Facial rejuvenation patients generally want to look healthy, and youthful – but still like themselves. Plastic surgeon Dr. Brian Cripe discusses the top three “botched” non-surgical cosmetic results he treats.

While it’s very common for patients to try botox and fillers to address and prevent signs of aging, eventually nonsurgical treatments run their course. Patients who have received too much Botox and dermal fillers often exhibit telltale characteristics: their faces are plumped, puffy, unnaturally smooth, and lack natural movement.

So why does this happen? Some providers don’t know when it’s time to stop injections and recommend a more permanent surgical treatment. In an attempt to curb or delay cosmetic surgery, patients can end up spending thousands on routine, expensive injections that leave them looking overworked and lacking youthful definition.

It’s important to note that not all injectors are prone to making these mistakes – some very talented cosmetic providers understand their products’ limitations and achieve great results.

Others, however, are quick to condone the latest and greatest non-surgical technique as an anti-aging “holy grail”, when in reality these costly treatments yield short-term effects at best, and long-lasting deformities at worst.

When considering the use of dermal fillers or fat grafting to address signs of aging, trained plastic surgeons consider not only your overall facial anatomy but also how important facial structures will age and change over time. In this article, we’ll review some of the top patient complaints I hear resulting from ineffective or irresponsible aesthetic injection use.

1. Filling Nasolabial Lines Instead of Addressing Mid-Face Volume Loss

The nasolabial lines, which run from the sides of the nose to the corners of the mouth, are often a concern for patients seeking facial rejuvenation. Nasolabial lines are influenced by multiple factors, including skin laxity, loss of fat, and bone resorption. However, solely focusing on filling these lines without addressing mid-face volume loss can lead to poor results for numerous reasons.

First, as we age it’s natural to develop nasolabial lines and simultaneously lose volume in the mid-face region. What some injectors don’t realize is that the lines alone aren’t the problem they need to address; it’s overall volume loss in the cheeks, temples, and under-eye hollows. Neglecting to restore volume in these areas while targeting nasolabial lines can create imbalanced, sagging, and poochy facial proportions around the mouth. I also see it resulting in an unnatural or overfilled appearance, as the lower face appears plump while the upper face remains sunken or deflated. Without restoring volume and support to the mid-face, nasolabial lines can continue to deepen and become more prominent over time.

Exclusively spot-treating nasolabial lines can also make other signs of aging – such as under-eye hollows or flattened cheeks more pronounced. These neglected areas can contribute significantly to an aged or tired appearance. It is crucial to consider the overall facial harmony and treat all relevant areas to achieve optimal and natural-looking results.

When dermal fillers – or, better yet, fat grafts – are administered in the mid-face, it has a youthful and lifting effect that minimizes the appearance of deep nasolabial grooves. This is why I perform fat grafting for essentially every facelift patient I see. By removing excess tissue and adding volume to the cheeks, patients appear more proportional, awake, and youthful versus saggy, poochy, or unnatural.

2. Overfilling and Prolonging Treatment

Overfilling often leads to an unnatural and disproportionate appearance. Whereas the goal of dermal fillers is to enhance and rejuvenate facial features, some injectors excessively fill the face, creating a puffy and inflated look that detracts from a patient’s natural beauty.

Overfilling can also cause loss of facial definition and contour – something that many patients want. Contours play a crucial role in conveying a youthful and attractive appearance. When fillers are used excessively, they can obscure the natural contours, resulting in a rounded or shapeless appearance. This lack of definition can contribute to an aged or artificial look, which is contrary to the desired outcome of facial rejuvenation.

Another issue with overfilling is the potential for functional problems. When excessive filler is injected, it can interfere with the normal movement and function of facial muscles. This can lead to difficulties in facial expressions, restricted movement, or unnatural stiffness in the treated areas. It is important to strike the right balance during filler treatments to ensure that both aesthetic and functional aspects are considered.

To avoid these poor outcomes, skilled injectors must assess each patient individually and develop a customized treatment plan. I like to take a conservative approach that respects the natural anatomy and proportions of the face.

3. Continuing Injection Treatments Once They’ve Run Their Course

Prolonging injection treatments, such as Botox and fillers, beyond their optimal duration can result in undesirable cosmetic outcomes. Continuously administering these treatments without addressing the underlying aging process can lead to several issues. Excessive injections can lead to the accumulation of filler material over time, resulting in an unnatural and imbalanced appearance. The inflated or overfilled look deviates from the intended rejuvenation goal.

Furthermore, relying solely on injections without addressing the underlying causes of aging neglects the comprehensive approach required for effective facial rejuvenation. While injectables may temporarily improve signs of aging, they do not address the fundamental changes that occur with time, such as volume loss or tissue laxity. By disregarding these underlying factors, the treated areas lack consistency with the overall facial aging process, resulting in an artificial or disproportionate outcome.

Additionally, persistent injection treatments without considering alternative modalities can limit the exploration of more appropriate interventions. Surgical procedures and/or fat grafting may provide better outcomes for specific concerns, such as mid-face volume loss. Overreliance on injections may hinder the exploration of more invasive, but also more targeted and effective cosmetic alternatives.

By adopting a holistic approach to facial rejuvenation, addressing the underlying causes of aging, and avoiding unnecessary and excessive injections, patients can achieve natural, balanced, and enduring results.

4. Taking Unsafe Risks and Not Acknowledging Their Limitations

Patients should be aware that any medical provider can administer cosmetic injections and any physician can market themselves as a “cosmetic surgeon,” regardless of their experience level or field of expertise. There are plenty of unqualified or unethical medical professionals working in the cosmetics space who simply don’t understand facial anatomy or who ignore the risks. For example, some injectors will be happy to add volume under the eyes or the tip of the nose with fillers – seemingly innocuous cosmetic procedures that both pose the risk of blindness.

For consumers, it’s paramount to select someone who has a deep knowledge of facial structures, tissue planes, blood supply, and innervation, and who always prioritizes patient safety and outcomes over personal profits.

At the end of the day, plastic surgery is the “gold standard” for facial rejuvenation treatments. I administer botox and fillers, and I also recommend patients use Retinols, lasers, and chemical peels to stimulate collagen production and cellular turnover. But eventually, patients who want to look younger will likely benefit from addressing the underlying causes of facial aging: tissue laxity and volume loss with eyelid surgery, a mini facelift, a full facelift, a neck lift, fat grafting, or a brow lift.

Prevent and Reverse Signs of Aging Today With Plastic-Surgeon Recommended, Non-Invasive Cosmetic Treatments

Our board-certified plastic surgeons would love to bring you in for a consultation to talk about treatment options and your aesthetic goals.

Author Profile: Brian Cripe, M.D., is an award-winning, board-eligible plastic and reconstructive surgeon proudly working with the Plastic Surgeons of Northern Arizona practice. Dr. Cripe specializes in cosmetic surgery, limb salvage, peripheral nerve microsurgery, hand surgery, and oncologic reconstructive procedures. He has performed over 5,000 surgical cases during his nine-year tenure as a surgeon.

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