Have we reached the peak?

Have we reached the peak?

The first time I had fillers, I was 32, five months away from my wedding. At that point, I had been having wrinkle-reducing injections for about four years (Botox is the best-known brand) and had a standing appointment with one of London’s top aestheticians. During a joint analysis of my face and its many angles (she held up a mirror to it, I shamelessly scrutinized it), she suggested I try a little filler to smooth out some of my insecurities: a small dose in the chin to lift a tummy that had appeared underneath, and a little around each temple to ‘open up’ the face where I thought it looked sad and tired.

Her work was flawless and unnoticeable; even my partner (who told me, quote, that he’d rather I didn’t mess with my face before we were married) didn’t notice, and while it pained me a little to cheat on my then-future husband (including telling him that the bruising on my chin was from me slipping in the shower), I was pleased with the results. However, six years later, that’s still the only time I’ve ever flirted with filler. Like many, I’ve turned my back on the procedure.

Dermal filler, or filler as it’s more commonly known, is made (almost exclusively) from modified hyaluronic acid (HA), something that occurs naturally in our skin to keep it hydrated and bouncy, but which degrades over time. Filler comes in varying levels of fluidity and viscosity and is designed to replace volume loss in the face that comes with aging, such as in the upper cheeks or under the eyes. The key word here is ‘replace’, and while it can also be used to correct anatomical imbalances and – as in my case – fix insecurities, it has been overused in recent years to puff up youthful profiles, with patients barely old enough to have formed a wrinkle, let alone needing volume replacement. Filler administered to young patients can be more aging than youth-protective.

“Hyaluronic acid fillers cause tissue expansion—it’s like a sponge that attracts water,” explains Dr. Kami Parsa, a Beverly Hills-based oculoplastic surgeon and aesthetic physician with a notoriously long waiting list. “If too much filler is injected, it will result in the slow expansion of your natural tissue, which will stretch the skin and potentially accelerate the aging process because the skin will become less elastic.”

We thought fillers would only last six to twelve months. Now we know they can last for years…

In addition to the potential aging effects of facial fillers, there are also more serious medical findings that scare people off. “It’s been over 20 years since fillers first received FDA approval in the United States,” says Dr. Parsa. “We now understand more about them and the potential negative consequences.” This includes the knowledge that they can block lymphatic vessels, causing swelling, but also the relatively new discovery that “whereas we originally thought these products would only last six to 12 months, we now know they can last for years.”

Since learning more about the potential longevity of dermal fillers, Dr Sindhu Siddiqi, founder of the No Filter Clinic in Kensington, has become one of the first in the UK to perform an ultrasound scan at every filler appointment to visualise the tissue and blood vessels beneath the skin and see where the filler has been injected. This also allows for safer and more accurate placement of future product. ‘Some research suggests that certain fillers can last up to five years in the face,’ she tells me, ‘and we’re finding that this is much more common than we previously thought.’ A patient may have had a filler years ago but still have some under the skin. ‘So getting the filler right is even more important: if it migrates or causes swelling, it’s not going to just go away on its own.’

Fillers are still popular, and some statistics are impossible to ignore. In 2022, Allergan Aesthetics (the supplier of Juvéderm, one of the most popular and trusted facial filler brands in the world) produced 100 million syringes of its products, “as demand continues to soar,” it tells me. In the UK, however, the trend is going the other way, according to an audit conducted by the British Association of Aesthetic Plastic Surgeons, where the number of people having fillers injected in 2023 fell by 26% compared to the previous year. While 2022 may have seen a post-Covid boost (due to postponed procedures due to lockdowns), that’s still a big step backwards.

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Dr. David Jack, a London-based aesthetician (and favorite among beauty editors) has also seen a rise in the number of people asking to have fillers dissolved. “I think years of poorly performed filler treatments are partly to blame,” he says, “but also the realization of the potential for fillers to disproportionately age the appearance.” Younger patients, he adds, are at high risk of this, “particularly if fillers are used to accentuate a feature, pushing it out of proportion to the rest of the face.” Too much volume, he explains, “can create a distortion that gives an ageless and dysmorphic appearance, which is incongruous with youthful features.”

Years of poorly executed filler work are partly to blame for this.

Dissolving fillers are something Dr. Parsa specializes in in Beverly Hills. These days, he dissolves the substance far more often than he injects it. “The industry narrative that ‘getting older equals losing volume’ is misleading,” he says, especially for people in their early 30s or younger. “I’ve seen an epidemic of fillers under the eyes that cause swelling and malar edema (fluid buildup in the area), a la Kylie Jenner.” Jenner’s appearance in Paris during Couture Fashion Week in January left many wondering what had happened to her face, which was unusually puffy, especially around her eyes.

While I’m all for people getting whatever work done to make themselves happy (it would be quite hypocritical to think otherwise), it has led many, myself included, to wonder if we’re not getting a little ahead of ourselves with ‘preventative’ aesthetics.

So have we reached a breaking point when it comes to “getting work done”? Not exactly. “While dermal filler use has declined, the overall demand for aesthetic treatments is increasing,” says Kristin Polega, an associate aesthetician at SkinSpirit Clinics, the leading provider of dermal fillers in the U.S., who notes the growth of collagen-boosting and regenerative treatments “with a greater focus on skin care and maintaining healthy skin.” “Preventive treatments are very valuable if you’re focused on maintaining skin health,” Dr. Jack agrees. Botox may also fit into this camp, as preventing muscle movement can prevent deeper lines from forming. The fact is, fillers should never have been considered preventative, and in that sense can do more harm than good.

Preventive treatments are very valuable if you focus on maintaining healthy skin.

With the demand for aesthetics on the rise, it’s clear that there’s still a long way to go when it comes to embracing natural aging. However, doctors are seeing that patients want to look “better for their age” rather than noticeably younger, and are therefore avoiding procedures like fillers that alter the shape or structure of their face. Instead, they’re focusing on the skin-enhancing kind that, according to Dr. Jack, “may reduce the need for more invasive procedures in the future.”

Would I personally use fillers again? I very well might. In the hands of an experienced practitioner, dermal fillers could be a fast, effective, and long-lasting option for replacing lost volume when my collagen levels are declining so quickly that booster alternatives can’t keep up. “Fillers still have a role in cosmetic treatments,” Dr. Jack adds, “but they’re becoming more refined. They’re being used more selectively.” For some women of a certain age, fillers and facelifts remain the gold standard. But for a growing number of us, the freedom to pursue a different path is too good to pass up.


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Main photo by Jennifer George

Jennifer George is Beauty Editor for both ELLE UK and Harper’s Bazaar, creating content for print and online, from period pieces to conceptual stills and make-up shoots. Despite a career focused on luxury (from events to editorial), her ride or die hair product is a steal at £4. With a Little Black Book of London clinics, doctors and hotels, she’s the team’s resident ‘tweakment’ and spa expert.