Are fillers cancelled? Er, not yet!  

There’s a lot of talk at the moment that fillers are ‘over’, ‘cancelled’; that celebs are having their fillers dissolved, that normal patients are so worried about ending up with chipmunk cheeks or trout-pout lips that they are turning away from injectables and opting for energy-based devices like RF needling to fix their faces instead. What on earth? Is this for real? Will ‘machine-face’ be the next big trend in aesthetics? It sounds like a great storyline, but does it really stand up? Here are my thoughts on why fillers aren’t going anywhere any time soon, with views from expert practitioners and filler manufacturers.

Filler-phobia

It’s absolutely true that the fear of looking weird after fillers is widespread. Most of us now recognise that when someone’s face looks a bit strange or overblown, it’s thanks to bad work with filler. (Bad work is a particular problem in the UK where we are still waiting for licensing regulations for aesthetic practitioners to become law.) None of us wants that, and many people conclude, understandably enough, that the way to avoid this is to steer clear of fillers altogether.

Playing into this is a greater awareness that fillers don’t always break down and vanish as quickly as they are generally supposed to. I was amazed to find, when I had an MRI in late 2021 after nearly four years without fillers, that there was nearly 30ml of product still residing in my face – though it’s all exactly where it’s meant to be, so it hasn’t put me off having more filler since then.

Famous faces are (allegedly) turning their backs on fillers.

We’ve heard so many celebs talking about having had their fillers dissolved, and how much better they look without them, that we all accept it as fact. From the way they talk, you’d think that having filler in the first place was a shameful behaviour that they’ve now outgrown – yet they rarely mention that in most cases, they’ve had had more filler injected – just more skilfully, by a better trained practitioner with a more artistic eye. You might think you’d know if they’d had filler, but as always, the best injectables are undetectable. When a practitioner tells me they’ve dissolved all of a celeb’s filler, and are using different treatments to prop up their beautiful face, I’ll believe it but in most cases, I’ll stare at the lips and cheeks and think, ‘Seriously? No filler in there at all??’

The Rise of Devices

And then there’s the onward march of the machines that are crowding their way into clinics, which many people see as an alternative to injectables. What kind of machines? Ones that use different forms of energy – laser, ultrasound, radiofrequency, RF needling, plasma – to provoke the skin to renew itself by boosting collagen production so that it ends up looking smoother, tighter, fresher and entirely natural. It’s quite extraordinary what these devices can do, given time, for the right candidates.

Machine face or filler face?

For me, the big problem with this face-off is that it’s not an either/or. Yes, the energy-based devices are exciting, and whether they’re promising to tighten the skin or tone the underlying muscles or smooth the skin’s surface, I’m as keen to try them out as the next aesthetic patient. You’ll know, I’ve tried enough of them over the years and shown you the results. But the one thing they can’t do is replace lost volume to soften a gaunt, ageing face. That’s what has made fillers so popular over the past 30 years, and because of that, fillers aren’t going anywhere.

I thought I’d round up some views from leading practitioners who use both injectables and devices in their clinics, and see what the filler manufacturers had to say on the issue, too.

Opinion: Dr Raj Thethi

Medical director of The Yorkshire Skin Centre, in Leeds.

“Practitioners who stick with purely injectable treatments are more likely to attempt to “fix” everything with the tools at their disposal. If done correctly, results can be great but will always have some shortfalls.

In my practice, I invested in multiple energy-based devices early in my career to allow me to take a more balanced approach. Combining energy-based devices to improve the skin-tissue quality where appropriate, and then adding soft-tissue fillers to optimise and replenish areas of actual volume loss seems to work well. Does this mean I’m using fewer fillers and skin boosters day to day? Absolutely! But that’s not necessarily a bad thing.

Aesthetic equipment is expensive to invest in and maintain and may not form part of every clinic’s ideal business model. Recognition of the different options available to fix problems is a key part of understanding the limits of your own competence and referring to someone who has invested in those things should form a natural part of the conversation with the patient. We need to learn to work together to optimise the care for the patient.

I advise patients that energy-based devices are like putting a cake mix in the oven. We don’t know how long the oven has been on and I don’t know the settings so we watch and wait to see how much the cake will rise. Once that has been established, soft tissue fillers, injectables and neuromodulators are the ganache, fondant and delicate sugar work. Both are needed to make a showstopper and both need to be respected as parts of the medical aesthetic journey.”

Opinion: Miss Sherina Balaratnam,

Surgeon, cosmetic doctor and founder of the Sthetics clinic in Beaconsfield, Bucks.

“This is such an interesting topic and it’s one that’s close to my heart because I love fillers, I use them every day. And, and I think strategically they deliver exactly what they’re meant to do, which is to restore, refresh, rejuvenate a face. As you know, fillers can linger longer than we realise. That’s something that we as injectors need to articulate to our patients. It’s something that our patients are also beginning to understand.

What our patients don’t realise is that we can’t just have one tool in our toolbox. We’ve always had multiple tools to address all the five layers of the face. That’s where patients can become confused because they keep asking practitioners to reach out for one thing.

While fillers can be used in both deep and superficial areas to refresh a face, we should also focus on the skin. When you have a high-functioning, well-hydrated and resilient skin that is treated with great skincare and devices, it will literally shrink-wrap around your face. So instead of the rise of the pillow face or the machine face, I think we should be looking for the rise of the high-performance integrated face. That takes a blend of high-tech facials as well as energy-based devices with carefully positioned and placed facial fillers. That’s what I love doing best.”

Are the filler manufacturers selling less product? 

The companies that manufacture fillers are well aware of the general mood towards fillers. “This is an area we are very keen to discuss more widely,” said one. “We have also recognised a trend towards people moving away from wanting to discuss fillers in place of the new devices and treatments.” Are they seeing a fall in sales as a result? Here’s what they had to say.

Allergan Aesthetics, makers of Juvederm dermal fillers and HArmonyCa

“At Allergan Aesthetics, we have seen a stable demand for our Juvéderm® facial fillers throughout 2023 and into 2024, with the demand increasing for the newest product in our portfolio, HArmonyCa^TM, our hybrid injectable containing both calcium hydroxyapatite and hyaluronic acid to provide prolonged collagen stimulation.

“Our purpose is to empower confidence; creating the products and technologies that drive the advancement of aesthetic medicine. We believe that facial fillers will always remain a core part of non-surgical cosmetic treatment plans, due to their ability to provide natural full-face rejuvenation and replace the volume lost during the ageing process. When consumers are considering non-surgical treatments, it is important that they choose an experienced medical practitioner that can guide them in the appropriate application of facial fillers to suit their individual needs.”

Vivacy, makers of Stylage dermal fillers

VIVACY, manufacturers of French-made STYLAGE® HA (hyaluronic acid) dermal fillers have seen a change in the aesthetic market, yet still an increase in dermal filler usage: “(Great) practitioners realise that HA filler is necessary to build the “scaffolding”, adding volume where necessary and replacing it where it is lost – no other technology can do this as effectively as HA.  We understand that aesthetic treatments work in conjunction with each other, not against – and there is nothing that will replace the role dermal fillers play in facial rejuvenation and beautification.”

Galderma, makers of Restylane dermal fillers

“The aesthetic industry is full of constant innovation and new devices & technologies often get the spotlight, but fillers continue to be as important in aesthetic practices as ever. Restylane has demonstrated year on year growth without any signs of slowing down. While people’s preferences when it comes to filler-based treatments may change, the demand remains constant. We emphasise the importance of a natural look and our products require less product for the same great result and have proven naturalness of dynamic expression with high practitioner and consumer satisfaction.”