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Huy Luong
You may have heard that we’re in an era of filler fatigue—and honestly, it’s not hard to see how we got here. From puffy cheeks to ballooning lips, we’ve all seen what happens when filler falls into the hands of an unskilled injector. But here’s the twist: For many, the fatigue is less about an opposition to getting filler in general and more about an aversion to the classic “pillow face” appearance that overfilling can cause.
According to the American Society of Plastic Surgeons’ 2024 Plastic Surgery Statistics Report, hyaluronic acid fillers were among the top minimally invasive cosmetic procedures of the year. Roughly 5.3 million patients opted for facial fillers, a 1% increase from 2023, while almost 1.6 million more used these injectables on their lips, the report said. Simply put, fillers remain extremely popular. But what’s changing is how they’re being used, dermatologists and plastic surgeons say. We’re collectively moving from a “the more the better” approach to a preference for subtle enhancements, says Bob Basu, MD, a board-certified plastic surgeon in Houston and president of the American Society of Plastic Surgeons.
It’s less about injecting multiple syringes of filler in the lips and cheeks and more about using it delicately and strategically to achieve a natural look. “Patients are viewing fillers and other modalities for volume restoration as part of a longer-term plan for facial balancing rather than a one-time hit or one-time procedure just to get volume,” says Dr. Basu.
Curious about the ins and outs and various capabilities of a syringe (or two) of filler? You’ve come to the right place. Here, find everything you need to know before getting injected to achieve the aesthetic you want.
Meet the experts:
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Bob Basu, MD is a board-certified plastic surgeon in Houston and president of the American Society of Plastic Surgeons.
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Caren Campbell, MD is a board-certified dermatologist in San Francisco.
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Melissa Doft, MD is a double board-certified plastic surgeon in New York City.
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Dendy Engelman, MD is a board-certified cosmetic dermatologist and Mohs surgeon in New York City.
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Robert Schwarcz, MD is a board-certified plastic surgeon in New York City.
In this story:
There are two types of filler: hyaluronic acid and biostimulatory.
Let’s start with the basics: What is filler, anyway? And what exactly are doctors injecting into people’s cheeks, lips, temples, ears, and chins?
For starters, there are two primary types of dermal fillers available for use in the United States: hyaluronic acid and biostimulatory. Hyaluronic acid, or HA, is the more widely used of the two—think: Juvéderm, Restylane, RHA, Belotero, and Revanesse. Hyaluronic acid is a naturally occurring molecule that attracts water, providing a volumizing effect when injected.
Some HA formulas, like Juvéderm Voluma XC and Restylane Lyft, have a thick viscosity and are great for adding volume to “less mobile” areas like temples and the midface, says Caren Campbell, MD, a board-certified dermatologist in San Francisco. Others, like Juvéderm’s popular “skin booster” SkinVive, have a much thinner formula that can be injected superficially to help add hydration and improve skin texture. “Think of it like injecting a moisturizer into your skin,” explains Melissa Doft, MD, a double board-certified plastic surgeon in New York City. “It’s more for skin quality and not volume.” Dendy Engelman, MD, a board-certified cosmetic dermatologist and Mohs surgeon in New York City, says she finds that the microdroplets of hyaluronic acid in SkinVive “boost hyadration and radiance” without altering a patient’s facial shape. In the lips, Dr. Campbell likes injecting Restylane Refyne for “subtle hydration and restoration,” and Juvéderm Ultra for a “fuller, more glossy look.”
Biostimulatory injectables, like Radiesse and Sculptra are made from ingredients like calcium hydroxyapatite, a mineral found in bones and teeth, or poly-L-lactic acid (PLLA), which is synthetic. While these kinds of fillers can provide a noticeable plumping effect, they also stimulate collagen production over time for a longer-lasting impact. “Sculptra is best for all-over volume restoration,” Dr. Campbell says. She recommends it for people experiencing an overall decrease in facial volume due to aging or significant weight loss. However, Dr. Campbell notes that Sculptra is “not appropriate” in more mobile areas of the face, including under the eyes, in the lips, or around the mouth. Hyaluronic acid is the better option for those areas, she says.
