The Era Of Instagram Face Is Over

You only see the bad work, they say. And filler has given us an eyeful over the years — an endless spectacle of doughy faces, duck-like lips, and bloated tear troughs.

While hyaluronic acid injectables, praised for their versatility and reversibility, have been plumping cheeks and camouflaging creases since 2003 when first sanctioned by the Food and Drug Administration, their popularity swelled to uncanny proportions about a decade ago. “That was the big inflection point when filler really took off,” says Dr. Christian Subbio, M.D., a board-certified plastic surgeon in Philadelphia. It was a watershed for the syringe — and the beauty standards in its crosshairs.

New fillers steadily rolled out — yielding a grab bag of gels, with unprecedented power, for every inch of the face — and providers of all stripes took up injecting, often fresh off a weekend course. “It was like a free-for-all,” Subbio recalls. “Almost no one was approaching filler with any kind of hesitancy, critical thinking, or concern.”

The era was marked by a desire to look done: voluptuous and sculpted, filtered and FaceTuned. In 2019, The New Yorker dubbed the phenomenon “Instagram Face,” retroactively naming Kim Kardashian “patient zero.” Kid sister Kylie Jenner similarly influenced the epidemic with her lip filler confession of 2015, a veritable superspreader that introduced Juvéderm to a new generation.

Globally, hyaluronic-acid-infused faces set the tone — at Hollywood award shows and European couture shows — but rarely did anyone own the habit. Flashing back to 2017, board-certified dermatologist Dr. Daniel Belkin, M.D. remembers how the cool girls of New York City would proudly post from his office, but they’d never admit to getting filler. “They’d say they were there for lasers, because filler, even then, was a little taboo.”

That didn’t stop people from indulging. The “optimized” look demanded upkeep, after all — multiple syringes, injected like clockwork, every few months. Hyaluronic acid is only temporary, we were told (by filler manufacturers, by white coats, by Kylie), vanishing at a preordained time, like Cinderella’s glam at the stroke of midnight.

We obediently booked touch-ups to keep our lips lush, cheeks full, jawlines crisp — and confidence high. The esteem boost alone kept us coming back, despite the swelling, bruising, and expense. Despite the filler mustache spreading across our top lip. Despite the creeping realization that our face no longer matched the one on our ID badge, issued just last fall.

The Makings Of A Backlash

Filler fatigue is everywhere — so prevalent it’s become a meme. It’s a defining element of our modern cultural touchstones. Take, for example, the vast speculation and criticism swirling around the seemingly overfilled faces of Courteney Cox, Kristin Davis, and Lisa Rinna. Or a pillow-faced Madonna sparking outrage at the 2023 Grammy Awards. Or TikTokers discussing Kylie’s Paris Fashion Week under-eye scandal earlier this year.

There’s no shortage of cautionary tales. But has the ubiquity of bad work (and its ensuing stigma) truly soured us on filler?

According to my sources — the forward-thinking injectors working to reshape the aesthetic zeitgeist — we are officially in the throes of a filler backlash. “Finally, we’re seeing a pumping of the brakes,” Subbio says. Patients are over the maintenance, the headaches, the Insta vibe, all of it. Clinicians, too: “Injectors are learning that these materials are not perfect — that if you overinject, you’re going to have a problem, maybe not immediately, but in six months, a year, or five years,” says Jennifer Hollander, a board-certified nurse practitioner in Beverly Hills.

Even in Hollander’s ZIP code, where excess has forever symbolized status, “there seems to be a bit of buzz around how fillers are bad,” she adds. “This wasn’t a conversation five years ago.”

Suddenly, everyone’s “worried about migration; they’re worried about looking done” (issues that savvy injectors can typically avoid, she notes).

In clinics and online, doctors are confronting a wave of disillusionment, fear, and regret. “Filler remorse is a huge thing that we’re seeing more of, particularly in the last six months,” says Dr. Jessica Weiser, M.D., a board-certified dermatologist in New York City. “Patients come in after having had filler elsewhere, often tons of it, and there’s this intense regret and self-flagellation,” she tells me. “They beat themselves up for not knowing better.”

