Hyaluronic dermal fillers are still the best treatment in aesthetic medicine, delivering natural-looking results that only fillers can achieve so quickly. Despite the surge of new biostimulators and lasers, dermal fillers are the only option that provide instant results, and in skilled hands, significant side effects are rare. Recently, there has been a wave of controversy around hyaluronic fillers on social media, claims that they migrate, enlarge and distort the face, leave permanent irregularities and lumps, cause edema, and never dissolve.
In this blog, I will explain why these are myths and why, in experienced and expert hands, dermal fillers remain the best non-invasive tool for natural facial rejuvenation. In fact, at major congresses like our TAMC Congress, most lectures are still dedicated to dermal filler techniques, as-alongside Botox. they remain the most popular treatments worldwide.
My career in aesthetic medicine began two decades ago, during the pioneering phase of this field, as I was among the early adopters of non-surgical aesthetics in London. Together with my colleagues from the British College of Aesthetic Medicine, we explored non-surgical tools to turn back the clock, erase wrinkles, and restore facial freshness and volume. At that time, in the early 2000s, we had only two tools - Botox and dermal fillers. Back then, we knew relatively little about optimal techniques and the long-term implications of these treatments. What I can say today, 20 years later, is that I still treat patients I began working with back then, and I have never encountered the issues mentioned above. My patients continue to look naturally rejuvenated and age-appropriate.
Before hyaluronic dermal fillers were developed, unsafe silicone fillers were used (permanent and responsible for the distorted lips we still see today), as well as collagen fillers, which delivered beautiful results but were short-lived and required allergy testing due to their animal origin.
In 1996, Swedish scientist Bengt Agerup in Uppsala developed the first stabilized hyaluronic filler using NASHA technology (Non-Animal Stabilized Hyaluronic Acid). This first modern and safe filler was Restylane, which remains my primary choice today. I often joke that Restylane is the Coca-Cola of dermal fillers - the original formula, still the best, launched around 2000. Soon after, Juvederm entered the market - the Pepsi of fillers in my view-making these two brands the global leaders to this day. New brands like Teosyal and Stylage have emerged, but in terms of safety and natural results, the originals - Restylane and Juvederm - remain unmatched. Importantly, the enzyme hyaluronidase allows for safe and effective dissolution if needed. Hyaluronic acid itself is ideal, as it naturally exists in our skin and plays a key role in hydration. It is produced through bacterial fermentation in the lab, resulting in a biocompatible product that integrates seamlessly into surrounding tissue.
Before continuing, let’s address a few common myths about hyaluronic dermal fillers. Unfortunately, negative narratives on social media mean that more patients arrive at our clinic hesitant to undergo filler treatments, opting instead for alternatives. While we now have many options, most patients still benefit most from dermal fillers, the only treatment that delivers immediate results with minimal downtime and side effects.
It’s also important to note that the primary way the face ages is through loss of fat volume (or due to medications like Ozempic, but that’s a topic for another blog). This leads to what I call the "deflated balloon syndrome.” Can anything restore volume like dermal fillers? The short answer is no.
These negative perceptions largely stem from two issues:
- A significant number of undertrained practitioners and illegal injectors use incorrect techniques, inappropriate doses, and lack anatomical knowledge or aesthetic judgment. Poor-quality, often illegally sourced products can also cause complications. My advice is always to choose an experienced doctor with a track record of natural results, using reputable brands like Restylane and Juvederm.
- Negative narratives on social media are sometimes driven by surgeons aiming to steer patients back toward surgical procedures, which are becoming less popular compared to non-surgical treatments (globally, non-surgical procedures outnumber surgical ones by five times annually).
Common FAQs and myths:
1. Do fillers always migrate?
The answer is NO. In 20 years and over 100,000 procedures, I have seen minor migration only 2-3 times, mostly above the lip. When properly injected with high-quality materials and anatomical expertise, fillers do not migrate.
2. Are dermal fillers always visible?
This is the worst myth. Poor results occur only when unqualified individuals inject incorrect amounts into wrong areas or layers, often using inferior products. My patients never have overfilled lips or cheeks, they simply look refreshed, rejuvenated, and subtly enhanced according to principles like the golden ratio. The goal is a "no-trace face.” Why do some celebrities look overdone? Likely due to pressure to appear youthful on screen and poor medical advice. Fortunately, trends are shifting, and actresses like Nicole Kidman are looking better than ever, while examples like Bradley Cooper and Jim Carrey highlight poor surgical not filler, outcomes.
3. Do fillers always cause swelling and facial enlargement?
Again, false. When applied correctly using products like Restylane and Juvederm, the face appears natural, balanced, and free of swelling. Even under-eye treatments can yield remarkable results with proper technique and patient selection.
4. Do fillers never dissolve?
Another increasingly common question. Hyaluronic fillers are not permanent. The natural enzyme hyaluronidase in our skin gradually breaks them down over 1-4 years, depending on the treated area. They can also be dissolved quickly if needed. While we once believed fillers lasted 9-12 months, we now know they last longer, which is why experience is crucial to avoid overtreatment.
Between 2005 and 2008, I was among the first to use fillers in the under-eye area to eliminate dark circles, and to reshape the nose non-surgically by injecting above and below the hump - achieving a straight nose in just five minutes. These remain my "wow” treatments. No other procedure can deliver such dramatic improvements in 5-10 minutes with minimal risk.
Thousands of satisfied patients over the past 20 years are a testament to the effectiveness of dermal fillers. We use them for non-surgical facelifts, chin and jawline definition, cheek and temple restoration, and even body treatments. Lip enhancement is one of my favorites, particularly using Juvederm Volbella and Restylane Kysse. Lip treatments perfectly illustrate how critical product choice, experience, skill, and artistic judgment are. The outcome depends entirely on whose hands you’re in either beautifully balanced, natural lips, or exaggerated, disproportionate results with migration.
The issue is not dermal fillers, they remain the best tool in aesthetic medicine. The issue lies in the practitioner and the products used. Hyaluronic dermal fillers are one of the greatest innovations in modern aesthetics, alongside Botox, and will continue to be the foundation of treatment plans. Today, when combined with technologies like UltraClear lasers or EmFace, and biostimulators such as Sculptra or Sunekos, as well as chemical peels and microneedling, we achieve even better and more natural results. However, none of these would be sufficient without Botox and dermal fillers, the only treatments that provide instant, transformative results.
The most common criticism today is that filler and Botox results are always visible. The truth is: only poorly done results are noticeable. Well-executed treatments enhance health and beauty subtly, so the person simply looks fresher, healthier, and naturally more attractive. That’s why I love this work, because every day I help people feel better in their own skin.