Avoiding Filler Fatigue

Filler-fatigue and “pillow face”, we’re taking a deep dive into how to avoid these skin care fails.

Hyaluronic acid (HA) based fillers are among the most widely used in cosmetic dermatology. They are a valuable tool for restoring volume and subtly elevating facial contours.  Enhancing lips, cheeks, and jawlines, and smoothing nasolabial folds and marionette lines, fillers can offer a rejuvenated appearance. They are particularly favoured for their biocompatibility – our bodies naturally produce hyaluronic acid – and their reversibility. HA fillers can be dissolved if necessary, using an enzyme called hyaluronidase, which our bodies also produce.

Some words of caution, hyaluronic acid fillers only offer slight lifting, so repeatedly adding more filler is generally not the best solution. Fillers should be used judiciously, with a clear understanding of their limitations. Using them to ‘chase every wrinkle’ can lead to an over-filled look, the so called ‘pillow-face,’ and risk ‘filler fatigue.’

Avoiding an unnatural or overfilled appearance

Filler fatigue occurs when the overuse or improper application of dermal fillers leads to an unnatural or overfilled appearance. It can be caused by:

Overcorrection: the temptation to continually add volume, leading to an exaggerated and unnatural appearance.

Layering of fillers: repeated treatments without adequate assessment of previous filler placement can result in layers of product that distort facial anatomy.

Inadequate dissolution: hyaluronic acid fillers are designed to be temporary.
Incomplete dissolution by the body’s natural hyaluronidase between treatments can lead to buildup and irregularities.

Misplaced injections: injections in the wrong anatomical planes can cause issues such as lumpiness, asymmetry, or migration of filler.

Signs of filler fatigue

So how do you spot filler fatigue? Here are some of the telltale signs:

Puffy or overly rounded features: excessive volume can create a bloated or unnatural look, particularly in areas like the cheeks and under the eyes.

Loss of natural contours: the face may lose its natural definition, with features appearing merged or amorphous.

Skin irregularities: over time, the skin can develop uneven textures, bumps, or a stretched appearance due to excess filler.

 Common areas for filler fatigue

People experiencing filler fatigue often seek to dissolve fillers in the following areas:

Tear troughs: This sensitive area can change over time, with fillers drawing in more water and causing swelling, even years after the initial treatment.

Lips: Inappropriate use of firm or thick fillers can result in an unnatural and exaggerated appearance over time.

Cheeks: While subtle filler application can yield excellent results, overuse in this area can lead to a disproportionate and unnatural look.

Dissatisfaction with fillers may now be the main reason for dissolving fillers. Other causes include:

Infection: a rare, but a possible complication that requires prompt treatment.

Delayed reactions: this can include swelling or the formation of nodules at the injection site.

Vascular occlusion: a serious but uncommon emergency where filler compresses or is injected into a blood vessel, potentially causing severe skin damage.

How to address filler fatigue

Preventing and managing filler fatigue requires a thoughtful and tailored approach.

Your dermatologist should undertake a comprehensive assessment before treatment. This should include a thorough evaluation of facial anatomy, previous filler use, and your goals. Digital imaging and 3D modelling can aid in planning and visualising results.

Adopting a “less is more” philosophy helps maintain a natural appearance. Moderation and minimalism are great mantras. Incremental treatments with conservative amounts of filler can prevent overcorrection.

Allowing fillers time to dissolve fully before additional treatments helps avoid layering and accumulation.

Ensuring precise placement of fillers within the correct anatomical planes reduces the risk of complications and promotes more natural results.

How are hyaluronic acid fillers dissolved?

Fillers can be dissolved using hyaluronidase powder mixed with saline. This is injected directly into the skin. The effects are usually noticeable immediately and continue to develop over 48 hours. Ultrasound can be used to guide the precise placement of the injections. Hyaluronidase will also dissolve some of the body’s natural hyaluronic acid. Although this will regenerate over time, people may initially feel that their appearance looks worse before it improves. This is usually temporary, with skin elasticity improving over the weeks after treatment.

Alternative treatment options to HA fillers

Hyaluronic acid fillers are a remarkable treatment option for restoring volume, but they are other rejuvenation options. Laser and energy-base treatments, microneedling, PRP and combination treatments can complement fillers and address underlying skin quality issues without adding volume.

Ultherapy® is a non-invasive treatment that delivers micro-focused ultrasound to create a thermal effect under the skin at precise depths stimulates the body’s own natural collagen production resulting in a gradual tightening and lifting effect.

Broadband Light (BBL) has a regenerative effect on dermal fibroblasts, stimulating collagen and elastin production to help boost skin quality and luminosity.

Morpheus 8 combines microneedling and directional radiofrequency. Morpheus8 works to remodel subcutaneous tissue and fat while also improving skin texture, fine lines and wrinkles.

Platelet Rich Plasma (PRP) is an effective and natural skin rejuvenation therapy. PRP harnesses the power of your own blood plasma to stimulate growth factors within the skin responsible for healing and collagen and elastin production.

Microneedling is an effective and natural way to amplify collagen and elastin levels. Medical grade microneedling works overtime to boost skin tone, clarity, firmness and elasticity.

Combination therapies, from Tone & Tighten to Radiance Recharge, there are a wide range of combination therapies available that use the latest technology and aesthetic techniques to help you are achieve your skincare goals.

To avoid filler fatigue, work with a dermatologist that shares your less-is-more approach. As with most treatment options, moderation is key to achieving your skincare goals.