When administered correctly, dermal fillers like JUVÉDERM™, Restylane®, Sculptra® Aesthetic, and Evolysse™, among others, can be some of the most convenient and dynamic minimally invasive treatments in aesthetic medicine. Not only can fillers replenish age-related volume loss in thinning features, but they can also be utilized to soften creases and dark shadows, lift and define facial contours, and restore a full, youthful look without surgery or major downtime. That said, Westchester board-certified plastic surgeon Neal Goldberg, MD, FACS understands how some patients may feel hesitancy before booking filler appointments despite having goals to look refreshed and age more gracefully.
The goal of treatment with fillers is always to provide subtle, natural-looking results that honor and accentuate the inherent characteristics of an individual’s face. In this blog, Dr. Goldberg highlights how masterful application and treatment from a highly experienced injection specialist can make a world of difference in the quality of one’s filler results.
Overview of Dermal Fillers
Dermal fillers are injectable substances used to restore volume, smooth contours, and rejuvenate the face without surgery or significant downtime. Many fillers are made from hyaluronic acid (HA), a naturally occurring substance found in the skin and body. Results from filler injections are visible almost immediately, with final outcomes typically apparent within one to two weeks once any mild swelling has resolved. For patients who are seeking meaningful aesthetic improvement but who are not ready for (or interested) in surgery, dermal fillers can offer a proven, low-commitment anti-aging treatment with a well-established safety profile.
While there are pervasive myths in popular culture about dermal fillers potentially distorting your facial features, the truth is that most filler treatments are performed every year without incident when administered by a highly trained injector. When results appear overdone or distorted, the cause is almost never the filler itself — the issue is typically the way the filler was placed, the amount of volume delivered, or the absence of a thoughtful, customized treatment tailored to each patient.
Common Signs of Poor Filler Results
Whether caused by poor injection technique and/or a misunderstanding of patients’ goals, subpar filler outcomes may be characterized by the appearance of overly full cheeks, exaggerated lips, or faces that simply no longer look like themselves. In many of these cases, it’s important to understand that potential complications are often the result of incorrect technique, excessive volume, an inappropriate product choice, or a treatment approach that does not prioritize a patient’s individual anatomy and natural proportions. Telltale signs of subpar rejuvenation may include:
- Overfilling: Those who have received too much filler, whether in a single session or through the gradual accumulation of multiple treatments over time, may notice that their face has taken on a puffy or overly rounded appearance that lacks natural dimension. The cheeks may look disproportionately large, or the face as a whole may appear swollen well beyond the typical healing window. This outcome often develops not from a single excessive treatment, but from an additive approach in which volume is repeatedly layered without accounting for what’s already present.
- Disproportionate lip augmentation: An unnaturally puffy look in the lips is one of the most obvious signs of suboptimal filler work. This occurs when volume is placed in the body of the lips without adequate respect for their natural shape, architecture, and proportions relative to the rest of the face. A well-executed lip treatment honors the natural contours of the lips, such as the definition of the Cupid’s bow, the line of the vermillion border, and the appropriate ratio of upper to lower lip. Your injector should enhance the lips in a way that looks balanced and intentional.
- Facial puffiness: “Pillow face” is a term describing facial proportions that have lost their natural definition and angular quality as a result of excessive filler placed across multiple areas, often over the course of several treatments. The cumulative effect is a face that appears unnaturally smooth and featureless, with softened contours that no longer reflect a patient’s underlying bone structure.
- Filler migration: “Migration” refers to the movement of product away from its intended placement site. This can occur due to incorrect initial placement, the mechanical forces of facial movements and expressions, or the gradual effects of gravity over time. When lip filler migrates above the vermillion border, it can create a blurred, undefined edge to the lip. Additionally, migration in the mid-face can alter the natural contours of the treated region in subtle but noticeable ways.
- Asymmetry: Asymmetry following treatment is another indication of imprecise filler work. While no face is perfectly symmetrical by nature, a skilled injector will always account for a patient’s natural asymmetries in their treatment plan.
Factors Affecting the Quality of Injection Outcomes
There are many factors that distinguish a natural, beautiful filler result from a low-quality outcome, including:
- A comprehensive understanding of facial anatomy: An experienced injector draws upon thorough knowledge of facial anatomy to guide every aspect of their technique, minimize risk, and respond appropriately if a concern arises.
- Choice of filler: Product selection is a more specialized decision than most patients realize. Fillers are available in a wide range of formulations, each designed with specific physical properties including varying degrees of thickness, firmness, and flexibility. A knowledgeable injector will know how to assess these factors and help determine which product is appropriate for each particular area.
- Technique: Correct application and depth of placement are essential during treatment with fillers. The solution must be deposited in the appropriate tissue layer for it to integrate properly, provide the intended correction, and avoid complications. The angle and direction of the needle, as well as the rate and volume of product deposited with each pass are technical decisions that require training, experience, and sound clinical judgment.
- Amount of volume: Volume application is critical during any filler treatment. In aesthetic medicine, restraint is often a hallmark of expertise. The goal is always to achieve a natural, proportionate result using the most conservative amount of product while still delivering the desired outcome. An experienced injector knows how to create meaningful improvement with modest volumes, while an under-trained provider may attempt to compensate for imprecise placement by using more filler, which compounds rather than resolves the problem.
Before any filler is placed, a skilled practitioner will conduct a careful evaluation of a patient’s facial anatomy, proportions, and symmetry; review any prior treatment history; engage in an honest, two-way conversation about goals and expectations; and communicate clearly about what filler can and cannot realistically achieve.
Enlisting an Expert Injector
The quality of your results depends heavily on the skill, knowledge, and judgment of the person performing your treatment. For this reason, selecting the right injector is the most important factor in navigating the treatment process. It’s a decision worth researching carefully, and one in which cost and convenience should not be the primary motivations.
Selecting a board-certified plastic surgeon-led practice to perform your injections is the best way to minimize complications and to help ensure the highest caliber of safety and results during treatment. Injectors who train and practice under the supervision of a board-certified plastic surgeon benefit from a level of anatomical knowledge and clinical oversight that’s difficult to replicate in other settings. For patients, this translates to a higher standard of safety, a more thorough assessment process, and a greater likelihood of beautiful, complementary results.
When under the care of an expert injector, fillers can be a safe and effective treatment with the potential to deliver beautiful, lasting improvement. If you have any questions or if you’re ready to book your appointment, don’t hesitate to contact Dr. Goldberg today. We serve patients throughout NYC, Westchester, and nearby areas.