Dermal Fillers: Why I’m Rethinking What I Want From Them

I’ve been doing a lot of learning recently around dermal fillers, and it’s really made me think about what I want from the products I choose to use in clinic.

I love dermal fillers. I think when they’re used appropriately, they can achieve some really beautiful, natural results.

But the more I learn about them, the more interested I become in what happens after we’ve injected them.

For a long time, we’ve talked about hyaluronic acid fillers as temporary products, often giving patients an estimated duration of 6–18 months, depending on the product and treatment area.

But it’s becoming increasingly clear that the reality isn’t always that straightforward.

We know from imaging studies that hyaluronic acid filler can sometimes remain detectable in tissues for considerably longer than the expected treatment duration. You know which one I mean too, the scary MRI of someone’s face lighting up like a Christmas tree and it’s old migrated filler that’s just sitting in tissue and then I had imagined me in a coffin in a hundred years with filler sat on my skeleton 😂 FYI it’s hyaluronic acid - it biodegrades just like your own hyaluronic acid in your skin or like your skin would after death. So absolutely not as scary as you think (for those that are strange like me).

And that’s something I think we need to be talking about more.

Because if a patient returns for treatment a year later, how do we know exactly how much of their previous filler is still there?

Has it fully degraded? Has some of it remained? Has it moved from its original placement?

And are we potentially adding more product into an area where there’s already residual filler?

These are questions I’ve been thinking about a lot.

I don’t want to spend years repeatedly adding filler to somebody’s face without properly considering what’s happened to the product I’ve previously placed.

I want more predictability.

I want to understand how a filler behaves within the tissues, how it responds to facial movement, how well it maintains its intended effect and what we know about how it breaks down over time.

I’ve also been learning much more about filler rheology, which is essentially the science of how a product behaves under different forces.

Things like elasticity, viscosity and cohesivity might sound quite complicated, but they’re really important when we’re deciding which products are appropriate for different areas of the face.

A filler needs to provide support where support is required, but it also needs to work with the natural movement of the face.

I don’t want somebody to look lovely when their face is still but have a result that looks unnatural when they smile or talk. Like your face doesn’t move or you have chipmunk cheeks - don’t worry, I’d never do that to anyone lol!

I remember being told not to lie on my face when I sleep after I had filler! Sorry that is not possible, I fully sleep on my face, so I want the filler to bounce back under force and remain where it is placed. It’s all the little weird things I think about before injecting, I’m not looking to introduce those funny looking pillows that you sleep on if you have filler as part of my aftercare just to preserve results. It’s not sustainable.

I also don’t believe achieving a good result should automatically mean using more product.

Recently, I’ve been looking at developments in filler technology and attending education around newer formulations. It’s been really interesting to see how manufacturers are approaching tissue integration, dynamic movement and achieving results with smaller volumes.

But I also think it’s important to distinguish between what a product is designed to do, what clinical studies have demonstrated and what we actually know about its long-term behaviour.

A newer product isn’t automatically a better product, and promising early results don’t necessarily tell us what will happen five or ten years down the line.

That’s why I want to keep questioning things.

I’m particularly interested in products that can provide appropriate structural support without compromising natural movement, and in having better evidence about their longevity and degradation.

I want to be able to make treatment decisions with as much understanding as possible, rather than simply relying on how a product looks immediately after treatment.

Of course, no filler is completely predictable. We can’t guarantee exactly how long it will remain in an individual’s tissues, and migration, swelling, nodules and other complications remain possible.

But I think we should always be working towards making our treatments more considered and reducing unnecessary intervention.

For me, this is also about thinking long term.

Some patients begin having aesthetic treatments in their twenties or thirties. What does that mean for them over the next twenty or thirty years?

How do we make sure we’re not continually treating the same areas without reassessing what’s already there?

How do we avoid unnecessary volume and preserve the natural characteristics of somebody’s face?

And how do we make sure the decisions we’re making today are still in that patient’s best interests years from now?

These are the things I want to understand better.

I’m not moving away from dermal fillers. If anything, learning more about them has made me even more interested in what they can achieve.

But I’m becoming much more selective about what I want from them.

Less unnecessary product. More understanding of the tissues. Better evidence. More predictable outcomes.

And most importantly, results that still look like you.

I don’t want to simply treat what’s in front of me today without thinking about what it could mean for you in the future.

That’s the direction I want to take my practice.

Ashleigh x 🤍