How Much Filler Do I Need Without Looking Overdone

Facial filler has become a mainstay in facial rejuvenation trailing only Botox in popularity.  According to the latest plastic surgery statistics report from the American Society of Plastic Surgeons, there were approximately 7.4 million injections of botulinum toxin (Botox) and 2.6 million dermal filler injections in 2018 

As we age, we lose facial volume resulting in laxity of the skin and deepening of facial lines and wrinkles.  By replacing volume in key areas, facial volume and be replaced giving a more youthful appearance.  In addition, fillers and be used to "fill in" deeper lines such as the nasolabial folds and marionette.  Finally, fillers can be used to soften transition zones in the face which give an aged look to the face such as the lower eyelid and cheek junction or teartrough.  Common places to place filler are the temples, lower eyelids, cheeks, nasolabial folds, marionette lines, lips, nose, chin, and along the jawline.  

Fillers come in different formulations such as hyaluronic acid (HA), calcium hydroxyapatite (CaHA), or polymethylmethacrylate (PMMA).  The most common filler category are the hyaluronic acid fillers such as Juvederm or Restylane family of fillers.  Hyaluronic acid fillers are composed of a soft naturally occurring gel that can easily be reversed and last between 12 and 24 months.

How much filler is needed depends on the area being treated and the desired outcome.  Fillers come in an average of 1.0cc aliquots delivered in syringes.  Syringes should be used in a single setting to preserve their efficacy and sterility and not saved or "split" between patients.  Enough filler should be placed to see adequate response without "overfilling."  A common mistake is to try and treat multiple areas with an inadequate volume of filler.  Underfilling results in a lack of visible response.  To avoid this, each area should be filled to full correction before moving to a different area.  It is helpful to treat the most important areas first before moving onto less important ones.  

Overfilling results when too much filler is placed and the area look unnatural or artificial.  To avoid this, it is helpful to evaluate each area in a mirror as it is filled.  If it is estimated that 1.0cc of filler would be needed, check the area after 0.5cc is placed before adding additional filler to that area.  Incremental filling will help to avoid overfilling.

Another common cause of overfilling is multiple injections over time.  Most fillers last between 12 and 24 months meaning that over this time period you can expect to lose about 50% of the filler that has been placed.  As you lose filler the treated areas will appear less filled.  However, there will likely be some filler remaining so that if the same amount of filler is placed the area will be more filled or plumper.  If this is repeated over time, the treated areas can easily become overfilled.  Importantly, hyaluronic acid (HA) fillers can be dissolved with hyaluronidase which is an enzyme that will dissolve the filler.  

Common amounts used to treat anatomic areas.

*Facial Filler by Dr. John Burns.  All patients are unique and results may vary

Make sure to discuss in consultation with your injector what areas you want treated and get an estimate for how many syringes will be necessary.  It is always acceptable to slightly underfill and come back for more than to overfill.