While filler longevity varies by product and patient, recent MRI studies have shown it lingering much longer than advertised. “Parts of it can last for well over 10 years,” says Dr. Talei, especially in certain areas of the face. Flora Levin, MD, a board-certified ophthalmologist and an oculoplastic surgeon in Westport, Connecticut, regularly sees patients who had undereye filler injected five or more years ago — “and it’s still hanging around,” she says. In her experience, traces tend to persist when the wrong type of injectable is used (some gels are stiffer, for example, while others are springier) and/or it’s placed too superficially in the tear troughs. 

What’s more, overly frequent top-offs can slowly carry people away from their OG appearance, causing them to forget how they used to look and to continuously strive to enhance their ever-shifting status quo. It’s called perception drift — and even injectors aren’t immune. Doctors have become accustomed to seeing overfilled faces, so they too have a bit of dysmorphia and will just keep injecting without recognizing a problem, Dr. Talei says. 

None of these factors exists in a vacuum, mind you, and all are playing out against a filtered backdrop of social-media illusion. “We have a little bit of a broken-mirror situation, where what is considered ‘normal’ is very much skewed and the slightest asymmetries are seen as something to be fixed,” says Dr. Levin. “It’s almost like there’s this stencil that everyone is trying to fit into.”

The beginnings of a backlash

While concerns over filler fatigue don’t seem to be curtailing the overall demand for these products on a widespread, statistic-altering scale, doctors say they are starting to see patients pull back in various ways. Some are minimizing the role of filler in their regimens, adopting a more natural vibe and leaning into energy-based devices, like Sofwave and Morpheus8, for firming. Others are flat-out forsaking hyaluronic acid and/or attempting to dissolve the gels they once paid a pretty penny for. 

But we’re not suggesting anyone ghost their injector. Rather, choose that person wisely: board certification, anatomic expertise, loads of experience, impeccable taste, an obsession with safety, and a willingness to say “no” are musts. Then, adopt a less-is-more mindset. If you have obvious fat loss or bone erosion, you may benefit from multiple syringes, but the key, doctors say, is to treat every issue with as little filler as possible and to place it with the utmost care. 

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