‘Filler Fatigue’ Is Setting In

According to social media, cosmetic procedures are now in their “undetectable” era.

After years of seeing telltale signs, like obviously volumised lips or an especially plump face, consumers can’t get enough of the fresh-yet-natural cosmetic work that they speculate stars like Lindsay Lohan and the singer Christina Aguilera have recently undergone.

It’s a sign of the growing consumer fatigue around injectable fillers. Better known by brand names like Allergan Aesthetics’ Juvéderm or Galderma’s Restylane, fillers are one of the most common non-surgical aesthetic treatments worldwide, with more than 3.4 million procedures annually in the U.S. alone. Often taking less than 30 minutes to administer with no downtime, they immediately add noticeable plumpness and volume to the skin, and are popularly injected into areas like the lips, cheeks and under-eyes. But when administered over-zealously, either in terms of dosage or repetition, fillers can lend the face a puffy, pillowy look, which has turned customers off.

“There has been an epidemic of really badly done fillers, which has given them a bad reputation,” said Dr. David Jack, an aesthetic medicine physician with clinics in London and Edinburgh.

As such, people are increasingly seeking out alternative treatments. Biostimulators, for example, generally work by stimulating the body to make more of its own collagen, a natural production that slows down with age — and some, like filler, also promise to restore volume.

Other non-invasive treatments like laser resurfacing and radiofrequency appeal to consumers as being part of a more curated treatment plan, requiring more skill to administer and giving an imperceptible but noticeable result. Injectable makers, too, are updating their offerings: While Galderma’s Sculptra biostimulator has been around since 1999, Allergan and Merz Aesthetics have recently launched into the category with Harmonyca and Radiesse, respectively.

Consumers are already starting to make the switch. 47-year-old Danielle, a public relations executive from New York, used to regularly get hyaluronic acid fillers, which immediately plump the skin. But recently, she decided to pay over $1,000 more for a class of products known as biostimulators, which offer no immediate gratification, but instead encourage the skin to produce more of its own plumping collagen. While multiple, costly sessions are needed, and the results are less stark, biostimulators claim to offer a more natural rejuvenation that looks like youthful skin, rather than injected skin.

But designing a treatment menu or product offering that dovetails with these desires means understanding their somewhat conflicting nature. Consumers are clearly ready to spend more on aesthetic treatments, and are willing to adapt to longer timelines in order to see results, but they also want to be reassured that the product they’re getting is of an even higher quality, and with less obvious signs.

The “Ick” Factor

Physicians and their patients alike sharing their filler procedures on social media helped normalise and spread them into the mainstream. Many young customers consider fillers and wrinkle-smoothing injections as part of their beauty maintenance, like eyebrow shaping or a manicure — and accordingly, a raft of med-spa and injectable clinics like Ject, Plump and Ever/Body have sprung up to meet the demand.

But many of those customers are lately rethinking their routines. 43-year-old Susan Yara, who co-founded the skincare line Naturium, said she started getting fillers in her 20s, but now feels they make her look older. “I look younger when I look more natural,” she said, adding that she’s had many batches of filler dissolved.

For Yara, who often shares footage and content of her aesthetic treatments, the desire to have less fillers was partly about realising how much of it was still in her body, years after having had the injections. She described stopping her injectable appointments when pregnant and breastfeeding, and realising that the product was still in her skin, looking lumpy and uneven. “It was making me look older or even more exhausted,” said Yara. Now, she’s a big fan of biostimulatory treatments, like Sculptra and MTF Biologics’ Renuva.

That growing knowledge that hyaluronic acid fillers can remain in the skin for longer than previously advertised is motivating many consumers.

“The [injectable] companies weren’t necessarily innocent … telling people that there was this prescribed schedule of when you should have these injections done,” said Dr. Corey L. Hartman, a dermatologist based in Birmingham, Alabama. Per Dr. Hartman, most fillers will not need a top up for at least 18 months to two years, though many companies and practitioners suggest a repeat visit every six months or so.

Instances of filler migration, documented in slews of grisly TikTok and Instagram videos, have begun to change consumer perception. Dr. Jack said that bad actors who offer injectable services without sufficient expertise — in some U.S states, physicians’ assistants or nurses can offer these services, while in the U.K, licensed cosmetologists can offer them — have distorted their image, saying that he sees practitioners inject in the wrong plane of the skin, using inappropriate equipment and over-injecting.

“When you use fillers judiciously, in the correct anatomical layers…you don’t have these issues,” he said.

Still, it’s been enough for many consumers to swear off them altogether, or to greatly reduce their usage. Yara said that while she would continue to get them in her lips, where there is no equivalent alternative procedure, she was largely done with fillers.

Stimulate not Simulate

If consumers are willing to give up a little instant gratification, manufacturers and injectors have more latitude to create products that take longer to work, or are perhaps more expensive to administer.

As Dr. Hartman put it, biostimulators are for the patient patient. Many, like Nucleofill and Sculptra, take as many as three sessions to show a visible difference on the skin and don’t immediately volumise. These can be an easier sell to patients who are afraid of looking overly “done”, he said. “It’s simulating something that’s already taking place in their skin, so they don’t necessarily see it as fake.”

Biostimulators will also help to subtly reinforce the line between undetectable and blatant cosmetic work, said Dr. Jack. He estimates that around 80 percent of his clinics’ client bases have some biostimulators, adding that he and his team often use them in combination with standard hyaluronic fillers — the fillers might plump the lips, while the biostimulators will refresh the eye region.

The advent of biostimulators is not only exciting for customers and manufacturers, but practitioners, too. If customers are happy to sign on for a longer treatment plan, and understand that the result they want will take multiple sessions and modalities, their patronage is more lucrative for physicians — encouraging the development of newer technologies with more advanced results.

It’s also indicative of a trend towards procedures that work in harmony with the skin, or perhaps require a lighter touch to administer skilfully.

Given how mainstream injectables have become, treatments that have an element of naturality — either in their formulation or their perception — give off an air of elevation, prestige and status. It helps that there are so many celebrities who seem to be embracing this sort of look, too.

But achieving that look can come down to the injector as well as the injection itself. Dr Hartman said patients are often surprised to learn that he himself has filler, as well as many of his staff.

“The examples of bad work put people off…but then they’re amazed when they realise I have it,” he said. “It doesn’t fit what their idea of filler looks like.”

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Danielle’s name has been changed to protect her identity.