Experts Reveal Their Best Advice for Achieving Natural-Looking Filler Results

From celebrities to soccer moms, more people are taking a natural-looking approach to fillers, and in many cases, you can’t even tell they’re there. Studio City, CA dermatologist Gene Rubinstein, MD says this is the case with the majority of his patients, who are asking for a natural-looking yet youthful effect.

Palo Alto, CA facial plastic surgeon David Lieberman, MD says this is a common trend across all aspects of facial aesthetics recently. “A focus on natural outcomes is the priority, and the expectation to achieve that undetectable, or effortless, look is very high,” he explains. “I think this is excellent. It raises the bar in our field. Our patients are educated and discerning, which drives our providers to deliver outcomes and educate at the highest level.”

For Dr. Rubinstein, most of his patients seek fillers to address three concerns: deeper lines around the mouth, under-eye bags and a lax jawline. However, he’s seeing less cheek filler for volumization. “It’s more about midface deep filler for weight loss and volume loss,” he says. “So ultimately, we are preserving the facial volume rather than enhancing the cheeks.” Glenn Dale, MD dermatologist Valerie D. Callender, MD adds that she’s noticed patients requesting less filler, too. For example, she’s using one to two syringes per session instead of three to four, to achieve a more natural look.

Perception drift occurs when a patient loses sight of their appearance, which can be a result of getting cosmetic work done, rapid weight loss or other shifts. “This phenomenon causes patients to lose sight of ‘normal,’ leading them to get more and more procedures to achieve a certain look,” says Louisville, KY plastic surgeon M. Bradley Calobrace, MD. “I see this in women who are trying to look ‘younger’ rather than more youthful. They feel every line or change in the face is a sign of old age, and that if they erase it, they will look younger. These patients want to erase every possibility of movement in their forehead and crow’s-feet. They want their under-eyes filled until perfectly smooth, and their lips plumped to hide upper lip lines.”

New York dermatologist Doris Day, MD says these patients also want their cheeks as full as they were in their 20s, even though their bone structure has changed and no longer supports that. “My way of addressing this is to hand each patient a mirror, and then instead of starting with what they don’t like and what they want to change, we talk about what they love and what we want to enhance.” Dr. Day feels as though it’s part of a doctor’s duty to help patients see their beauty, celebrate it and navigate enhancing it, rather than reinforce the idea that they would be going from flawed to less flawed.

In many cases of perception drift, patients become overfilled. Part of a dermatologist’s or plastic surgeon’s job is managing filler fixes when patients realize they have too much or it’s misplaced. “They don’t like what they see in terms of how the filler has changed their appearance, and often, they don’t know when it happened,” Dr. Lieberman says. “I think this speaks to not only perception drift, but also the way filler changes its behavior and interaction with soft tissue over time. This has to be accounted for when doing any nonsurgical treatment.”

“In aesthetics, the uncanny valley describes the point at which enhancements make a face look almost—but not quite—human. It’s when facial symmetry, volume or smoothness becomes so exaggerated that it feels unnatural or unsettling,” explains New York plastic surgeon B. Aviva Preminger, MD. Small tweaks accumulate, leading to exaggerated features. “Avoiding this means respecting the nuances that make a face unique, like slight asymmetries, natural animation and soft transitions.”

The uncanny valley look “can happen when you have too many different people doing injections,” says Dr. Day. “Each injector has an idea and an approach, and even though each one may have good ideas, their approaches don’t match each other, which leaves you looking unnatural and unbalanced. I do a thorough assessment and use fillers discretely, in different areas of the face, to balance, support and contour the face rather than simply erase lines. I also create a calendar for each patient that combines skin care, injectables and devices like Sofwave and laser resurfacing, to help give a natural, authentic and lasting result.”

Patient education is also crucial. “There are times when I have to tell patients that fillers are not the best option for them, or that we need to dissolve pre-existing filler before moving forward,” Dr. Day says. “Sometimes it takes more fillers, done in more areas of the face, to get the best outcome.” Dr. Rubinstein educates patients that they will look more natural when they don’t overvolumize their cheeks and/or lips, even if he injects other areas like the nasolabial folds, the frame of the face, the temples or the midface. “For men, we stay away from injecting the apple of the cheek and concentrate on the frame of the face and under-eye hollowness,” he adds.

Additionally, patients and injectors always need to be thinking ahead. “It’s really necessary to ensure we are thinking about the patient in five, 10 or 20-plus years,” says Dr. Lieberman. “Filler can be done strategically and with beautiful results, but it needs to be a carefully curated process that is best done in small steps over time, and by a true expert.”

“My tip is to undertreat and wait,” says Dr. Lieberman. “Results evolve, and overtreatment can be a forever problem.” Dr. Calobrace encourages limiting the use of fillers to simply restoring volume rather than overdoing it. “Each time a patient gets filler, they should use less because some is still present,” he adds.

The art lies in restraint.

Additionally, Dr. Rubinstein says it’s important to keep a patient’s facial features soft. “Making the female face too flat or the male face too cheeky triggers the look of someone trying too hard to reverse aging,” he explains. “Right now, we are using more RHA Redensity and Sculptra for soft and natural rejuvenation of the skin.”

Dr. Day recommends making sure you have a proper assessment and share the same vision for your outcome as the person doing your injections. “Patients often point out lines they don’t like, but I don’t take that to mean I simply need to fill those lines. The information helps me understand not only what they see, but also the emotions connected to the lines, or the expressions creating the lines. For example, crow’s-feet make them feel like they look tired, or marionette lines make them feel like they look sad. When I connect the emotion to what they see, I can then better guide them and offer a comprehensive approach to give them the best results.”

According to Dr. Preminger, the goal should be subtle contouring, restoring volume loss and enhancing features while also maintaining natural facial movement and proportion. “The best compliment a patient can receive is, ‘You look great; were you on vacation?’ and not ‘What did you have done?’” Dr. Callender often refers to old photos of patients when they were 10 to 20 years younger and discusses how they can achieve those results, restoring volume rather than overfilling and losing that natural look. “Always remember that less is more,” says Dr. Preminger. “The art lies in restraint.”

Taking breaks from procedures and seeking unbiased opinions from others can be beneficial as well, explains Dr. Calobrace, who encourages injectors to say “no” if they think a patient is falling into a troubling pattern. “If they come in often and continue to want ‘tweaks,’ it’s a warning sign,” he adds.

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