Since the day Kylie Jenner pouted her way into our beauty consciousness in 2015, dermal fillers have been increasingly in demand. While the cosmetic surgery industry in the UK is currently worth around £3.6 billion, it's aesthetic treatments such as wrinkle-relaxing toxins and dermal fillers that account for 9 out of 10 procedures. Indeed, 13.6m non-surgical treatments were carried out worldwide in 2019 alone – a 50.6 per cent increase since 2015.

The quick, non-invasive nature of injectable tweakments, where a doctor or aesthetician inserts hyaluronic acid via a needle into specific contours of the face to manipulate its structure, has won a legion of fans over the years thanks to its (supposedly) natural result compared to going under the knife. But what happens when we become a little trigger-happy with the syringe? We get 'filler fatigue' – a term that's, unfortunately, being used more and more within the aesthetician industry as our quest for perfection becomes too much of a good thing.

Here, we ask the experts how to avoid filler fatigue and achieve the natural look so many desire.

What is filler fatigue?

Although the term suggests we're perhaps exhausted at the global obsession with fillers, it actually refers to what happens when hydrophilic filler draws in more water and creates a swollen-looking finish rather than the sculptured result intended. One person that is well versed with the term is cosmetic dental surgeon and advanced facial aesthetics clinician Dr Nina Bal. Appearing on E4's series Body Fixers, Dr Bal has seen her fair share of filler faux pas. “Sadly we are seeing more and more filler fatigue in recent times,” she says. “This is a result of patients having multiple millilitres of dermal filler injected and the area treated becoming augmented in a negative way. This may appear as puffiness, asymmetry, fullness to the area or even heaviness that was not previously there.”

Without proper regulation, it's no wonder that the number of official complaints about non-surgical procedures has more than doubled to over 600 cases in the last three years, according to Save Face, a national register of accredited practitioners. “The most common areas we are seeing this occur in clinic is the under eyes (tear trough), jawline, lips and cheeks,” they say.

How to identify if you have filler fatigue

Whether you're a dab hand in the aesthetician chair or a filler newbie, the fear of things going wrong is an unnerving reality. Although we've all heard the horror stories and seen the images of botched treatments, filler fatigue is more subtle in its appearance. “Anatomically, every patient will present differently,” Dr Bal explains. Despite the aim of looking rejuvenated or naturally refreshed, there are the undeniable artificial telltale signs of a treatment gone awry. “What I'm seeing is patients who have had jawline filler who feel their lower face looks heavier post treatment, or there's an increase in jowling and deeper nose-to-mouth lines. For those who have had their lips over-treated, they may find they have a ‘shelf’ above and below the lips, while those who have had their cheeks over-treated may see or feel a fullness in this area that's not in keeping with the rest of their face. If tear troughs are overfilled or the filler has been injected over the zygomatic ligament, this can result in a very unnatural swelling and puffiness under the eyes that make you look even more tired than having deep hollows.”

Misuse of tear trough filler is especially concerning. "MRIs have been completed in patients who have had a treatment more than 10 years ago and it was found that many still had dermal filler present. These patients are presenting with chronic puffiness and poor lymphatic drainage of the area.”

What causes filler fatigue?

You've done your research and read the testimonials – but sometimes things just don't quite go to plan and, according to Dr Bal, the reason is two-fold. First, is mistreatment: “This is, for example, when a patient has been told that cheek or jawline filler will 'lift' their cheeks or jawline, which is incorrect,” she says. “Dermal filler does not have the ability to lift – it can contour an area to create the illusion of lifting but patients are having multiple millilitres of dermal filler injected repetitively in the hope of 'lifting' when this is simply not the best treatment option for the patient.”

The second is over-treatment: “This refers more to patients who continually have the same treatment and the treating injector does not complete a thorough re-examination and re-consultation with the patient. We most often see this in the lips – where the patient has multiple treatments, and they start to lose the ‘anatomical’ shape of their lips.”

The result? An over-inflated visage that's far from the balanced end result you were hoping for. Technique and restraint aside, experts are quick to warn that hydrophilic filler in particular is a significant player in filler fatigue. Popular brands such as Juvederm Ultra, for example, tend to draw in more water that's held in the filler molecules, migrating up to two centimetres from the injection site – leading to a lymphatic back-up and creating a more doughy finish.

How to avoid filler fatigue

As tempting as it is to be lured in by a practitioner promising discounts, deals and specials, the reality is that filler is expensive to maintain and is not a treatment to scrimp on. “Dermal filler treatment carries risks, and we are luckily starting to move away from treating the areas as per the patient's request,” Dr Bal says. “It should be a very thoughtful, holistic and dynamic discussion between the patient and injector; rather than them asking for a certain amount of filler, the injector should be educating the patient on what the safest and best treatment recommendation to avoid filler fatigue is.” On the flip side, Dr Bal also believes that the patient should be choosing an injector who has a holistic approach to treatment and a deep understanding of the anatomy of the face and the long-term changes due to ageing that must be considered. Her best advice? It's a journey, not a race.