Because we both know the limits of even the most diligent retinol routine, an actor famous for her kittenish smile and tailored separates levels with me. For a woman on the rise in this business, there are not just parts to consider, but procedures.
Her face is her instrument, and it will require maintenance, but instead of using fillers—which she calls “the devil”—she will stall out the aging process with treatments and lasers like Morpheus8 and Fraxel. And then, before she turns 50, she will invest in a surgical solution. With a grin, she deems it a kind of au naturel aging: It’s her same skin, just less of it. As she explains: “It’s low intervention until the facelift.”
Despite the omnipresence of so-called Instagram face, with its characteristic puffed-up cheeks, button noses, and smoothed-out nasolabial folds, fillers are, in fact, a somewhat recent invention—and the actor is not alone in her scorn for them. It’s been about two decades since the FDA approved the first non-animal hyaluronic acid injectable to treat and plump, after which doctors and medi-spa innovators used the aesthetics not just to approximate facial implants, but also to reshape jawlines and foreheads. Filler has made the nonsurgical nose job possible, and thinner formulas can now smooth out the hollows responsible for dark circles. But in 2022, when the American Academy of Facial Plastic and Reconstructive Surgery issued its annual trend report, the findings showed that filler use is on the decline: Doctors were doing 14 percent fewer injections compared to the year before. Filler reversals are on the rise too.
“The filler companies started narrating this concept that aging is a volume-loss problem,” explains Kami Parsa, MD, recalling the advent of the injectables. Paul Baek—a former K-pop star who founded the skin-care brand Matter of Fact—heard the same pitch. “Clinicians used to compare it to a grape wrinkling into a raisin and wanting to plump it back out,” he says. “But, of course, we all know that faces are a little bit more complicated than grapes.” Though it’s true that we lose volume as we age, the texture of our skin evolves too: While certain features recede, others start to seem more prominent. For those issues, filler can feel like a Band-Aid.
“There is filler fatigue going on,” continues Parsa, who specializes in treating overfilled faces at his practice in Beverly Hills. Filler-related pitfalls include: flotation-device-like cheeks and lips strained to their limits, scarred tissue, features warped into unnatural anatomic proportions. “The face just gets bigger and bigger and bigger,” the actor tells me. Parsa has seen it too. He blames both the cadence at which injectables are administered and the inherent properties of the molecular compounds involved. “Over time, tissue gets stretched,” he says. “It’s a slow change, so [patients] get the ‘filler face’ without even knowing it.” And then there’s the additional inflammation that fillers themselves can cause. “That’s their nature,” Parsa adds. He theorizes that injectables can even interact with the lymphatic system.
And while misapplied filler can be dissolved, Parsa is skeptical of that process. The same wellness warriors who fret about microplastics seem not to care one whit about the breakdown of medical aesthetics. Where does all the molecular facial padding go? “We were told that these products last 6 to 12 months,” Parsa points out. Two decades later, that’s less clear. One plastic surgeon I speak to tells me she still finds decade-old filler lodged in patients’ tear troughs.
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