At Costhetics, we work hard to keep an open mind about all things related to cosmetic surgery and non-surgical enhancement. That’s not as easy to do as you might think.

That’s not as easy to do as you might think. As humans, we tend to go all in on one side or another of every question, despite the fact that most choices are much more nuanced than a simple either/or. This is especially true of dermal fillers. The question is not whether or not dermal fillers work to re-contour an ageing face. They do.

The question is whether or not they will work for your face.

What Fillers Can and Cannot Do

First things first: not everyone needs or wants facial fillers. In some instances, a loss of facial volume can actually improve the contours of your face as you age. Jennifer Connolly is a perfect example. Her youthful face was slightly full, obscuring her exquisite bone structure underneath. This happens to many people when they lose their facial baby fat.

For others, however, a loss of facial volume can leave them looking older.

When most people think about filler injections, they think about plumping up deflated lips or adding volume to the cheek area. In the hands of a professional, these effective injections:

• Support facial structures that have lost volume
• Balance facial components for better overall symmetry
• Smooth transitions between “hills and valleys” in the face
• Soften facial creases
• Improve the appearance of scars
• Enhance shallow contours
• Plump thin lips

Dermal fillers are different than wrinkle-relaxing injections. They can’t:

• Freeze muscles
• Stop the development of wrinkles and fine lines

What Fillers SHOULDN’T DO

A key problem with fillers is over-filling and looking pillow-like. Too many injections or an excess of filler material during each appointment can:

• Overly inflate cheeks
• Obliterate the natural cheek-eyelid junction
• Cause the midface to bulge unnaturally
• Obscure the eyes

Over time, too much facial filler can stretch out the tissues under the skin ““because those tissues aren’t going to bounce back the same way as you get older,” reports HuffPost. Lips are also susceptible to too much filling, leaving dissatisfied patients looking permanently overfilled.

Adding insult to injury, fillers can migrate. “I think it’s a big mistake to inject into the pink part of the lip,” another surgeon told HuffPost. “The lip is a muscle, and the filler gets moved around and can clump and lump and deform the lip and will pretty much require surgery to get rid of it if you do it more than once or twice.” All of these risks are reduced when the injector is properly trained and supervised.

What Injectors Shouldn’t Do

What injectors shouldn’t do is overfill or put too much filler in your face during just one appointment, and this is when your injector’s credentials are important. It takes skill and experience to understand that overly puffed cheeks won’t look youthful, they’ll look puffy and unnatural. Lips are also at risk for overfilling.

“A tiny drop of filler placed into the Cupid’s bow can add structure and support, helping to minimize top-lip wrinkling without risking the dreaded duckbill effect,” dermatologist Laurel Geraghty tells Allure Magazine.

From The Doctor’s Perspective

“Individuals ask for dermal filler,” says cosmetic surgeon Dr Gavin Chan, “when they become aware of having lost facial volume due to ageing…but is losing volume a bad thing?” Dr Chan points to performers like Christian Bale and Charlize Theron who have previously gained weight for different roles. When each plumped up, their facial contours changed, too, with cheeks and chin lines becoming obscured by the extra kilos. In a similar vein, he points to actress Jennifer Connolly whose face was roundish, soft, and less defined when she was young. Today, the 49-year-old actress has lost volume (baby fat) and gained the chiselled features she is known for.

This begs the question: If we think slimmer faces are more attractive, why are we using dermal fillers to create contours?

In his terrific YouTube video, Why I Stopped Filling Faces, Dr Chan warns against injectors who use fillers to define the cheek and jawline. He explains that many of the ‘after’ photos posted on the Internet make it appear that cheeks and jaws have been enhanced. Over time, however, the filler flattens “smooshes down,” says Dr Chan and spreads. This results in a loss of contour and a face that is puffy and undefined.

Dr Chan also warns that more filler is not always better. In fact, he says, the only way to have well-defined facial features is to be at an appropriate body mass. When there is limited facial fat, features are more pronounced. If you become too slim, however, and your entire face looks unattractively gaunt, fillers are not the answer. Dr Chan explains that adding volume to so many parts of the face is simply “unfeasible.”

Instead, the doctor recommends the use of dermal fillers to balance the features including:

• Temples
• Cheeks
• Chin

Fillers are especially valuable in smoothing transitions between facial features. For example, fillers can be used to soften tear troughs and create a more aesthetically pleasing line between the eyes and cheek. He encourages his colleagues to use the tiniest amount of filler possible when treating facial proportions.

Who’s Holding the Needle

Practitioners of all kinds — with varying degrees of training and experience — are capitalising on the demand for anti-ageing and beauty injections. Dermal fillers are generally considered safe, and while this may not seem problematic, it is. Complications of dermal filler injections administered by unqualified individuals include:

• Facial lumps
• Facial asymmetry
• Over-plumped lips
• Flattened (rather than filled) nasolabial folds
• Scabbing
• Scarring
• Skin death

You and your face deserve nothing but the best. Cosmetic physicians and doctors have an intimate knowledge of human anatomy that helps prevent this and other worst-case scenarios.

There you have it. To fill or not to fill, that is the question. Only you can answer it. Just know that whatever you choose to do, Costhetics thinks you’re A-Okay!