09/22/2026
There has been a growing trend, particularly among plastic surgeons, of criticizing dermal filler and pointing to overfilled faces as evidence that patients should abandon injectables in favor of surgery.
I understand where some of that criticism comes from.
For years, aesthetic medicine went through an era where nearly every sign of aging seemed to have the same answer: add more volume. Cheeks, temples, jawlines, lips—every hollow became something to fill.
But when filler is repeatedly added without reassessing the patient's anatomy, it can create heaviness, distorted proportions and an unnatural appearance.
That’s a problem with how filler is being used—not filler itself.
As both a dermatologist and surgeon, I don’t see filler and surgery as opposing philosophies. They are different tools designed to accomplish different things.
A facelift can reposition descended tissue and address significant laxity in a way filler cannot. But strategically placed filler can restore support, improve proportion and subtly balance the face without surgery.
The question shouldn’t be, “Filler or surgery?”
It should be, “What is actually causing the change we’re seeing?”
Sometimes the answer is filler. Sometimes it’s a laser or another technology. Sometimes it’s surgery. And sometimes, the right answer is to do nothing.
That’s also why I don’t believe in treating filler as a commodity.
Faces don’t come in syringes.
Every patient has different anatomy, volume loss, skin quality and goals. Treatment should follow the anatomy—not a predetermined number of syringes or a social media trend.
I welcome the conversation around overfilling. But swinging the pendulum from “filler for everything” to “filler is bad” is another oversimplification.
Natural-looking aesthetic medicine isn’t about filler vs. surgery.
It’s about having the judgment—and restraint—to know when to use each.
— Dr. Ariel Ostad
