s elasticity and collagen content, which wane as estrogen dips).
Aim for balance, not perfection
Exaggerated features, doughy skin, a balloon-about-to-pop tautness—the qualities that signal “filler face” are mostly born of shoddy injection technique. That’s everything I’ve been yammering on about for thousands of words now: wrong product, too much volume, and poor placement in someone who shouldn’t have had filler in the first place. But when injectors do their jobs well, “you look better and we’re invisible,” says Dr. Day.
As it turns out, though, there’s another enemy of good filler: the pursuit of perfection. “When you try to make someone look too perfect—that’s when things get weird,” says Dr. Chang. Which is why “I don’t chase lines, ever. You only end up distorting the face.” In older patients, especially, “if you aim to resuscitate the face to the nth degree, they’re going to look ridiculous,” adds Dr. Hirmand. In her experience, a person’s age is always somewhat evident from their eyes, she explains, because the bony orbit changes shape over time, making the eyes look smaller and more recessed. And if the eyes read as 65, she says, but the surrounding skin is lineless and plump, “our subconscious is going to think, Wait, why does this person look kind of strange?”
“I don’t chase lines, ever. You only end up distorting the face.”
Remember, it’s normal, it’s human, to have creases, hollows, shadows—high points and lows. When you overinflate a face and level the topography—by erasing the nasolabial folds, say, or blurring the transition between temples, cheeks, and lower lids—the vibe gets very uncanny.
With filler, the objective should always be “to balance the face, not unnaturally alter it,” says Dr. Mahmood. So while it’s cool to gently accentuate the apples of the cheeks or subtly strengthen a wimpy jawline, “we have to maintain the harmony between the different parts of the face,” adds Dr. Hirmand. “When one part is out of whack, that’s when you can tell something was done.”
Skip the routine touch-ups
Since hyaluronic acid doesn’t diminish as swiftly or reliably as once thought, many injectors have moved away from calendar-dictated touch-ups. “We don’t have standing filler appointments,” says Dr. Chang. “Patients just call if they think they want a little more, but that’s pretty rare. They know that being slightly underdone looks so much better than being overdone.”
That said, just because some portion of each injection hangs around, piling up over time, that doesn’t mean your filler will look freshly done for the duration. Its initial oomph fades as it flattens out and weaves its way into your tissues. “When it’s lost the power to give you that noticeable volumization,” says Dr. Somenek, “that’s when we can talk about a touch-up.”
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Originally Appeared on Allure