One thing to note: Biostimulatory filler may require several sessions to achieve the results you want. “It’s never a one-size-fits-all experience,” says Dr. Campbell. “Sometimes it’s less than one vial, sometimes a series of six vials total over three months.” For example, she explains, a patient with volume loss from weight loss may need two vials per treatment over the course of two treatments, one per month, paired with a yearly touch-up. In comparison, older patients who “haven’t maintained volume” may need three treatments of two vials per treatment over the course of four to six weeks, with maintenance touch-ups every eight to 12 months.
Some filler can be removed or reversed.
If you get your lips filled with HA and hate how they look, the substance can be dissolved with hyaluronidase. (This treatment doesn’t work for biostimulators, though their effects do fade over time.) Dr. Basu says the dissolvability of HA fillers gives his patients comfort, especially those who are worried about having a bad reaction or experiencing a rare complication called vascular occlusion, a blood vessel blockage that can lead to serious side effects, like blindness. “But again, this is where we always advocate for a ‘less is more’ approach,” he adds.
While filler isn’t a forever thing, that doesn’t mean that even HA injectables necessarily disappear completely after a few months. “Although people say that filler goes away, there are some longer-lasting filler effects that (can) stick around,” shares Dr. Basu. “As someone that does a lot of facial surgery, when we operate on patients that have been overfilled—even (if it was) years ago—we see remnants of filler in our tissue planes.” He explains that this doesn’t make a facelift or neck lift impossible, but it can make the process “a little bit harder” in some instances.
Filler is not just for the lips.
When you hear “filler,” you might think of the lips, but there are so many ways to use these substances on the face and body. Filler can be injected all over, including in the temples to reduce hollowness, the cheeks and midface to plump, and even the earlobes to restore volume lost due to aging or weight loss.
The prevalence of weight loss medications has made a difference in the filler world too. Multiple doctors we spoke with for this story all highlighted a considerable uptick in patients who have lost substantial weight on a GLP-1 and are looking to restore some of the facial plumpness shed in the process. While significant skin laxity usually requires surgical intervention, filler can be used in GLP-1 patients with midface hollowing, says Dr. Basu. “That’s where HA fillers are a wonderful tool,” he says.
Biostimulators like Radiesse, on the other hand, can be used in “clever” spots like crepey skin on the arms, around the elbows, and on the upper knees, Dr. Doft says. Doctors can also mimic some of the effects of a chin implant or nose job with well-placed filler. (However, it’s worth noting that the nose is a vascularly complex area, and it’s vital to have a board-certified dermatologist or plastic surgeon perform a liquid rhinoplasty.) These nonsurgical enhancements are ideal for patients who want a subtle tweak to their profile or are curious about potential surgical interventions but don’t feel quite ready to go under the knife.
For example, when filler is injected into the nose, doctors can help with “straightening or improving symmetry,” says Dr. Doft. Chin filler, on the other hand, enhances facial balance, particularly from a profile view, says Robert Schwarcz, MD, a board-certified plastic surgeon in New York City. He prefers using Restylane Lyft for sculpting stronger chins, which he says has “the most ability to stand up on itself and not sit flat like a puddle.” Dr. Schwarcz typically performs chin filler on a patient twice a year to maintain the desired shape, though some do eventually opt for surgery, he notes.
Still, while filler can transform your face by subtly contouring, smoothing wrinkles, giving deflated lips a boost, and even tweaking the shape of your nose, it’s important to remember that it can’t do everything—including, perhaps most notably, lifting dramatically sagging skin.
“Less is more” is the rule of thumb.
Doctors widely agree that a “less is more” approach is typically best for filler and that, when done well, it can help restore balance to the face and provide a subtle refresh. “One major misconception is that filler always makes people look overdone or ‘puffy,’” Dr. Engelman says. “In reality, when placed strategically and administered by a skilled injector, filler can look incredibly natural. It’s about restoration, not exaggeration.” Dr. Basu agrees. “The best filler work is the kind you don’t notice,” he says.
Baby steps are often a good idea when it comes to filler, according to the doctors we interviewed. After all, little tweaks can make a major difference. “I would encourage people to please not look for big changes with filler—just look for very small, subtle changes,” Dr. Schwarcz shares. “That’s a successful filler experience.”