Contrary to the soaring injectable stats being recorded by plastic surgery societies, some doctors are fielding increasing requests for less filler — or none at all. The once-familiar echo of “I’m here for my Botox and filler” is fading from the halls of popular practices. “I have a lot of patients saying, ‘I’ll pretty much do anything but filler,’” Weiser reports. And she’s happy to oblige. In her SoHo office, devices like Sofwave (ultrasound-based skin tightening) and Secret RF (radiofrequency microneedling) rule while “filler is a last resort and always has been.”

A few stops north, in the Flatiron District, Belkin finds himself “coming up with creative solutions” for the growing list of patients who are abandoning hyaluronic-acid filler. For the record, he still believes filler “can be a good tool” and “look very natural” when used sparingly.

He attributes much of the recent blowback to a few bad actors who continue to push gross amounts of hyaluronic acid — usually when trying to “lift” or “tighten” the skin — and inevitably produce results that feed filler stereotypes. What some fail to consider, adds Belkin, is that “filler is a shapeless gel. It doesn’t keep its sharpness. It collapses and moves,” he says. “Someone can start off nice and chiseled and end up looking like a blobby face.”

The Trouble With Filler

Only in the past few years have studies begun to elucidate certain truths about hyaluronic acid injectables. The most industry-rocking revelation to date: Filler can stick around longer than advertised, especially in the cheeks and under the eyes. “We used to think it dissolved on its own within a year or two, but now we’re learning it can last a decade or more,” Belkin says. A portion breaks down, but remnants remain.

The longevity estimates that injectors once parroted were rooted in clinical trial data. But those numbers, it turns out, didn’t accurately reflect a filler’s lifespan. Rather, they indicated that a percentage of patients still had some visible effect from the product after six or 12 or 24 months — whenever the study wrapped. “That’s when the researchers stopped looking [at outcomes], but the filler was still there,” says Dr. Stella Desyatnikova, M.D., a board-certified Seattle facial plastic surgeon renowned for her expertise in managing filler complications under ultrasound.

Recent MRI studies showing traces of hyaluronic-acid filler in faces up to 12 years post-injection have largely debunked antiquated durability claims. The reality is with myriad factors influencing how filler behaves in the body — including the way it’s formulated, where and how deeply it’s injected, and the mood of one’s metabolism — it can be nearly impossible to predict exactly how long it’ll last. (That said, just because doctors can spot filler on a scan doesn’t mean you can see its effects in the mirror. These gels have been shown to lose their pop over time.)

The rise of ultrasound is making filler easier to track, however. For Desyatnikova, the technology affords a kind of “quality control,” she says. “When patients come back years later, I check to see if their filler is in the same spot [I originally put it].” The intel she’s gathered from imaging has improved her precision and informed her discussions with patients. “When they ask how long a filler will last, I tell them anywhere from a few months to several years,” she says. “For under-eye filler, I say, it’s basically a one-and-done — it can last forever.”

Adding to the nuance, timetables aren’t static. Your first dose of filler probably won’t persist like your fifth or 10th, notes Dr. Amelia K. Hausauer, M.D., a board-certified dermatologist in Campbell, California. “Once you’ve done it multiple times — layering filler over filler — it hangs around a lot longer,” she finds. You may need to adjust your expectations as you go, gradually widening the window between top-offs.

Ironically, Desyatnikova points out, patients used to stress about filler disappearing too quickly, and now they worry about it lasting longer than they’d like. They understand that permanence can come at a cost: As filler piles up, “it can move, block lymphatics, retain water, become boggy, and lose its shape,” Subbio says. “We’re seeing all of these consequences of past injections.” And more: “People are going, ‘Wait a second — I don’t look like myself.’”

What Lies Ahead

Having had a front-row seat to filler’s failures has made the best doctors ultra-conservative. They’re injecting fewer CCs, less frequently (to enhance or restore features, not exaggerate them). They’re refining existing filler during touch-ups instead of rotely adding more. (“If someone’s starting to look puffy — because filler swells as it degrades — I’ll dissolve a little to take the edge off and they’re good for several more years,” says Desyatnikova.) They’re saying no on the regular, and winning over patients in the process.

