One of the most persistent misconceptions in the realm of cosmetic treatments is due for a much-needed correction.

Anyone who has thought about a quick cosmetic procedure—such as smoothing forehead lines or erasing crow’s feet—has undoubtedly encountered a set of familiar assurances.

These include the beliefs that facial fillers are completely safe, that they disappear within a year, and if dissatisfaction occurs, the results can simply be reversed.

‘They’ll be gone in a year.’

‘If you don’t like how you look, you can just dissolve it away.’

While those statements are often true, they are not always the case. And now, a top Beverly Hills plastic surgeon has confessed to me that face fillers aren’t as harmless as millions of Americans are being led to believe.

‘Hyaluronic acid filler can cause necrosis [premature death of living cells] and ischemia [restriction of blood supply to tissues],’ said Dr Timothy Katzen, a plastic surgeon, who has been in practice for 25 years.

‘Injecting filler under the skin is like inflating a balloon,’ explained Dr Katzen. ‘When you put in filler, it puts pressure on surrounding tissue. If it is [an extreme application], it can block circulation and even cause cellular death.’

If you’ve ever considered a ‘lunchtime tweak’ to smooth out your forehead or flatten those crow’s feet, you’ve likely heard it all before

‘Injecting filler under the skin is like inflating a balloon,’ explained Dr Katzen (pictured). ‘When you put in filler, it puts pressure on surrounding tissue’

Don’t just take Dr Katzen’s word for it. A 2024 study presented at the annual meeting of the Radiological Society of North America puts it plainly: if improperly administered, face fillers can result in real medical emergencies.

Indeed, hyaluronic acid (HA), an organic substance naturally present in the human body, is the preferred dermal filler used by most reputable plastic surgeons. But in the hands of poorly trained cosmeticians, it can trigger terrible side effects.

‘If [HA] filler is injected in the wrong place [in the face] it can migrate to the central retinal artery causing blindness,’ said Dr Katzen. ‘These are known risks that patients should be well-informed of.’

Here’s another myth about hyaluronic acid: it readily dissolves away on its own. That’s not always the case, either.

A 2024 study published in a Journal of the American Society of Plastic Surgeons examined 33 patients who has received HA fillers in the face.

MRI scans of the participants found detectable HA fillers in the faces of all 33 patients after two years. One patient had HA filler after 15 years!

Making matters worse, according to Dr Katzen, some patients may think they’re receiving temporary HA fillers when they’re really receiving something else.

‘Sometimes individuals, who are not medical doctors, will mix a proprietary blend of hyaluronic acid and other products, perhaps even silicone [a permanent filler], to give patients longer lasting results,’ said Dr Katzen.

Moreover, if you don’t like the results and opt for an injection of a hyaluronic base to dissolve the hyaluronic acid, you increase the risk of developing scar tissue from repeated trauma.

MRI scans of the participants found detectable HA fillers in the faces of all 33 patients after two years. One patient had HA filler after 15 years!

You’d hope that amid all these concerns, the cosmetic medicine industry would be pumping the brakes – and certainly, some like Dr Katzen, are – but you don’t need to scroll through Instagram for long before you see some celebrity, acquaintance or clinic pushing an easy beauty make-over.

Enter ‘Ozempic Face.’ Women (and men) who lose weight through medications – known to compromise muscle tissue – end up with faces looking prematurely aged and drawn.

The quick aesthetic solution pushed for them… more filler, of course.

The cycle is endless: age a little, inject, distort, correct the distortion, inject again. It’s a treadmill, and once you are all the way in it’s hard to get off.

Some women (and even girls) are taking face fillers in early 20s – for so-called ‘preventative care.’ But the more shots one gets the more potential damage they do. And what happens when these life-long filler patients decide that they’re no longer achieving the look they desire, and they elect to go under the knife?

Dr Katzen said that it is much more challenging to do a face or neck-lift on a patient who has been regularly received filler.

‘Even temporary filler can cause an inflammatory response,’ Dr Katzen revealed. ‘[As a result] plastic surgeons often encounter lumps that may be caused by transient swelling from fillers.’

‘As surgeons, we don’t always know whether we can remove these lumps, which can be caused by inflammation or scar tissue, making the procedures more difficult.’

Add to this a culture that increasingly treats aging like a medical failure and filtered Instagram posts like the standard of beauty, and you’ve created the perfect storm: a society terrified of looking human and bad actors who are thrilled to monetize that fear.

Now, this column isn’t about demonizing every injector. There are excellent, ethical professionals out there. But filler is filler. No special technique can override the biological reality of what it does once it’s in your face.

And there is a better option – in my opinion – and it’s one you almost never hear about because it isn’t quick, cheap or convenient.

‘Even temporary filler can cause an inflammatory response,’ Dr Katzen revealed. ‘[As a result] plastic surgeons often encounter lumps that may be caused by transient swelling from fillers’

It’s called fat transfer – a producer that moves a patient’s own fat from one part of the body to another.

Biologically, it makes infinitely more sense to inject yourself with your own cells. The body recognizes it, integrates it, and ages with it. So, you don’t look ‘filled.’ You look like you.

‘Fat-transfer is a superior procedure to any filler,’ said Dr Katzen. ‘Fat transfer must be done by a plastic surgeon, which makes it more expensive, but it is generally better for the patient.

‘It is more natural, there is less foreign body reaction, it lasts longer and there are lower complication rates. I’d say about 90 percent of my patients opt for fat transfer over fillers.’

One fat-transfer procedure – typically costing between $2,000 and $8,000 – often costs the same as what many people spend on filler maintenance over two or three years.

The healing takes longer, yes, but the payoff is greater stability, safety, and a future where you can finally step off the hamster wheel of injectables.