Is Filler Fatigue Real?

When dermal fillers first became popular some umpteen years ago, it seemed like no one would ever tire of their ability to sculpt and rejuvenate sans surgery. And it certainly didn’t seem like anyone would ever be on the quest to find the next best thing. The truth is though that filler fatigue can happen — and it is becoming more prevalent — but not for the reasons you might think.

Why Filler Fatigue Happens

In some patients, the more often they receive filler injections, the less content they become with the results. They still want to see definition and volume like they once did, but it becomes a game of chase. The phenomenon is known as filler fatigue, and it boils down to the simple premise of a patient feeling as if filler no longer works for them.

Why some say they no longer notice positive changes with filler comes down to a few causes:

• Societal Standards: There is mounting pressure to look young, which creates fatigue and leads patients to turn to other modalities. “They become tired of hyaluronic acid gel fillers to lift and fill the midface,” says Ryan Neinstein, MD, a board certified plastic and reconstructive surgeon in New York City.
• Gravity: There's the gravitational factor. Gravity's effect on the skin and body never takes a day off, nor does it stop. The aging process continues even when injecting fillers.
• Overuse: The overuse of fillers and even neuromodulators can lead to less-than-ideal results and leave patients wanting more.
• Misuse: The products are misused by unqualified professionals, says Julie Russak, MD, a board certified dermatologist in NYC, which can lead to unsatisfactory results. In some cases, even if an injectable is used correctly, a patient may need an additional procedure, besides filler, to treat their concern.
• Overfilling: “It’s when a filler is used only for volume replacement — especially in large volumes — that people refer to filler fatigue as the skin stretching out due to the overuse of product,” Dr. Russak notes. This stretching effect impairs skin elasticity, making it appear not as tight as it once was.

The concept of filler fatigue does not affect every patient. Plenty never tire of the remedy and are filler patients indefinitely. But those who feel filler burnout starting to settle in — Dr. Neinstein says it tends to occur in the mid- to late-forties — often begin to make more rational decisions about why they are potentially overspending on temporary remedies instead of considering customized and lasting surgical results. “Filler products are reversible and lack long-term sustainability, plus the costs can be overwhelming,” he shares. “There is a lower barrier to surgical entry when patients exhaust the non-surgical arena because they do not have to wonder if they are overdoing it or reaching beyond the psychological threshold they have set.”

Too Much of a Good Thing?

For all of the benefits filler provides, having too much injected (a.k.a. overfilling) can lead to an unnatural and distorted look that disrupts the natural balance of the face. “You can immediately recognize this imbalance in someone whose appearance is unnaturally plump,” suggests Brendan Camp, MD, a board certified dermatologist in NYC. Because a lack of harmony can result from improper use of filler, it is crucial to seek out and choose a board certified dermatologist or plastic surgeon who understands facial anatomy and takes a prudent approach that yields natural-looking results.

It's not so much about the type of filler or technique used as it is about knowing what is and is not suitable for the face. “It can happen with any filler or any part of the face,” says Debra Jaliman, MD, a board certified dermatologist in NYC, though she adds that it’s less likely for younger patients to notice the effects of filler fatigue. The recurrence of injecting over and over can cause the face to look heavier, as each treatment session draws water to the area so the product can plump as intended. All this extra water can be retained in the face and potentially impede lymphatic drainage. In extreme cases, it can even change the skin's elasticity and cause it to be less resilient due to the skin having to support above average amonuts of water.

Rejuvenating vs. Refilling

As we age, the amount of volume in the face decreases and gravity sets in, forcing the face to sink. “We also see a loss of collagen in the skin, which results in sagging and loose texture,” Dr. Russak explains. However, she says, if you only look at the face in terms of using filler as a volumizing agent to stretch out the skin so lines disappear, it’s easy to run the risk of overfilling the face and creating a doughy, distorted look. “It’s important to take into account all of the factors of an aging face and not just volume loss,” she advises. Those other elements include skin laxity, fat loss, decreased collagen and elastin, and even bone resorption.

Even an aging face can appear full (or very full), which, Dr. Russak shares, is because volume has sunk to the lower face and created marionette lines, cheeks that drop down, and deep nasolabial folds. “Because of this, it’s important to lift the face to work against gravity rather than ‘fill,’” she says.

How to Avoid Filler Fatigue

Injectable fillers are great for minor tweaks, but when they become more habitual or routine than necessary, they can start to cause problems. Unlike neuromodulators, which should follow a maintenance schedule every three to four months, inject fillers only when needed.

To avoid expending the benefits of fillers, Dr. Jaliman recommends sticking with hyaluronic acid-based injectables because they easily dissolve if they are causing problems. More permanent fillers cause inflammation within the skin, leading to scar tissue to build up and adverse effects down the road. Rather than rely solely on one treatment, she also says that multiple modalities often need to be used together (think: lasers, peels, radiofrequency, Botox®, fillers, and skincare) for a comprehensive result.

Fillers play an essential role in the aesthetic arena, and most dermatologists and plastic surgeons agree that they have their place in proper patients. “When used in the appropriate setting, fillers are great at making subtle changes in skin lines and shadows that trim years of one's appearance in a matter of minutes,” Dr. Camp says. Yet, when they no longer provide the desired result, it may be time to weigh the options and decide if a switch is in the cards.

Beyond injectables, age-rejuvenating surgical procedures, like a facelift with fat grafting or blepharoplasty (among many other things), may be the better choice to create a youthful look that offers longer-term satisfaction. Just keep in mind that, even when going under the knife, there still may be a reason to go under the needle. At the end of the day, it’s a balancing act to create a harmonious face.