"Filler Fatigue": How to avoid the "doughy" look.

Several times a week, I see patients who are considering facial fillers for the first time. They understand that fillers are an excellent non-surgical tool for providing volume and structure, but they are terrified their faces will look distorted.  I empathize with them. Unnatural, doughy-looking results are so prevalent—even among “the rich and famous.” It’s difficult not to be suspicious.

The fear of fillers has almost eclipsed the paranoia formerly reserved for prospective facelift procedures. In the right hands, though, fillers can provide a remarkable, soft, youthful outcome restoring lost volume and enhancing aging features. I believe there are just as many natural results as unnatural results—you just don’t notice those who have chosen an expert injector. Their appearance is age appropriate and balanced. An expert injector understands proper proportions and is highly familiar with facial anatomy. Disaster happens when the wrong type of filler is put in the wrong location in the wrong amount. And then repeated, because some patients believe “…if a little volume is good, then more is even better.”   I call this “filler fatigue.” 

Looking “overdone” is not always the fault of the practitioner. Patients often demand more and more. Recently, I walked into my consultation room to find one of my patients who evidently did not heed my advice to “hit the pause button” and see me annually. She claimed she was anxious and went to several other doctors to give her the filler I advised against. She was holding so much fluid in her face, she appeared 15 years older than the last time I treated her. Her face was formless—no curves or hollows. We will correct this over time, but she serves as a warning of unfortunate situations that can (and should) be avoided.  

How do I help my patients sidestep “filler fatigue”?  First, I actively listen to what they are trying to accomplish, and taking that into consideration, use the following approach to share my filler facts:  

• Consultations are important. I always see a patient in consultation before booking an injectable appointment. Evaluation of facial anatomy is critical. While Botox or other neurotoxins last approximately 3 months, fillers can last 1-5 years depending upon the type of filler and a patient’s rate of aging.
• How often should a patient return for treatment? There is no way to precisely predict when and how much until the time arrives. This is why I see my non-surgical patients annually. We study photos and compare year by year to determine next steps.
• Some fillers can be “reversed” with an antidote called Hyalurnodaise.  However, fillers are not benign. Cheeks are a popular place to use filler, but if you repeatedly introduce too much filler, the nature of the tissue can irreversibly change.
• Not all fillers are created equal. They have different physical properties and are area specific and application sensitive. Lips, cheeks, nasal labial folds, glabella (between eyebrows) area—all use different types and concentrations of filler. It takes a practitioner with deep understanding of facial anatomy and experience with a combination of fillers and recommended doses to optimize the result.
• Fillers can carry serious complications. As techniques, products and treatments have evolved, deeper planes of the face are targeted. This helps to achieve a 3-dimensional rejuvenation but also more serious risk. Blood vessel supply to the face is all interconnected. Unintentionally piercing a blood vessel can block circulation to the skin or eyes causing skin to die and/or vision loss.