Nobody walks into their injector’s practice and requests to look completely unrecognizable. Yet, we often see real life examples of “too much of a good thing” when it comes to injectables and fillers. Whether it be a celebrity, reality TV star, influencer or the neighbor across the street, it’s easy to clock when someone has been dealt with a heavy hand by their injector.
In years past, questionable plastic surgery consisted of overpulled faces and eyes that looked way too tight. Today, the pendulum swings the other way with overinflated contours and unnatural looking proportions that look bigger, not smaller. “The classic overfilled area of the face we see often is over injected lips and now, more frequently, we’re seeing overinflated ‘Apple’ cheeks,” says Delray Beach, FL dermatologist Dr. Janet Allenby. “Sometimes a little less obvious, but we’re also seeing the temples overfilled and lately a lot of men with overinflated cheeks and chins, too.”
While it’s easy to say so and so has had “too much work done,” there are a variety of reasons that can lead to a less subtle, more dramatic result. Here, our experts explain why this problem is becoming so prominent and which mistakes lead to this puffed up, pillowy result.
Using the Wrong Filler
“Certain fillers are meant to be injected in deeper layers of tissue and certain fillers are meant to be injected in more superficial layer of tissue,” explains Palo Alto, CA facial plastic surgeon Sachin S. Parikh, MD. “It’s a discussion with your provider to make sure that they are injecting and picking the correct filler for the needs in your face, whether they’re addressing tissue loss in the deeper fat pads or using a filler that’s only going to look good more superficially. When you use a filler that is meant for deep tissue and it’s injected in large amounts, you can start to create that overfilled look.”
Using Too Much Product
According to San Francisco dermatologist Amelia Hausauer, MD, one syringe of filler is equivalent to the size of a blueberry. “If you were to squeeze it out and measure, it is the size of a blueberry, so it’s not very large. It doesn’t take a very large volume in order to look overfilled or overdone,” she says. This is why you have to be so strategic about where you inject.”
Too Soon for a Touch Up
Dr. Hausuaer adds that sometimes the issue is not too much, but too soon. “For patients who have neurotoxin placed, the filler surrounding that muscle can last longer because the muscle is not contracting against the filler,” she says. “Also, people may think they’re ready for a touch up because they’re going by the calendar and how long it’s supposed to last, but that’s not always the case. Recently they did a MOHS study where they found residual filler up to 10 years after a patient had been injected. So the stuff hangs around in the tissue longer than expected. Whether we can clinically detect that with the eye or not is a different question.”
Poor Filler Placement
Placing filler in areas that disrupt the natural contours of the face can also lead to a pronounced appearance. “When there is a strange bulbous look to the cheeks, like in a marionette puppet, the flaw may be the overfilling of the medial cheeks,” says Bloomfield Hills, MI dermatologist Linda C. Honet, MD. “Sometimes the medial cheeks are so overfilled, they can literally push up on the lower eyelids and can narrow and shrink the eye aperture, making them appear squinty at rest. In contrast, the overfilling of the upper lateral cheeks can make a face appear sharp and harsh.”
“There are a lot of misconceptions in the aesthetic field including a complete lack of standardization of aesthetic education. This leads to every injector playing to their own tune and producing unnatural outcomes,” adds New York City oculoplastic surgeon Irene Gladstein, MD. “It is of paramount importance to pick a provider who has keen aesthetic eye, values natural appearances and will create a long-term treatment plan to guide one today, tomorrow and ten years from now.”
Jumping From Injector to Injector
One note our experts want to stress is the importance of continuity of care. Hopping from one injector to another means this history of the injectables that are metabolizing in your system are not following you from treatment to treatment. “If you’re jumping around, there’s no continuity,” says Dr. Parikh. “It’s not like those providers are talking to each other and they’re not getting the information on what was injected beforehand to know which needs to be done next.” Staying with one trusted expert injector can help you achieve more natural-looking results as they are monitoring how your body reacts to the products, how long they last and how often you undergo treatment.