Facial fillers have become a staple for those looking to get a “little work done.” Although they’ve been around in various forms since the 1800s, the popularity of facial fillers has surged in the past decade. Thanks to safer formulations and the influence of the Kar-Jenners and other social media stars, the dramatic effects of a well-placed injection have become widely recognized. Despite fears of overfilling and migration in the era of “Instagram face,” fillers continue to grow in popularity, with an 8% increase reported over the last year by the American Society of Plastic Surgeons. But have they reached peak popularity, or are we just getting started with the filler r(evolution)?
Featured Experts
- Dr. Karan Lal is a board-certified dermatologist in Phoenix, AZ
- Kimberly J. Lee, MD, is a board-certified facial plastic surgeon in Beverly Hills, CA
- Joel Schlessinger, MD, is a board-certified dermatologist based in Omaha, NE
“There is a dichotomy of how people think about filler,” says Phoenix, AZ dermatologist Dr. Karan Lal. “There are people who do not want fillers because they believe that fillers will change the way that they look. There’s another group of people who want filler as a means to maintain their appearance. I always say that it would take a lot of filler during multiple visits to really change someone’s appearance.”
1800s: The Origins of Facial Fillers
Altering the face with injectables is nothing new. In 1830, German chemist Karl von Reichenbach invented paraffin wax from petroleum. Just 14 years later, Irish surgeon Francis Rynd developed the hollow-tipped hypodermic needle. By the end of the 19th century, doctors had combined these inventions and used paraffin as a filler for cosmetic procedures like wrinkle reduction and breast augmentation. However, paraffin wax was problematic due to its tendency to migrate under the skin, leading to complications such as embolization and the formation of granulomas, or small nodules.
It wasn’t until 1981 that bovine collagen (called Zyderm) became the first FDA-approved filler after trials with petroleum jelly, silicone and various animal collagens proved unsuccessful. According to Dr. Lal this early material, derived from cow collagen, required allergy testing and provided only temporary results, typically lasting just a few months. “Even human collagen was once used for injectable purposes. We learned rather quickly that the collagen-based products were associated with a lot of problems.”
“The earliest fillers that I used were simply called ‘collagen’ fillers,” recalls Omaha, NE dermatologist Joel Schlessinger, MD. “They lasted about two months at best and were limited by the fact that they had to be tested initially for allergy, so patients had to wait about two to four months to make sure the fillers didn’t cause allergies, which could be a huge problem.”
1990s: Enter Hyaluronic Acid Fillers
The limitations of bovine collagen paved the way for the next major breakthrough in filler technology: hyaluronic acid (HA). “Hyaluronic acid, which emerged in the late 1990s, was a game-changer,” says Dr. Kimberly Lee. “As a substance naturally found in the skin, it’s highly biocompatible, offering more natural-looking results.” This advancement led to fillers that not only lasted longer but also significantly reduced the risk of allergic reactions. It was a pivotal moment for dermal fillers, setting the stage for their widespread popularity today. “With these new fillers lasting anywhere from six to 12 months and having a lower likelihood of causing allergic reactions, their appeal among patients grew rapidly,” adds Dr. Lee.
Since the introduction of HA fillers—such as Juvedérm, Restylane and RHA fillers—there have been numerous advancements in what fillers are available and how they perform. Facial fillers have evolved from basic materials into sophisticated compounds with varying densities, viscosities and durations. Dr. Lal notes that “over the years, there have been advances in the cross-linking of hyaluronic acid molecules, which has increased the longevity of fillers.” This cross-linking process improves the stability and cohesiveness of facial fillers.
“By crosslinking, the HA fillers are able to hold their shape better, leading to longer lasting results and more precise outcomes,” explains Dr. Lee.
Early 2000s: Biostimulatory Fillers
Another significant evolution in dermal fillers has been the development of biostimulatory fillers like Sculptra and Radiesse, which were FDA-approved in 2004 and 2006, respectively. Unlike traditional HA fillers, these products stimulate the body’s natural collagen production, offering gradual and long-lasting improvements in skin volume and texture. “These fillers encourage the body to produce its own collagen, providing a more natural and gradual enhancement,” Dr. Lee explains.
However, biostimulatory fillers are not dissolvable like HA fillers. “The beauty of HA fillers is that we have the ability to dissolve them if someone is unhappy with the results or if a complication arises,” says Dr. Lal. “Other fillers, such as Bellafill and Radiesse, which are non-hyaluronic acid based, do not have dissolving agents, which can be concerning if a problem arises.”
Facial Filler Misconceptions and Backlash
Despite their widespread popularity, facial fillers are not without their critics. A common misconception is that fillers can drastically alter one’s appearance, leading to an unnatural or “overdone” look.
“People always assume that fillers are going to be ‘too much’. No doubt, there are unscrupulous injectors out there who inject to the point that lips are deformed or cheeks are like tomatoes,” adds Dr. Schlessinger. “These are the ones that give fillers a bad name, but there are also artists out there that know when to stop and leave room for improvement rather than doing it all at once.”
“Good filler placement should not alter your facial appearance,” Dr. Lal asserts. “It’s about strategic correction of fine and deep wrinkles and volume deficits.”
Another concern often raised by critics is whether fillers age you over time. The belief that fillers might stretch the skin or cause long-term damage is a topic of debate. However, Dr. Lee clarifies, “when done correctly, fillers do not age you. In fact, they can stimulate collagen production, which can improve skin quality over time.”
Still, there is a growing awareness of the risks associated with overuse. The so-called “pillow face” phenomenon, where excessive filler leads to a bloated appearance, is a cautionary tale. “There’s a group of patients addicted to fillers, and this can be dangerous,” Dr. Lal warns. “Fillers are meant for strategic correction, not to replace proper skin care or to lift the face.”
2024 and Beyond: The Future of Facial Fillers
Looking ahead, the future of dermal fillers is bright, with ongoing research and innovation promising even more advancements. Dr. Lal says combination fillers, which blend HA with other biostimulatory agents like calcium hydroxylapatite, are on the horizon. “These fillers are available outside the United States and have some of the best data for true skin rejuvenation,” he says.
Additionally, the recent FDA approvals of fillers in new areas, like the under-eyes and jawline, as well as the introduction of SKINVIVE for skin hydration reflect the expanding capabilities of these products. “Skin boosters, which improve skin tone and quality, are very popular abroad and are finally making their way to the U.S.,” Dr. Lal says.
Dr. Schlessinger adds, “We are doing clinical trials on new fillers as we speak that should last longer and have more utility in areas like the lips, creases and other ‘untouchable’ areas. The future is bright and I am so excited to have been a part of this monumental area of beauty for our patients.”
