Filler Aesthetics + Ethics: A Candid Perspective from an Experienced Aesthetic Injector
With over 25 years of experience in aesthetic medicine, and as a trainer who teaches injectors across the country on the best practices and safety techniques for facial fillers, I have seen the full arc of dermal filler trends. From early adopters to today’s growing concerns, I understand both the art and responsibility that come with filler injections.
Today, I want to talk about a topic that I feel strongly about: filler aesthetics and filler ethics.
Just a few years ago, hyaluronic acid (HA) fillers were widely praised. Now, many patients are asking:
"Do fillers migrate?"
"How often should I get lip filler?"
"Should I dissolve my filler and start fresh?"
There is some truth behind the growing skepticism, but also a lot of misunderstanding.
The reality is:
HA fillers can last a long time
They are hydrophilic, meaning they attract water
When overused or placed improperly, they can lead to puffiness or filler migration
And unfortunately, some providers do not take a full-face approach or prioritize patient safety.
Where Filler Migration Happens Most
While social media often exaggerates the issue, true filler migration does occur primarily in two areas:
1. The Lips
If you inject lip filler every six months, but the product is still lingering from a prior treatment, it has nowhere to go. This can cause filler to migrate above the lip line, creating a swollen or unnatural look.
Patients love full lips, but filler should be spaced at least 18–24 months apart for optimal safety and aesthetics.
2. The Under-Eye Area
Even with excellent technique, under-eye filler migration is more common due to the delicate, thin skin. Puffiness and shadowing can develop over time—especially when touch-ups are done too frequently.
The Importance of Choosing an Ethical Filler Injector
This is where injector ethics matter. As a provider, my job is not just to say "yes"—it is to guide patients with honesty, precision, and long-term vision.
Sometimes that means saying:
“You had filler six months ago. Let’s wait and reassess in a year.”
Good results require restraint, planning, and a deep understanding of facial harmony, not just volume correction.
When it comes to injectables and aesthetic treatments, providers must remember that we are medical professionals first—not just technicians. Treatment decisions should never be driven solely by profit. Instead, they must be grounded in what is medically appropriate and psychologically beneficial for the patient.
Many aesthetic procedures are performed to enhance self-esteem or restore function, and the long-term well-being of the patient should always come first. It is our ethical duty to guide patients thoughtfully, respectfully, and responsibly through their treatment options.
What If You Think Your Filler Has Migrated?
If you are experiencing lumpiness, swelling, or a change in your facial shape, you may need a professional evaluation. In many cases, the best solution is to dissolve the filler and start with a clean foundation.
At our practice, we offer ultrasound-guided filler assessments and dissolving treatments. This allows us to safely locate and dissolve misplaced or migrated filler with precision.
Learn more about our process at our Referral Center for Filler Complications.
Final Thoughts
As a San Francisco-based aesthetic injector with over 25 years of clinical experience, I believe in using fillers conservatively, strategically, and ethically. The goal is never just to "fill," but to enhance your features with care and long-term results in mind.
If you are looking for natural results, facial balance, and ethical care, we are here to help.