Let’s face it, it seems as if almost everyone is getting cosmetic work done these days. With price points more feasible for everyday beauty consumers and education more readily accessible, the general public, outside of the 1 percent, are opting for aesthetic enhancements more than ever before.
The accessibility creates a slippery slope of overdone work if one isn’t careful. Enter: Filler Face—the online label given to the phenomenon where filler treatments meant to provide an overall refreshed and youthful look are causing people to appear unnatural, and far older than their actual age.
Meanwhile, “I like to focus on health and wellbeing, and primarily on skin health,” licensed aesthetic professional Celina Craig RN BSN FNP-S tells ESSENCE. “I think people forget that the skin is the largest organ of your body, and it’s also something that needs to be focused on and treated.”
Below, the expert dives deeply into what filler face is and debunking myths about botox and filler.
What are the different types of injectable treatments?
Craig outlines the different types of injectable treatments, which are most commonly sought out, and how they are tailored to different concerns. “For preventative care, you’re typically going to see [patients] ages 20s-30s, who are not showing visible signs of aging, meaning deep lines, sagging, or laxity,” he says. “They look overall youthful, and are trying to maintain that. Corrective would be someone, maybe in their 40s and on, who is already showing visible signs of aging, and trying to stop or reverse it to some degree. What I usually say is that the age you botox is the age you’re maintaining.”
What is the difference between botox and filler?
Botox is used to freeze the youthful skin in place, or prevent the skin from aging further. For further corrective treatment, filler and injectables such as Sculptra, a collagen stimulant, would be used to fill fine lines or loose skin. The average treatment cycle for botox is three to four months, keeping patients at three annual visits if they’re consistent. Filler can last anywhere from one to three years, with newer studies indicating that the effects are longer lasting than the medical trials testing window. The demographics of who is seeking out treatments tend to be evenly spread, however Craig has noticed a shift in recent years.
“I wouldn’t say that it’s geared more towards younger or older clients. It’s moreso [the fact that] at first it was such a luxury expense that it was reserved for the rich, and now it’s more affordable,” she explains. Still, she notes that the most common services younger people come to her for are lip or under eye filler. Once more informed, it is common that clientele may opt for different services post-consultation, including using filler a bit more intentionally. All of which is a result of proper education from the provider.
Why does botox make younger people look older?
It is often warned that when using botox in an isolated area, it freezes the muscle in place, but as a result causes other muscles to overcompensate, increasing the appearance of wrinkles in other areas. To this Craig responds, “absolutely. This is why people who are younger look a lot older, because we’re not treating the face as a whole. Whether it’s preventive or corrective, we need to be looking at the face globally. Essentially, the face muscle is a big sheath, and once you stop something, the other thing works a little bit more.”
Can filler really migrate?
The same applies for filler treatments. When a patient or provider treats a spot locally without considering how it will affect the entire face, unnatural and overfilled appearances may start to sprout. And yes, filler can migrate, but it is not as extreme as the internet would have one believe.
“It depends on the plane you’re injecting and the product you’re injecting it with. [If either are] incorrect, it’s probably going to migrate and diffuse. So yes, it can migrate and diffuse, but you do break down the majority of it. There may be a percentage lingering, but it’s something that can be easily dissolved,” she assures. That being said, for those who receive filler treatments over a longer period of time, some dissolving maintenance is eventually required. Lips are prone to migration due to the constant movement via eating and speaking. “With time, it can migrate and it’s not necessarily the injector or product’s fault, that’s just our natural anatomy.”
How can I tell if filler is overdone?
“If I put a needle in your lip and the products won’t push, that’s an indicator that there’s not enough space. If a patient comes in and they want lip filler, but they’re overfilled, it’s because they see the filler outside of the lip. The filler has to find its place, so it’ll move, and you’ll see that people get what’s called a filler mustache.”
