Face Too “Full” After Filler Injections? Dr. Herzog Weighs In

If your face looks too “full” after filler injections, what can you do? Dr. Herzog weighs in on this question in response to a Family Savvy reader who found herself in this dilemma.

Question: Dr. Jo, I had Juvederm a couple of years ago and really liked it. Recently, I had two syringes of Voluma, and I am not happy with the results. My face feels overdone and too “full.” I thought that Voluma would be like Juvederm, just longer lasting. What do you think happened, and what can I do? Thanks so much for any advice you can give.

Dear Reader,

Voluma is a hyaluronic acid (HA) filler that is injected into areas of the face to add volume. Some of the most common HA fillers are Juvederm, Restylane, Belotero, Voluma and Perlane. Of all the HA fillers, Perlane and Voluma are a bit stiffer, are meant for deeper injection, and should last longer then the others.

These days, it is rare for doctors to directly inject parentheses (lines around the mouth or nasolabial folds). Instead, they address parentheses by filling areas around them, such as cheeks.  For this reason, finding fillers that could be approved for the cheek became the goal of a few filler producing drug companies. Voluma is the newest kid on the block to be approved by the FDA for the cheek area. Perlane will soon be approved for the cheek area as well.

The different fillers have different FDA labeling, but experienced injectors can make use of their qualities in different ways. I only inject these “lines”(parentheses) in younger women with fairly new finer lines, as the best way to get rid of these folds is to fix the problem that caused them, not to puff them up. The reason that most people have parentheses lines is because they have lost volume in the cheeks above.

Returning the mid-face’s volume will simultaneously lift those creases and “volumize” the mid-face. Thicker/firmer fillers like Voluma, Perlane and Radiesse do this well. Voluma was created and FDA approved for the cheek, and it fills this need.

When injected well, Voluma does a good job of giving the mid-face a lift. However, we need to keep the rest of the face in mind and not just create two big apples that look like they belong to a twenty year old and ignore the rest of the face. I saw someone recently whose face, although lovely, had been injected poorly in my opinion. It was obvious that she had some sort of filler injected into her cheeks, but her jowls and other facial areas were untreated and therefore appeared to sag.

When injecting filler(s) into the face, we need to keep the balance of the entire face in mind. I do not think that two syringes of Voluma is that much volume; however, if not placed well, you will not be happy with the end result.

Voluma and Perlane injections, as opposed to Radiesse, can be dissolved if you are unhappy with the outcome. However, you might go back to your doctor and discuss what bothers you. Maybe he or she can help you find the correct balance. It would be a shame just to dissolve all of such expensive filler, but you should ultimately be satisfied with the results.

I would be happy to tell you what I think if you would like to send a photo.  Make sure that you are not smiling in the photo,  as that pushes your cheeks way up. Photos can be sent confidentially, and they do not have to be shared online. Just email them to jamie@familysavvy.com, and Jamie will make sure that I receive the photo and your question.

Hope this has been helpful to you and our readers.

Be safe and be well,

Dr. Jo