Filler Fatigue: Reasons Why People May Experience It

Trends in facial plastic surgery can be fickle. The pendulum can swing towards or against almost any surgical or non-surgical procedure. Examples include:

• Toward or away from buccal fat removal surgery
• Follicular Unit Extraction (FUE) versus follicular strip (FUT) hair restoration surgery

A third example is the recent reported shift away from hyaluronic acid filler, also referred to as filler fatigue. There may be multiple reasons why..

Some May Feel Filler Is Being Overused

Two reasons may be related to differences in aesthetic goals between the patient and the injector, or that the injector has no other available treatment. Patients may feel that fillers are recommended too frequently as a treatment for their aesthetic concerns when it may not be the best option. One example is patients who have received hyaluronic acid filler to their jawline to address jowls and other age-related changes. The problem with this is that it can worsen the appearance of the lower face by making it appear wider and more bottom-heavy, especially in women. (See: When Is Jawline Filler Not Aesthetically Appropriate?) Other patients may feel they received too much filler, though in an aesthetically appropriate location. This may be because too much was injected initially or that they had received injections too frequently. This may occur in the lips, tear troughs, or other locations.

Some May Tire of the Products Themselves

Some patients express frustration with needing to return for more filler after it dissolves. It may be that individuals who have received filler for a long time are growing tired of having to return to replace it. They may also learn about longer-lasting options such as facial fat grafting. Hyaluronic acid fillers have been Food and Drug Administration (FDA) approved for just over twenty (20) years. However, the range of products within this category has proliferated over the past few years. It is likely that only recently patients have received fillers long enough to grow tired of them. (General background: FDA dermal fillers overview) Patients are also learning more about the risks associated with fillers. Though low, these risks have been present since fillers were first used and are discussed with patients during the consultation process, and are included in the signed consent form. A skilled injector who is prepared for any potential adverse outcome can further mitigate the already low risk of serious complications. (See patient safety info from the American Society of Plastic Surgeons.) Finally, patients are concerned that some filler may last longer than the manufacturers of these medications anticipated. It is not clear, however, whether this would ultimately affect aesthetics unless the individual was not satisfied with the treatment in the first place. For more on product distinctions, see: Qualities of Hyaluronic Acid Dermal Filler Products.

How to Avoid Filler Fatigue: Better Candidates, Better Injectors

In summary, there may be user-specific reasons and medication-specific reasons for reported filler fatigue. This is inevitably more likely because the industry has pushed more individuals to inject and more individuals to receive fillers. The pendulum may swing back if only the best-qualified providers inject a better-selected patient cohort. If you’re looking to avoid burnout with injectables, you should consider:

• Working with a qualified physician injector and discussing a long‑term plan rather than single‑session goals
• Choosing more conservative dosing and appropriate intervals between treatments
• Considering alternative options for adding volume (e.g., fat grafting)
• Dissolving hyaluronic acid filler before treating again, when indicated

Contact Us

Questions about treatment planning or concerns about filler and how to avoid filler fatigue? Please contact our Cincinnati office, and our team will be happy to help.