Craig is adamant about walking a patient through treatment plans so they can conceptualize everything for themselves. In overfilled cases, she always hands her patient the mirror so they can identify the filler bubble forming behind their lips, which in reality makes the lips appear smaller.
“If we dissolve it, you’d be surprised how your lip actually pushes back out. You probably don’t even need lip filler after that. With about 50% of my patients, I don’t refill them after I dissolve because their lip is now showing without the heaviness of [migrated filler] covering it. They’re okay with dissolving, but I do have to hold their hands to do it, because in their mind, dissolving is making it smaller. Taking your time to educate and explain is the biggest thing so that they understand what’s happening.”
Why are providers allowing this to happen in the first place?
“You have to remember that even though it’s healthcare, regardless if it’s aesthetics or primary care, it’s still a business,” she cautions. “Who is running that business and how they operate, will determine how the providers are.” She says many of the discrepancies between ethics and business occur when aesthetic clinics pressure providers to meet a monetary quota. This practice prompted her to open up her own practice, Refresh Me Aesthetics, because she saw too often how common it was for lips, under eyes, and cheeks to be overfilled at the patient’s request, without proper knowledge to recommend against it. Though patients can be persistent, it is ultimately up to the provider to carry out or refuse service. “It’s not a patient problem, it’s a provider problem,” she emphasizes.
How to avoid adverse effects
It comes down to education and patience. “If you don’t understand what you’re doing well, then you kind of let the patient choose their destiny,” she explains. Being informed and experienced is crucial, as is the ability to impart that wisdom to clients without exacerbating insecurities or turning them away. It takes a careful approach to suggest a different treatment route without making patients feel that they need more of something. “I think that especially when you’re new in the industry, people tend to overfill patients, because they might say they need or want something, and you don’t know how to tell them, ‘No, let’s do this instead.’”
She uses lip filler as an example once more: “Let’s say a patient comes in and wants bigger lips, and they don’t need to be bigger, but their chin is more recessed. I don’t want to create an insecurity here, but if we add chin filler, we’re balancing the face, and now the lips look the way they’re anticipating. It’s more about understanding how to balance the face with treatment. If you educate them, people tend to listen and understand. It’s when the provider doesn’t educate them, doesn’t have the patience, or their owner’s down their throat, that’s when it gets dicey.”
What leads to filler face?
Unnecessary or incorrect treatment can often lead to this “filler face” phenomenon which can cause a lifetime of insecurity. She details coming across clients with unhealthy fixations on treatments, and the extra time that is needed to ensure she isn’t contributing to addictive behaviors. She believes trend-chasing and indulging in excess is detrimental in any industry, and looks to set a precedent for herself and others through her own practice. Craig is no stranger to denying services to patients who insist on excess, but does all she can to provide them with tools to make more informed decisions.
“If I don’t feel it’s safe or necessary, I will not treat them. There comes a point where it’s unsafe to inject more filler. There is an increased chance for a vascular occlusion, meaning, the filler gets into the vein or a blood vessel, blocking blood flow to your face. Extreme cases can cause necrosis and require surgery to remove all the dead tissue. Now there’s another insecurity, because imagine someone who’s hyper focused on their face, now experiencing a dent in their skin.”
What should the goal be?
Craig also discusses the contradictions of needing to simultaneously be perfect and “natural,” and believes that is moreso a product of social media. People, specifically women, are faced with digital landscapes that critique every flaw, while also shaming those who seek to address them. Receiving aesthetic treatment shouldn’t expose one to shame or undermine their self worth, and it doesn’t mean they weren’t confident beforehand. Responsible providers teach their patients that the goal is not to chase perfection, or replicate the unattainable and photoshopped finishes seen across feeds, but instead looking to these practices as self care.
Ultimately, everyone has texture, wrinkles, and blemishes, and it is no moral failure for wanting to treat them. By rooting aesthetic medicine in education and transparency, providers can safeguard patients from falling victim to the filler face, or the hamster wheel of false perfection.