Last month, a story exploded in the consumer media looking into the reality of dermal filler longevity.1 This has been a topic of discussion in the medical aesthetic community for some time, but a recent Daily Mail article written by beauty journalist and author of The Tweakments Guide Alice Hart-Davis has put a spotlight on this concept for members of the public.
In the article, Hart-Davis wrote about the results of a 2021 MRI scan showing that despite not having had injectables for four years, there was still a total of 35ml of filler in her face This contrasts the notion that dermal fillers are a short-term solution lasting between six and 18 months.2
On the general reaction to the story, Hart-Davis says there has been a massive response to the article, with doctors, nurses, surgeons, dentists and dermatologists sharing it around the world. She explains, “Many aesthetic professionals have commented that this is not news to them – they have for years seen evidence in their own clinics of filler that is hanging around for much longer than expected. But everyone else – patients, consumers – were astonished, because it doesn’t fit with the general perception of hyaluronic acid (HA) fillers as something that will dissolve in time, certainly within a couple of years. They were concerned even though the filler in my face is all in the right place and is not causing any problems.”
With patients concerned about what the news might mean for them and their future treatment plans, we spoke to aesthetic practitioner Dr Sophie Shotter and aesthetic radiologist Dr Mobin Master to get their advice on how to speak about filler longevity with your patients, and whether it should impact your treatment planning/consultation.
An emerging concept
Dr Master has been a pioneer in bringing filler longevity to greater attention, first noticing it back in 2019. He comments, “I started getting referrals for facial MRIs of patients who had eyebags of unknown cause, who denied having filler for more than two years. Many of the MRIs showed filler still present in the tear trough area. As more of these referrals started coming in, many had residual or large volumes of HA filler despite denying any treatments, ranging from two to 15 years.” Following this, Dr Master then started his own retrospective trial, looking at patients who have had persistent or misplaced filler in the face.3 He comments, “This trial showed the value of MRI as a great ‘snapshot’ of the face and a roadmap to dissolving unwanted areas.”
Dr Shotter has also been aware of longer-lasting dermal filler for some time, commenting, “I personally am not surprised by this news. I’ve seen patients who clinically still have filler present many years after treatment, and anecdotally we know from patients who have had positron emission tomography (PET) scans that filler can appear on those even 10 years later.”
Changing treatment approaches
As a result of the growing evidence that HA dermal filler is lasting for longer than expected, Dr Master advises that practitioners need to ensure they are taking good clinical photos before any filler treatment, as well as progress photos to assess how the face has been filled or potentially ‘over-filled’. He explains, “It means when we use HA filler, we need to position it correctly from the start. Any errors or poor outcomes will remain for a very long time and may still be seen.”
He adds that this will be a positive for aesthetic medicine, as it will stop practitioners using guesswork and therefore minimise the risk of error. He explains, “As more become aware, they are more likely to review their face and work off the clinical photography, rather than assumption. Practitioners are stopping refilling purely on a ‘time’ or ‘recommended’ basis. This has made the use of filler far more scientific and evidence based, which is refreshing! The refill process should have a visual, clinical basis and looking back at baseline photos is very important.”
Dr Shotter doesn’t believe practitioners need to change their current approach to consultations, noting, “The outcomes of this news coverage shouldn’t impact our patients or how we interact with them. However, I do think that we have a responsibility as the consulting practitioner to discuss these things frankly when asked. I have always been honest with my patients that the results of fillers usually last between one and two years, but that doesn’t mean all the filler disappears then.” She adds that she won’t change the frequency of treatments for patients either, commenting, “The ageing process still continues to progress and the visible results of fillers do ‘wear off’. So, I will continue to assess my patients at regular intervals and treat only if they have a clinical indication. It doesn’t change our clinical assessment of their needs, but we shouldn’t dismiss a treatment done five years ago as irrelevant.”
What to communicate to patients
Dr Master advises that if patients present to you with concerns, you should reassure them that all treatments will be tailored to individual patient requirements. He says, “At this stage, as clinicians, I believe it’s a good approach to address those concerns and make it clear that the use of the filler will be related to the photography and progress photos. Filling according to the six-to-24-month recommendations is no longer relevant if the face still seems full. Clinicians can reassure that the face will not be ‘overfilled’, and this is best prevented by filling carefully and gradually.”
Progressing the concept of filler longevity
Dr Shotter believes this increased awareness is a huge positive for patients and practitioners. She notes, “I very much hope it makes patients think more carefully about what they have injected, and to consider that fillers involve having something injected into the face that could be there for as long as a surgical implant. This means it should be treated with the same degree of respect. They should ensure they have treatment with a qualified and respected medical practitioner, and they should ask what products they use. I see it as a chance for ethical medical injectors to credit themselves appropriately.”
However, Dr Shotter adds that more research needs to be done in this area to fully understand what this means for the specialty, noting, “We need to do significantly more research to determine how common a case like Hart-Davis’ really is. Currently we don’t have this data available to us.” She adds that it’s important for medical practitioners to stay abreast of the latest developments so they are in a better position to educate patients.
Dr Master also acknowledges that there needs to be further research into this area for practitioners to further assess what this might mean for aesthetic medicine. He concludes, “Indeed there needs to be larger trials, as per my first paper in Plastic Surgery USA.3 In fact, I have just completed the largest cohort study on longevity, which I am working on submitting this month.”
Aesthetics will be following developments in this area as they emerge.
1. Daily Mail, I’ve got 20 years of filler stuck in my face, 2023, <https://www.dailymail.co.uk/femail/ article-11620871/Ive-got-20-years-filler-stuck-face-meant-dissolve-MRI-scan-revealed-truth.html>
2. Alice Hart Davis, How Much Filler Did Alice’s MRI Scan Show, 2022, <https://thetweakmentsguide. com/blog/how-much-filler-did-alices-mri-reveal/?fbclid=IwAR3fZML9I0-u-BcXoIWD394rtOpsLehKs5N 2ktc8G7cdtHjm7T4Ye9cynfQ>
3. Mobin Master, Hyaluronic Acid Filler Longevity and Localization: Magnetic Resonance Imaging Evidence, 2021, <https://pubmed.ncbi.nlm.nih.gov/33002985/>