What is Filler Fatigue?

Filler fatigue may refer to two different issues. 1. It may refer to the psychological stress that patients develop of needing to get frequent filler injections in order to maintain their appearance. 2. It may refer to an anatomical/tissue structural problem of the face tissues getting stretched and puffy over time due to ever increasing volumes of fillers being injected into the face.

There is controversy among plastic surgery professionals as to whether filler fatigue as a structural/anatomical problem really exists. Some state that patients that have been using fillers for 10 to 15 years to maintain their youthfulness, the sag and stretch they have experienced is due to their natural aging process. That means that there is no cause and effect of fillers making people look older. Other state that people that have been overfilled beyond the capacity of the tissues to adjust (to the product), the procedure itself has damaged the face.

Treatment and Prevention

We believe there is a some of truth to both lines of reasoning.  There are patients that have aged, and they require to move on from the fillers into longer lasting, structural support surgical solutions in order to maintain their youthfulness. Trying to correct age related sagginess with fillers alone will create a balloon face, not a youthful face.  

Dermal fillers are  a temporary solution for improving the appearance of the face as the skin starts to age. Fillers are best used in modest amounts and not too frequently. Radical appearance changes using fillers can stretch the skin and skin attachment points, obstruct lymphatic drainage, accentuate migration of the fillers, especially in high mobility areas such as the lips.  Good old common sense should be basic; fillers are not magical potions, nor exaggerated demands should be made of them.

Filler in the cheek is great for someone who has a flat midface or somebody who doesn’t have very significant cheekbones, putting filler in someone whose cheekbones are already defined pretty much just stretches out the underlying tissues.  Eventually, the area becomes so expanded that “the volume of filler necessary to hold up and inflate that pocket becomes so much that it tips the balance of the face so that you have a very large cheek area and by comparison, the chin area and jawline look small.  Then the patient gets into a vicious cycle of facial distortion, the “alien face”; as the patient attempts to balance out the disproportions with greater and greater amounts of fillers, jumping from doctor to doctor looking for the “perfect physician injector”. 

Depending on the patient’s age, goals, and overall structural anatomy there are other alternatives to fillers that can be used to enhance beauty.  If the problem is predominantly skin quality; PRP, Profhilo, Mesotherapy or Fractional laser/Radiofrequency can be used.

For more advanced age-related sagging and stretching of the tissues, modalities such as injectable collagen deposition inducing treatments (Sculptra, Thin PLLA threads, AestheFill), Energy based devices such as High intensisity Focused Ultrasound (HIFU, SHIFU, Ulthera) can be used to promote skin and supporting connective tissue shrinkage and new collagen deposition.

There comes a moment where aging is even more pronounced and simple surgical options must be used to deliver meaningful results. Among these are facial liposuctions with or without skin tightening devices such as Endolift Laser, Smartlipo, Jplasma, among others. 

Advanced cases with facial bony, fat and muscle atrophy require formal surgery. Depending on the patient’s personality and characteristics, these surgical procedures may need local or general anesthesia and may include things as fat transfers, blepharoplasties, forehead lifts and a variety of types facelifts whose names can be such as Ponytail lift, Curl lift, SMAS lift, Deep plane lift, Mini lift, Short scar lift, Smasectomy, Platysmaplasty, etc.

In summary, there is no single treatment for all patients. Individualization is the key and as time goes by, changes in treatment are advisable and necessary.

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