Rumour: “If you stop fillers, your face will sag more than before” — What does the science say?

Short answer: there is no strong scientific evidence that stopping hyaluronic acid filler makes the face sag more than it did before the filler. The filler gradually loses its effect, and the face returns to its own natural course of ageing. However, because you also grow older during the years the filler lasts, how you look after stopping should usually be compared not with photos from before the filler but with your age at that point. The long-term effect on the tissues of very frequent treatment with more filler than necessary, on the other hand, has not yet been researched enough.

Where does the rumour come from?

After treatment, a person who has had filler gets used to seeing their face looking fuller and more rested. As the effect wears off, the change noticed in the mirror is compared with this familiar image. The difference often seems bigger to the person than it really is.

In addition, someone who has had fillers for a few years and then stops has also continued to age during that time. The appearance that emerges when the filler is stopped is different from how they looked a few years earlier. This difference is easily blamed on the filler; yet most of it comes from time itself.

What happens to hyaluronic acid filler in the body?

Hyaluronic acid is a water-retaining substance found naturally in our skin and connective tissue. The products used as fillers are a form of this substance processed so that it stays in the tissue longer. Over time, the body slowly breaks this substance down with its own enzymes.

How long the effect lasts varies with the characteristics of the product, the treated area, the amount and the person’s metabolism. Your physician will explain the expected duration for the product used. Because the breakdown is gradual rather than sudden, the face also returns to its earlier balance slowly, not all at once.

Another feature of hyaluronic acid filler is that, if necessary, it can be dissolved by a physician with an enzyme called hyaluronidase. This is an option that can be used in the case of an unwanted result or a complication.

Why does the face sag over time?

Facial ageing does not have a single cause. Research shows that with age, several layers change at the same time:

• Bone: in some areas of the facial skeleton, for example around the eye sockets and along the jawline, bone is lost with age and the support for the soft tissues decreases.
• Fat tissue: the fat compartments of the face lose volume or shift with age.
• Connective tissue: the ligaments that hold the soft tissues in place loosen over time.
• Skin: collagen and elastic fibres decrease; the skin becomes thinner and loses its elasticity.

Sunlight, smoking, rapid and large weight loss and genetic factors can speed up this process. Filler can temporarily hide some of these changes; however, it does not stop the underlying ageing process. What becomes visible when the filler is stopped is the point this process has reached by then.

A real concern: too frequent and too much filler

There is one area in which the rumour is not entirely unfounded. Some physicians are discussing whether treatments done at short intervals and in large amounts over many years may lead to stretching of the tissues, a tendency to swelling or an unnatural distribution of volume in the face. Whether part of the filler may stay in the tissue longer than expected is also among the topics being discussed; the evidence on this is limited.

The scientific evidence on this subject is still limited and is mostly based on expert opinion and small case series. Still, there is a common message: a small and measured amount, intervals set by the physician’s assessment, and assessing the face as a whole at every session are important. A larger amount does not always mean a better result.

What happens if you want to stop fillers?

No special procedure is needed to stop fillers. The effect fades on its own over time. During this process, it may be helpful to know the following:

• The change is usually gradual and takes place over months; you should not expect sudden sagging one morning.
• It is more realistic to judge how you look against your current age rather than against old photos from before the filler.
• If you notice irregularity, firmness or long-lasting swelling in an area, see the physician who performed the treatment or another physician.
• Which approaches other than filler might suit you can only be assessed through an examination.

For the usual course after treatment and the warning signs, see our article “Aftercare Following Medical Aesthetic Procedures”. For information on treatments aimed at skin quality that are discussed instead of, or together with, filler, the article “Skin Booster Injections” can guide you.

Conclusion

Stopping fillers does not take the face to a worse point than it was at before the filler; the face returns to the natural course of ageing that the filler was hiding. Where the rumour contains a valid warning is treatment that is more frequent and in larger amounts than necessary, and the evidence on this is still limited. For detailed information about the product, its risks and the treatment process, you can read our article “Hyaluronic Acid Filler”. The decision should be made together with your physician after an examination.