Have We Reached A Breaking Point For Facial Filler? One Beauty Editor Investigates
The first time I got dermal fillers I was 32 years old, five months shy of getting married. By that point I’d been having wrinkle-relaxer injections (Botox being the most known brand) for around four years, and I was at a regular top-up appointment with one of London’s leading aesthetic doctors. During a joint analysis of my face and its many angles (her holding a mirror to it, me shamelessly scrutinising it), she suggested I might try a little filler to help smooth out some insecurities: a tiny dose in the chin to lift a paunch that had appeared under it and some around each temple to help ‘open up’ the face where I thought it looked sad and tired.
Her work was immaculate and imperceptible; even my partner (who told me, I quote, he’d rather I didn’t f*ck with my face before we got married) didn’t notice, and although it pained me somewhat to deceive my then-future husband (including telling him the bruising on my chin was caused by my slipping in the shower), I was pleased with the results. However, six years on, that remains the only time I’ve flirted with filler. Like many, I’ve turned my back on the treatment.
Dermal filler, or filler as it’s more commonly known, is (almost exclusively) made of modified hyaluronic acid (HA), something that occurs naturally in our skin to keep it hydrated and bouncy, but depletes over time. Available in varying levels of fluidity and viscosity, filler was designed to replace lost volume in the face that comes with ageing, such as in the upper cheeks or under the eyes. The key word there is ‘replace’, and though it can also be used to correct anatomical imbalances and– as in my case – remedy insecurities, it has been overused in recent years to puff up young profiles where patients were barely old enough to have formed a wrinkle, let alone need volume replaced. If any-thing, filler administered in young patients can be ageing, not youth-protecting.
‘Hyaluronic acid fillers cause tissue expansion – it’s like a sponge attracting water,’ explains Dr Kami Parsa, a Beverly Hills-based oculoplastic surgeon and aesthetic doctor with a famously long waiting-list. ‘If too much filler is injected, it will result in the slow expansion of your natural tissue, stretching the skin and potentially accelerating the appearance of ageing as the skin becomes less elastic.’
We thought fillers would only last six to 12months. We now know they can stay for years...
Aside from the potential ageing effects of filling the face, there are also the more serious medical finds that are putting people off. ‘It’s been over 20 years since fillers first received FDA approval in the United States,’ says Dr Parsa. ‘We now understand more about them and the potential negative consequences.’ This includes the knowledge that they can block lymphatics, causing swelling, but also the relatively new discovery that ‘while we initially thought that these products would only last between six to 12 months, we now know they can stay there for years’.
Since learning about the potential longevity of dermal fillers, Dr Sindhu Siddiqi, founder of the No Filter Clinic in Kensington, has become one of the first in the UK to use an ultrasound examination at every filler appointment, to visualise the tissue and blood vessels under the skin and see where filler has been injected. This also ensures a safer and more accurate placement of future product. ‘Some studies suggest that certain fillers can last up to five years in the face,’ she tells me, ‘and we’re finding that this is much more common than we previously thought.’ A patient might have had filler years ago, only to find some is still lurking under the skin.‘So the correct placement of filler is even more crucial: if it migrates or causes puffiness, it won’t just disappear on its own.’
Fillers are still popular, and some stats are impossible to ignore. In 2022, Allergan Aesthetics (the provider of Juvéderm, one of the most popular and trusted brands of facial filler globally) produced 100 million syringes of its products, ‘with the demand continuing to rise,’ it tells me. However, in the UK, the trend is going the other way, according to an audit taken by the British Association of Aesthetic Plastic Surgeons. Here, the number of people who had fillers injected in 2023 decreased from the previous year by 26%. While 2022 might have seen a post-Covid boost (from delayed procedures due to lockdowns), that is still a big jump backwards.
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Dr David Jack, a London-based aesthetic doctor (and beauty-editor favourite) has also seen an increase in people asking to have fillers dissolved. ‘I think years of badly done filler work are partly to blame,’ he says, ‘but also an awareness of fillers’ potential to disproportionately age the appearance.’ In young patients, he adds, the risk of this is high, ‘particularly if fillers are done to accentuate a feature that pushes it out of normal proportions to the rest of the face’. Over-volumising, he explains, ‘can create a distortion that gives an ageless and dysmorphic appearance, incongruent with youthful features’.
Dissolving filler is something that Dr Parsa in Beverly Hills specialises in. In fact, today, he dissolves the substance much more frequently than he injects it. ‘The narrative promoted by the industry that “ageing equals volume loss” is misleading,’ he says, especially for those barely into their 30s, or even younger. ‘I’ve seen an epidemic of under-eye filler that leads to swelling and malar oedema (the accumulation of fluid in the area), à la Kylie Jenner.’ Jenner’s appearance in Paris at Couture Fashion Week this January had many people questioning what had happened to her face, which was unusually puffy, especially in the eye area.
Although I’m all for anyone having whatever work they want done to make themselves happy (it would be rather hypocritical of me to think otherwise), it did prompt many, myself included, to wonder if we’re getting a bit ahead of ourselves in ‘preventative’ aesthetics.
So, have we reached a breaking point when it comes to ‘having work done’? Not exactly. ‘While there has been a decline in dermal-filler usage, the overall demand for aesthetic treatments is rising,’ says Kristin Polega, an aesthetic-physician assistant at SkinSpirit clinics, the USA’s leading provider of dermal fillers, who notes the growth in collagen-boosting and regenerative treatments ‘with a heightened focus on skincare and maintaining skin health’. ‘Preventative treatments are highly valuable when focusing on maintaining the skin’s health,’ agrees Dr Jack. Botox can sit in this camp, too, as prevention of muscle movement can stop deeper lines from forming. The fact is fillers should never have been considered preventative, and can do more harm than good in that sense.
With the demand for aesthetics ever increasing, it’s clear that when it comes to embracing ageing naturally, there is still some way to go. However, doctors are seeing patients wanting to look ‘better for their age’ rather than noticeably younger, and therefore steering clear of procedures like fillers that will change the shape or build of their face, instead focusing on the skin-boosting kind that, according to Dr Jack, ‘can reduce the need for more invasive procedures in the future’.
Would I personally return to fillers? Quite possibly. In the hands of a well-practised doctor, dermal fillers would be a quick, effective and long-lasting option to replace lost volume when my collagen levels are depleting at a rate that boosting alternatives can’t keep up with. ‘Fillers still have a role in cosmetic treatments,’ adds Dr Jack, ‘but it is becoming more refined. They’re being used more selectively.’ For some women of a certain age, fillers and facelifts remain the gold standard. But for a growing number of us, the freedom to take a different path is too good to pass up.
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