A good consultation is worth every penny.
A thorough consultation, ideally with a board-certified plastic surgeon or dermatologist, is essential for achieving the results you want, doctors say. “You hear the patient’s concerns, you evaluate their anatomy, and together, it’s shared decision-making to come up with a game plan, a treatment plan, that the patient feels comfortable with,” explains Dr. Basu. “Our job as plastic surgeons is to really educate the patient about the pros and cons so that together we can make the best decision.”
Despite the prevalence of med spas and “injectable bars” where patients can pop in for a syringe or two, it’s important to remember that filler is a medical treatment, Dr. Basu cautions. “Some people think (it’s) just like, ‘I’m just getting my hair colored.’ No,” he says, adding that even if you’re getting a nonsurgical treatment, “this is medical care, and a proper medical evaluation to make sure you’re safe is vital.”
If you go to a practitioner who is not board-certified as a dermatologist or plastic surgeon, you should still receive a thorough consultation before getting an injection. Also, don’t be afraid to ask a lot of questions about the practitioner’s training and their protocol in the event of a complication.
It might hurt a little.
Even if it’s just a small jab, sticking a needle into your face is generally not the most pleasant experience, and areas like the lips and nasolabial folds are particularly sensitive. Some doctors use numbing cream, a vibrating tool, or a dental block to help reduce in-the-moment pain.
Patients may experience bruising or swelling post-injection, which can be managed with ice packs for the first 24 to 48 hours or so. Another effective anti-swelling remedy is a delicious snack that may be hiding in the fridge. “Pineapple has (the inflammation-fighting enzyme) bromelain in it, and so it’s a great natural way of helping with the swelling afterwards,” explains Dr. Doft.
If you notice small bumps around your injection site, they can generally be massaged away, says Dr. Doft. “I usually tell my patients (to) massage it…like you’re kneading bread.” Keep in mind, though, the pain and bumps should start to fade within 48 hours following your injection. If you experience ongoing or worsening pain, or notice your skin turning white or red around the injection site, this could be a sign of an infection. Sudden vision changes can also indicate a medical emergency. If you’re second-guessing any symptoms during your healing process, it’s best to play it safe and reach out to your provider.
Watch out for the “danger zones.”
While filler can be injected in a myriad of areas, some spots are riskier than others—especially the eyes. “I don’t love injecting around the eyes,” says Dr. Doft. “I will once in a while, but it’s definitely not my favorite place to inject.”
Dr. Basu refers to the undereye, the tear trough, and the area around the nose as the “danger zones.” In addition, many doctors advise against injecting the glabella, also known as the elevens, those vertical wrinkles that form between the brows for the same reason.
Though fillers are typically considered safe when injected by a qualified provider, getting treated in these areas can come with a higher risk of vascular occlusion. Potential impacts on the lymphatic system, which helps keep the body’s fluid levels balanced and protects against infection, are a particular concern around the eye as well. “The lymphatics are so delicate there that it can lead to malar bags, or fluid collections, like on the upper cheeks, and those can be really difficult to get rid of,” Dr. Doft explains. The Tyndall effect, a bluish discoloration from filler that has been injected too superficially, is another possible side effect and is most commonly seen in the thin-skinned undereye area. However, it’s not limited to that area.
Doctors recommend that people who are pregnant or breastfeeding skip fillers, as well as those who are allergic to specific ingredients for in fillers. Individuals on blood thinners should stay away, too, as there is an increased risk of bruising and hematoma, explains Dr. Basu.
Other countries tend to get new products way before we do in the United States.
If you’re learning about new filler brands via your TikTok For You Page but can’t find them at a doctor’s office near you, there’s a likely reason for that: The FDA approval process is notoriously tough, and it can take years for a product to earn the agency’s stamp of approval.
So while we may have to wait a little longer than our friends around the globe, technology is moving fast, and doctors are excited about what’s next. “The future of injectables is all about treatments that enhance skin health, elasticity, and structure from within,” says Dr. Engelman.
For more plastic surgery trends:
Now watch as a dermatologist explains lip injections:
Originally Appeared on Allure
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