Some doctors have all but quit filling the under eyes, an unforgiving spot where injections tend to backfire. “I have patients who had tear trough filler placed 10 years ago [by other providers], and they still have ballooning,” says Weiser. Only a select few — those with deep hollows, zero fat bags, and thick, tight skin — truly qualify for under-eye filler. For the rest of us, “it’s never going to look good,” she says, and there are better treatments for the area (like lasers that zap blue veins to lessen shadows and resurfacing devices that smooth crepey skin).

Injectors are recognizing the limitations of filler and suggesting surgery when it’s clear that an under-eye bag or a jowl will be better served by a scalpel than a syringe.

As mindsets shift, a fresh aesthetic is emerging. Those who haven’t forsaken filler entirely “are pulling back from looking snatched and over-injected,” says Hollander. “They want to look good, but they want to look natural.” People are trading Kardashian extremism for what she calls a “’90s clean-girl aesthetic” — quiet volume, minimal tweaking, greater individuality — which Hollander herself embraces. “I love a plain lip,” she tells me. When patients need perspective, she has them stream shows from the ’90s “to see how normal faces look.”

The 2024 aesthetic elevates skin — more specifically, what Weiser calls the three Ts: tone, texture, and tautness. “Those are the things that make a face look youthful,” she says, “much more so than volumization and augmentation.” The promise of great skin lures patients back to her office every few months. “Ninety percent of what we’re doing is devices and maybe a little neuromodulator,” Weiser says. “I’ll sprinkle in filler only when I feel they really need it.”

Lasers, microneedling, platelet-rich plasma, and chemical peels are edging out filler in many medical practices. “Looking glowy goes a long way,” Hausauer reasons. And doctors trust these tools to brighten, firm, and revive the face without skewing normal proportions.

Eventually, Hausauer anticipates “there will be more ways to improve skin quality with a syringe, but right now, it’s hard to get away from using a device for at least some component of your skin quality regimen.” (What about the so-called skin boosters? SkinVive, the only one currently FDA approved, is a thin, crosslinked form of hyaluronic acid. It can temporarily hydrate and plump the skin when injected in droplets across the cheeks, Weiser says. But in her opinion, it doesn’t give the long-term benefits of a device.)

When patients need to replenish volume, a syringe is generally in order. But it needn’t contain hyaluronic acid. Doctors are commonly reaching for collagen-stimulating injectables, like Sculptra and Radiesse, to add natural-looking fullness to areas that deflate with age, like the temples and the buccal hollows of the cheeks. “I think the vast majority of us agree that biostimulation — whether it’s injectable- or device-driven — is the future,” says Weiser, “as opposed to just vats of hyaluronic acid.”

Indeed, injectables in the pipeline aim to regenerate skin by supplying it with what it needs to make more of its own proteins and moisturizers. Also being investigated are novel materials, like an algae-derived gel that purportedly doesn’t swell and has a low risk of migration. If approved, it could offer an alternative to conventional fillers. Not that anyone is forecasting the fall of hyaluronic acid: “I don’t think it’s ever going to go away,” says Belkin.

Ultimately, the fate of filler lies with injectors, the most prudent of whom are relegating it to more of a “bells and whistles” role, says Hollander. Going forward, “everything should start with the skin,” she insists. “Your filler will shine the moment you have beautiful skin.”

Experts:

Dr. Daniel Belkin, M.D., board-certified dermatologist in New York

Dr. Stella Desyatnikova, M.D., a board-certified Seattle facial plastic surgeon

Dr. Amelia K. Hausauer, M.D., a board-certified dermatologist in Campbell, California

Jennifer Hollander, a board-certified nurse practitioner in Beverly Hills

Dr. Christian Subbio, M.D., a board-certified plastic surgeon in Philadelphia

Dr. Jessica Weiser, M.D., a board-certified dermatologist in New York City