I’m curious about the side effects of filler. Does it really build up in your face and just stay there, like for the rest of your life? If the results are supposed to last only a few months, why do I see people talking about long-term effects? Should I be concerned?
You’re right to be curious and concerned about the side effects of dermal filler. Not because these products are inherently harmful or because there’s proof they stay in your face for the rest of your life, but because getting filler is serious business.
Contrary to what a lot of advertising and content on social media would have you believe, filler is not a quick and simple aesthetic tweak. There are multiple types of fillers approved for cosmetic use in the United States, including hyaluronic-acid fillers (such as Juvéderm and Restylane), which can be dissolved with injections of hyaluronidase, and biostimulatory fillers made with calcium hydroxylapatite (like Radiesse) and polylactic acid (like Sculptra), which promote your body’s own production of collagen and elastin and cannot be dissolved or removed easily. The longevity and potential side effects of each filler are different. But in theory, the effects of most U.S.-approved fillers are designed to last somewhere between six months and two years, and the most common side effects are bruising and swelling, according to the FDA. In practice, things are more complicated than what you’ll read on the FDA website.
For example, “we have MRI evidence of filler lasting up to 12 years,” say Mobin Master and Stefania Roberts, cosmetic physicians in Australia who have published research on the long-term effects of filler. “Patients hear that and may freak out, but oftentimes filler can remain in the dermis and it’s not doing anything clinically relevant,” says board-certified dermatologist Melissa K. Levin, the founder of Entière Dermatology in New York City, meaning its presence isn’t necessarily affecting your health or appearance.
That said, other things can go wrong. One issue experts have noticed — especially as more people get filler — is that it may last longer than expected in some areas of the face, leading some people to add more filler prematurely. “There seems to be early scientific evidence that longevity seems to be more common in the mid-face — the cheeks, next to the nose, the tear troughs, and the nasolabial folds,” say Master and Roberts.
Why would someone continue to get filler when they’re already, uh, filled up? Levin says it could be that a person’s concept of what they look like can shift as they get more cosmetic work done. “You can have a perception drift of what is normal and then the provider can also have the perception drift of what is normal. So people tend to chase this idea of what they think they should look like, and they stack and stack the filler and that leads to an overfilled look,” she says. That’s one reason it’s important to see a provider who takes photos before every appointment. “Not taking photos is a red flag,” says Levin. “Many of my patients don’t want to see the photos, but we always take them, and sometimes it’s helpful if they don’t notice a difference and we can look at the photos together to see what’s changed.”
Another issue that has been documented anecdotally is filler movement (just search “filler migration” on TikTok and YouTube). But this “migration” may actually be misplacement or overfilling, according to new research published by Master and Roberts. In one study, Roberts injected Master’s face, then conducted imaging studies that showed the filler “flattened” a bit over a 27-month period but did not move to other areas of his face. Master and Roberts’s explanation: “Migration is often a consequence of misplacement or overfilling in one session or repeated sessions.” If more filler is injected in the same “compartment,” it has nowhere to go and can “spill” into an adjacent area. If someone experiences that particular complication, it doesn’t necessarily mean the filler was injected improperly, but a good provider will point out the issue and may suggest injections to dissolve the existing filler (if it’s a dissolvable product like a hyaluronic-acid filler) before injecting more into the original site.
But the above complications are just two long-term issues to be aware of if you decide to get filler; there could be other concerns depending on your genetics and your medical history. That’s why I have to issue a PSA: Please book a consultation with a board-certified physician who has experience in aesthetic medicine before you get filler. I realize some states allow physicians’ assistants and nurses to inject filler independently or under physician supervision, but the laws often change and I’ve seen plenty of stories of medi-spas operating illegally. Sometimes, people push back on having a consultation with a physician, but, says Levin, “you want to make sure you and the provider have a congruent philosophy, not only of beauty but also of aging.” You are literally interviewing this person to see if you trust them to inject a foreign substance into your body!
Over the past ten years, I have gotten Restylane and three types of Juvéderm injected into my face and been thrilled with the results. But I do think one of the reasons I’m satisfied is that I found a dermatologist I trust and have stayed with her. You should do the same. “I always tell patients I’m not a makeup artist. I’m not here to make you pretty for a month or three months. I’m a physician, so I care about your skin health for your lifetime,” says Levin. Do yourself a favor and find a provider with a similar point of view.