Aesthetic medicine faces new challenges as trends, social media, and patient expectations evolve. Overfilled faces are becoming more common, influenced not just by injectables but by perception, current culture, and digital tools. At IMCAS Asia 2024, Dr. Marina Landau, a dermatologist with over 25 years of experience in cosmetic procedures from Israel, and Dr. Marcin Ambroziak, a dermatologist and injector from Poland, shared their insights on the causes, management, and ethical considerations of overfilled faces.

Introducing the Experts

Dr. Marina Landau: I’m Marina Landau and I’m a dermatologist. I’ve been doing cosmetic procedures for the last 25 years. So I have both the medical and cosmetic perspective, and judgment, of everything that I’m doing in my office and what is performed anywhere else.

Dr. Marcin Ambroziak: I’m originally from Poland, and I’m a dermatologist. I’ve been doing this for 25 years. I opened my first office 25 years ago, and now we are the leading company in Poland because we have plastic surgery, dermatology, clinical dermatology. Most of our employees are injecting. So my perspective is as an injector myself, and as part of the organization that is doing everything possible in aesthetic medicine.

The Rise of Overfilled Faces

IMCAS Team: What are the primary factors contributing to overfilled faces in your practice?

Dr. Marina Landau: Overfilled syndrome has nothing to do with a specific product. It actually has to do with the patients' and doctors' perceptions, what is the desired outcome of the procedure.

Dr. Marcin Ambroziak: And communication.

Dr. Marina Landau: Patient happiness sometimes goes exactly against the beauty of the patients. The initial intention was correct. With the aging process, one of the things that happens is that we lose facial volume. Not all faces are prone to the same volume losses. At the age of 25 versus 45, there is a decrease in volume.

Dr. Marcin Ambroziak: If you have a new hammer, everything seems to be a nail. Whenever we had a new tool, like volumetric hyaluronic acid products, we were trying to inject it everywhere we thought volume was lost. We started with the cheekbones, then the temples, then the mandibular area. And all of a sudden, our patients came back with swollen faces, like a sponge.

Dr. Marina Landau: Because of social media, our patients also lost a little bit of control. It's not only doctors.

Dr. Marcin Ambroziak: And when you asked about the product that is making it worse, there is one: it's called Instagram.

Dr. Marina Landau: Yes, social media.

Patient Psychology and Social Media Influence

IMCAS Team: How do patient perceptions and social media influence overfilling trends?

Dr. Marina Landau: A little bit more will probably make your face look unnatural. And the patients stop seeing themselves. Not only patients, doctors too. It is happening to human beings because this is how our brain is tuned. You get used to it and you want a little bit more.

Dr. Marcin Ambroziak: It’s a bit like an addiction.

Dr. Marina Landau: Addiction to injections?

Dr. Marcin Ambroziak: It’s like running. If you don’t run and you used to run, then you feel like you haven’t brushed your teeth. The good feeling of what you see in the mirror is very addictive.

Dr. Marina Landau: At a certain point, we lose the ability to understand what is considered attractive. If you ask the general population and a group of doctors: ‘Is an overfilled face considered to be nice?’ Ninety-nine percent will say ‘of course not,’ but you show them overfilled, then you have a little bit of a different percentage.

Dr. Marcin Ambroziak: Filters and generative AI are changing perceptions. Patients come with their own filtered pictures and say, ‘I can see I could look like this. Just do it to me, please.’

Dr. Marina Landau: If they come with the edited picture, and assuming that Artificial Intelligence is still not what is considered beautiful, this would control the phenomenon of overfilled face, because they would probably come with a picture of themselves which is not overfilled. It is still some sort of psychological phenomenon.

Ethics, Patient Selection, and Gradual Correction

IMCAS Team: How do you manage patient requests that you believe are excessive?

Dr. Marina Landau: Medical business is a little different from a shop. If a woman enters a shop and she wants to buy five outfits, and none look nice on her, there is no way the shop will not sell it to her. When a woman steps into the medical business, I think it is a duty, sometimes, to say no. Even if 50% of patients go to somebody else, it’s very difficult, but for me, it is very clear.

Dr. Marcin Ambroziak: It is a matter of taste. If the patient is not dysmorphic, then it’s about preference.

Dr. Marina Landau: A way to solve this conflict is to say ‘One syringe, not more. If you want more, go to somebody else.’ You have some income, the patient is happy, and you are not breaking too many rules according to your opinion. I followed a young patient for three years without injecting her, saying ‘Not yet.’ She accepted her natural lips over time.

Correcting Overfilled Faces

IMCAS Team: What are your strategies for correcting overfilled faces safely?

Dr. Marina Landau: Before treating the overfilled face, we need to come to the conclusion that we are dealing with an overfilled face. It is possible to degrade the filler slowly so the brain adapts. Overfilling does not happen in a single session; small amounts over time are safer.

Dr. Marcin Ambroziak: Energy-based devices help. If we tell them that HIFU or radiofrequency will additionally help the sagging, lifting, and wrinkle effect, and we know it will make the hyaluronic acid work a little faster, then they are motivated to come for that treatment.

Dr. Marina Landau: Combination therapy makes sense when each treatment addresses something different. For example, volume loss and epidermal improvement can be treated separately. Doing two treatments that do the same thing is unnecessary and increases risk. I need good proof that it is justified scientifically.

Dr. Marcin Ambroziak: Consider the face like a three-story building: foundation with stimulators or hyaluronic acid, first floor with wrinkles, and surface with skin texture. Combining treatments at each level achieves faster, more efficient results.