What’s Happening to Women's Faces?

Pricked, plumped, and puffed to perfection—some say it’s sexy, others call it fillerexia.

A strange phenomenon is happening among young women. Some of them look older than a Real Housewife, but you’ll struggle to find a single wrinkle. Their skin is as smooth as a Madame Tussauds figure, cheeks as plump as Baby Taimur’s. Their pout? Hello, Angelina. While the intention was likely sexy, the caricature-like proportions look neither young nor old. Just strange. To blame: too much dermal filler, a substance injected into the skin to smooth lines and boost volume. While FDA-approved fillers have been available and used predominantly by women over 40 since 1981, they now have a fan club among those who need them least—women in their 20s.

“The people who are coming to see me for filler now are as young as 19,” says Anne Taylor, MD, a plastic surgeon in Ohio, USA. According to stats from the American Society of Plastic Surgeons, filler usage among 20-somethings has spiked by nearly one-third since 2009 to more than 64,000 procedures in 2014. While injections aren’t surgery, they can be painful...and pricey. So what’s the appeal? Celebrities, according to every doctor interviewed for this article. “Girls in my office have repeatedly said, ‘I want lips like Kylie Jenner’s’,” says Norman Rowe, MD, a New York City plastic surgeon. Like glossy hair or perfect abs, these hyper-smooth, sexualised features are seen as aspirational. And now, they’re increasingly accessible.

One of the biggest reasons for fillers’ popularity: ubiquity. “There are more FDA approved fillers on the market than ever,” says Sachin Shridharani, MD, a Manhattan based
plastic surgeon. “Dentists, ob-gyns, and other medical professionals are offering fillers because they see how lucrative it can be,” he says. To Dr Sachin, going to anyone other than a board-certified derm or plastic surgeon for injectables is “about as wise as seeing me if you’re having a heart attack.” Last year, the FDA issued an alert
about soft-tissue fillers. If they’re improperly injected, the side effects include blindness and stroke, among others.
In the right hands, fillers are generally safe and increasingly less of a commitment. Certain older collagen versions required allergy testing (as they were made with animal by-products), and liquid silicone (which has never been FDA-approved for cosmetic purposes) is permanent. But today, most fillers are made with hyaluronic acid, a natural compound that dissolves between six to 12 months. “It’s the gold standard,” says Dr Sachin. It has less potential for irritation, and mistakes can be ‘erased’ with injections of a (pricey) enzyme. With its modern user-friendly rep, filler seems more like a throwaway beauty treatment than a risky medical procedure. Suddenly, a Big Ang– approved beauty regimen sounds almost sensible. No wonder filler has about as much stigma as getting your hair coloured. 

There’s a certain logic to filling the 40-plus crowd. “They’ve lost collagen and fat over the years, so they’re looking for all-over fullness in the face, sometimes lips,” says Dr Sachin. Here’s the trouble: some docs tend to use the same amount of filler on a young patient as they would on older ones, he says. What may be a bit of filler on a 60-year-old is “like a drop in the ocean,” but on a 25-year-old? Chipmunk City. Too much filler doesn’t just make a young person look bizarre, it can also make her look older. Of course, this OTT aesthetic isn’t always an accident. Often enough, it’s at the patient’s request. “For some, it’s a status symbol,” he adds. “It shows you have your Louis Vuitton bag and your lips—obvious fillers can complete the look of affluence.” And for some patients, it can be a slippery slope. “The mind has an incredible way to recalibrate itself,” he says. Dr Sachin often sees this with patients who get breast augmentation. After the initial procedure, they’re on a high. Once their eyes adjust, the buzz wears off...and they want to go bigger. The same attitude applies to fillers, “which is why they have an addictive nature.” Call it fillerexia. His advice? Ask yourself if you’re really upset with your natural face or if you’re just chasing a trend. If it’s the latter, “keep these procedures in your back pocket for when you’ve actually lost volume—they’re not going anywhere.”