'Every drop of filler is still in her face.' The hidden cosmetic truth we're not talking about.

Injectables have boomed in recent years. It's no secret. Between the influence of celebrities, and social media's filter-heavy images, it's no wonder the demand for aesthetic procedures has blown up — especially dermal fillers. 

Made out of substances such as hyaluronic acid, dermal fillers can help add volume to the face, whether it's plumping up your lips, changing the appearance of your nose, or creating a new jawline.

Watch: Alisha Bhojwani's experience with tear trough filler. Post continues below. Post continues below.

But while most dermal fillers are classified as medications that require prescription by a registered medical practitioner (a doctor), you don't need a medical license to inject them. And how much training you need to complete before performing injectables can be a bit of a grey area.

As you can probably guess, this lack of regulation can lead to some serious issues — including botched cosmetic treatments.

Listen: To fill or not to fill? It's not for the faint-hearted. Injectables are big business but it's not a decision to be made lightly. Get your ears on this episode of You Beauty for the straight facts. Post continues below. 

And as dermal fillers continue to rise in popularity and we see an increase in the number of clinics promoting 'competitive' prices with poor experience and technique, the practice of over-injecting and over-filling is growing (read: the filtered 'Instagram face' IRL). 

So, how much do we actually know about fillers? 

Can fillers last longer than we're being told?

A recent Australian study by radiologist and cosmetic doctor Dr Mobin Master was one of the first to prove the location and longevity of fillers in the face can be monitored and detected by using magnetic resonance imaging (MRI). 

Off the back of this study, it was found that fillers last a whole lot longer than what we're being told.

While most filler manufactures market their products as lasting six to 18 months, cosmetic physician Dr Gavin Chan told ABC News: "We found filler lasted for two years, anywhere up to 12 years. So it's a massive difference to 18 months."

Huge.

These MRI findings came about after Dr Chan saw a patient who complained of filler moving and changing in her face. She hadn't had a treatment in at least two years. 

Looking at her scan, Dr Chan told ABC News, "I wouldn't be surprised if every drop of filler she's ever had is still there."

Not only do these kinds of scans show that filler can remain in the face for many years, but it can also detect migration to another area of the face. For example, lip filler spreading down towards the chin or up and around the nose.

Yep, this is a thing.

"This finding on MRI has gained a lot of traction and with good reason," Dr Imaan Joshi from Skin Essentials told Mamamia. 

"For years we were advised that fillers only lasted six to 12 months, necessitating the 'need' and advice that patients attend for regular 'top-ups'."

As Dr Chan said in the interview with ABC News, it's something he sees all the time, "especially when you have clinics, which offer very, very cheap prices per mil, and they need to get patients in and out quickly."

"There's no question of whether they need it or not. It's, you come in, you pay your amount for your one mil [in the lips], you get it done," he said. "It might only be three months since your last injection."

The result? An accumulation of leftover filler in people's faces. Layers upon layers of it.

Why are we being told filler lasts around six to 18 months?

"In the absence of regulations, or indeed, even colleges that undertake rigorous training, accreditation with mentorship and supervision, most injectors rely on ad hoc training based on limited data from the very companies that sell the products," explained Dr Joshi.

Put simply, this is the timeframe filler manufacturers are telling medical injectors.

"This creates a conflict of interest and unrecognised bias, as it's also based on their own limited in-house studies for short periods of time to gain regulatory approval to sell these drugs," she said. 

According to Dr Joshi, "With rapid uptake of these products, we discovered that what plays out in the real world is different."

As a result, the aesthetics industry is now seeing more and more people requesting to 'hide' adverse results or have their fillers completely dissolved.

Take Ellie, for example. 

She told Mamamia, "I got lip fillers, and I was originally quite happy with the results. I had been told that they would only last between three to four months, so I was excited to 'try it out'. 

"I got the treatment done in June 2019, and at the end of October 2020, my lips were still considerably large and had that giveaway sign of a 'duck lip' flip on the top lip that goes upwards."

"I hated the side profile of it and want to go back to my roots and back to basics — AKA my natural lips. I'm all for trying things once, but I think the look of fillers on me aged me years! 

"When I went back to the clinic for a consultation, the cosmetic nurse told me that she was 'confused' and 'unsure' why the filler hadn't dissolved naturally."

"She also told me there's no certainty that dissolving my lips will be symmetrical and it also might dissolve some of my natural lip as well. I was horrified."

What are the implications of filler lasting longer than we thought?

According to Dr Joshi, "In reality, we know now that the rate at which each individual breaks down filler varies. It’s unpredictable and in many cases may last for years without causing any harm if placed correctly." 

However, there can also be some unwanted side effects associated with the longevity of filler. 

Dr Joshi said these are mainly related to things like incorrect placement, which may lead to a need to dissolve the filler, as well as overfilling, leading to migration.

We're talking about signs like unwanted puffiness and lumps beneath the skin.

She also shared that "certain filler brands, anecdotally, have a higher risk profile for side effects and complications."

As well as this, she said due to the longevity of certain brands, the filler may also be harder to dissolve, with multiple sessions of dissolving needed.

"This may lead to extra cost and discomfort to the patient, especially if they don’t know what brand was used," she said.

When it comes to what experts are seeing in their clinic, Dr Joshi said she commonly sees filler migration, likely due to too infrequent filling and top-ups.

"I’ve also seen poorly placed filler, typically in lips and under the eyes, that lead to unsightly lumps and bumps."

Yeesh.

"Rarely, I see scarring due to multiple sessions via multiple injectors of filling, dissolving and then refilling."

How to protect yourself.

In order to save yourself from any nasty surprises, finding an injector who is going to meet your needs from both the technical and emotional point of view is the key. 

"I can only speak to my own set of rules," said Dr Joshi, "But we fill to replace volume deficit until we’ve corrected for it and no more. Or to enhance within reason (e.g. lips) that the anatomy can tolerate and no more." 

"Thereafter, we do nothing until such a time, as more may be needed. In my patients this is typically every 12 to 24 months, with a far smaller amount than initially needed IF and if we have an ongoing working relationship where I’m seeing them regularly for other treatments." 

We recommend thoroughly researching a person's qualifications before booking an appointment, and ask them if you can see some before and after photos so you are familiar with their work

"Having baseline photos also means if they come in believing they need more filler and we compare their baseline to now, they can appreciate why they may not need more after all, and how perception drift has occurred," said Dr Joshi.

She also reminds us that price should not be the main determiner of where to go. "Ideally you should aim to get it done once and done right."

While injectable treatments may be considered a simple procedure, it’s so important to keep in mind that it comes with some serious risks — especially if performed incorrectly. 

Dr Joshi told Mamamia, "I anticipate a lot of pushbacks because people have gotten used to this way of thinking of medical aesthetics as 'just beauty' rather than elective medical procedures for providers who try to be ethical." 

"As AHPRA registered professionals, we have a duty of care to first do no harm and I think that’s been forgotten at the moment."

"We are inadvertently harming people often without even realising it ourselves." 

Have you had filler before? What has been your experience when it comes to injectables? Share with us in the comment section below.

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