There are more choices than ever – even ones you can undo.
In aesthetic medicine, few topics generate as much conversation as facial implants and fillers. Both are designed to restore volume and structure lost with age, yet their long-term behavior in the body has become an increasingly important part of the discussion. As patients seek more natural-looking results that will age well, experts are urging a shift from short-term fixes to thoughtful, long-range planning.
“Volume loss is one of the defining features of facial aging,” said Dr. Marcelo Hochman of The Facial Surgery Center. “But how you restore that volume – and where – matters tremendously over time.”
How Fillers and Implants Work
At their core, fillers and implants serve different purposes. Facial implants are solid, medical-grade material placed directly on bone, most commonly in the chin and cheeks. They augment skeletal support, essentially replacing structure that may be naturally deficient or diminished. Dermal fillers, by contrast, are injected into soft tissue to temporarily restore volume or smooth contours.
That distinction becomes critical as patients age. “Implants go on the bone and support the tissues from underneath,” Dr. Hochman explained. “Fillers sit in the soft tissue. If you’re augmenting a bone deficiency, putting volume into soft tissue can look acceptable at first, but, over time, it may not behave the way you expect.”
Jawline and Chin: When Structure Matters Most
Two areas where this difference is especially apparent are the jawline and the chin. While fillers are often marketed as quick solutions for chin projection or jawline definition, Dr. Hochman cautioned against relying on injectables in those areas for the long term.
“The chin is a structural issue,” he explained. “Adding filler into fat and deep tissue may look OK initially, but, over time, especially in an area with constant movement, you can end up with irregular contours if some filler dissolves and some does not. A chin implant is a much more stable, natural-looking solution.”
Cheek Filler Placement and Common Misconceptions
Cheeks, on the other hand, can respond well to filler when placed correctly. Problems arise when filler is injected too high on the cheekbones in an attempt to “lift” the face; it’s a misconception Dr. Hochman sees frequently.
“Injecting filler doesn’t actually lift tissue,” he said. “Most people don’t need volume high on the cheekbone. They need it more medially, closer to where fat naturally descends near the nasolabial fold or tear trough area. Misplaced filler is one of the biggest reasons faces start to look unnatural.”
Tear Trough Fillers and the Tyndall Effect
The under-eye, or tear trough, area is particularly delicate. The skin there is extremely thin, and filler can become visible, creating a bluish or translucent appearance known as the Tyndall effect.
“You’re literally seeing the filler through the skin,” Dr. Hochman said. “That’s not desirable, and it’s very hard to fix.”
Long-Term Filler Behavior and Reversibility
Long-term behavior of fillers has become a growing concern in recent years. While many hyaluronic acid fillers are marketed as lasting six to 18 months, imaging studies now show that remnants can persist in tissues for years.
“That extended longevity is a double-edged sword,” Dr. Hochman cautioned. “If the patient is happy, great. But if filler migrates, forms nodules or causes inflammation, those issues can also persist much longer than expected.”
Hyaluronic acid fillers do offer one important safety advantage: reversibility. They can be dissolved with an enzyme if needed. There’s no dissolving agent for non-hyaluronic acid fillers, including silicone-based products, making complications much more difficult to manage. “For those products, you have to be extremely cautious as to where you place them and how much,” Dr. Hochman said.
Facial Implants Over Time: Stability and Flexibility
Facial implants, despite being permanent, are surprisingly adaptable over time. Modern implants are malleable, scored to conform to anatomy and fully reversible. Chin implants are placed through a small incision under the chin, while cheek implants are inserted through the mouth, leaving no visible scars.
“If anatomy changes over time, implants can be removed or replaced,” Dr. Hochman said.
Natural Results and Who Performs the Procedure
The overarching goal, he emphasized, is always a natural look.
“If it doesn’t look natural, something is wrong, regardless of whether it’s a filler or an implant,” he said. “That’s why who performs the procedure matters just as much as what is used.”
Skin Care Trends and a Long-Term Philosophy
This philosophy aligns with broader trends toward subtlety in beauty. A variety of products have hit the market touting age-defying properties to achieve a fresh look without injections or surgical procedures. Among these, Korean skin care has grown in popularity due to its natural products and “glass-like” results. With lengthy multistep routines and ingredients such as snail mucin and ginseng, social media influencers have brought this over-the-counter trend to the forefront. But even these more “natural” options come with a downside. In addition to complicated steps, the products are not suitable for all skin types, including sensitive skin, and yield varying results.
While Dr. Hochman noted that he does not specialize in Korean skin care, its emphasis on skin health, prevention and restraint mirrors principles he believes are essential.
“It’s best to maintain skin quality over time rather than aggressively correct problems later,” he said. “That’s very much how we should be thinking about fillers and implants; they should avoid overcorrection and respect how the face will age.”
Risks, Filler Fatigue, and Planning for the Future
No material behaves exactly the same in every body, and time always changes the equation. Filler fatigue, filler migration, nodules, overfilling, long-term tissue changes and loss of natural expression are among the more common negative side effects.
“Younger patients need to be especially careful,” he said. “You don’t want to cause long-term issues by putting something somewhere that limits your options later.”
In an era of fast fixes and widespread access to injectables, it’s important to prioritize a long-term perspective. With thoughtful planning, appropriate material selection and experienced hands, implants and fillers can support graceful aging.
By Anne Toole
