Two doctors reflect on the normalisation of fillers, and how a keener understanding of how it works can help to prevent undesired effects like overfilling
Kylie Jenner was only 17 years old in 2015 when her covetable “pillow lips” inspired the viral #LipChallenge on the Internet, causing thousands of impressionable young girls to artificially plump their lips by sucking them into a shot glass, the negative pressure causing their lips to temporarily swell. At the time, the reality TV star denied getting work done, stating that her lips were au naturel, even if they looked vastly different from when she was a child. Later on, when she did admit to having lip fillers, the number of Google searches for the procedure shot up by 70 percent.
By 2019, Jenner and the rest of the world have become much more open about getting fillers. And botulinum toxin, once marketed as a solution for visible signs of ageing on the skin, has now evolved to become a preventative procedure, where anti-wrinkle injections are touted as a reliable and safe treatment to prevent the formation of lines and wrinkles even before they appear.
The Kylie Jenner phenomenon left a huge impression on Dr Gavin Chan, a cosmetic doctor and liposuctionist based in Melbourne, Australia, who’s provided anti-wrinkle, injections, dermal fillers, liposuction and laser treatments to clients for the past 18 years. “It’s difficult not to succumb to these trends,” he reflects. “These influences may have, in part, led to the overfilling we often see today.”
Social media is a dangerous place. Dr Lisa Chan, a general practitioner based in Hong Kong with a keen interest in aesthetic medicine, believes that social media plays a big part in creating unrealistic beauty standards and causes users to develop an obsession with perceived flaws. “It’s not ideal to try to copy someone else’s look instead of highlighting your own natural beauty,” she laments.
A doctor who once also succumbed to patients’ demands, Gavin Chan calls the problem of overfilling a conundrum. “Since then, I’ve fought against overfilling in my practice and through my YouTube channel,” he says. “It’s so common despite its unattractive nature and I believe it’s a perfect storm of patient, practitioner and product factors.”
Most consumers and practitioners believe that temporary hyaluronic acid fillers only last six to 12 months – something Gavin Chan subscribed to as well, until he noticed that overfilled patients remain overfilled despite years passing without adding more fillers.
“I investigated this phenomenon with radiologist Dr Mobin Master in 2019,” he says. “He performed MRI scans on filler patients who had fillers two or more years ago and found that their filler persisted – up to 12 years in some cases.” Since then, more research and studies have backed up their claims. The fillers stay – it’s only the “effect” of fillers that may last months rather than years. When Master further studied the effect of fillers on his own face, he would find that the properties of fillers changed over time. They flattened and spread out, losing its initial effect. As the fillers move, it becomes an impetus for patients to have more filler done even though the filler is still present.
There’s another problem with fillers – they can be addictive. In another study done by Dr Toni Pikoos, a psychologist who specialises in body dysmorphic disorder (BDD), 19 percent of patients show signs of addiction after filler treatments. “Studies show the prevalence of BDD is about 2 percent in the general population but soars up to 15 percent in the subpopulation of those seeking cosmetic procedures,” says Lisa Chan, who’s treated overfilled patients whose fillers are placed too superficially or too deeply resulting in soft tissue displacement and malpositioning.
Lisa Chan believes BDD can lead to overfilling, but that “overfilling can also be caused by a practitioner’s inaccurate initial facial assessment, inappropriate choice of filler, incorrect product placement and over-zealous treatment.”
As a doctor, she tries to set realistic expectations with patients from the outset. “It’s always better to look natural and harmonious rather than aiming for excessive volume,” she says. “It’s important to really understand what a patient wishes to achieve through the injection of fillers, sometimes a different treatment is a better choice to reach their aesthetic goals.”
Lisa Chan will usually go through a patient’s aesthetic goals with them first, before evaluating the impact of overfilling on facial harmony and discussing treatment options. “With patients who seem ready for it, I’ll encourage a treatment plan that focuses more on bringing out their natural beauty so they can regain confidence in their appearance,” she says.
“It’s actually harder to say no to someone and have to explain the reasons why rather than to just inject them,” says Gavin Chan. “Overfilling not only has aesthetic consequences but also significant psychological consequences, with the overfilled not wanting to return to a face without filler.”
But as more doctors like himself understand the potential longevity of fillers and their properties, he’s become more careful, and more selective about the way he injects. “My use of fillers have become significantly less frequent and I only inject in small amounts. On average nowadays, I inject fillers once a month in my practice. Instead, I’m more focused on treating skin quality and performing cosmetic procedures that centre around improving attractiveness.”
“I choose to spread sessions out instead of injecting everywhere in one go as a little can go a long way,” Lisa Chan adds. “I think society as a whole needs to become more self-aware – how we look doesn’t define who we are.”