The International Society of Aesthetic Plastic Surgery counted 4,737,957 hyaluronic acid filler treatments worldwide in 2025. That is 25.2 percent fewer than the year before, and fewer than in 2021. Poly-L-lactic acid fell 33.7 percent. Calcium hydroxyapatite fell 25.7. Fat grafting to the face held at 944,410.
I think we have seen that facial fillers have been quite overdone, and patients are really getting away from looking overfilled and want to look more natural. We have seen that these hyaluronic acid fillers may not dissolve completely, and they do tend to migrate. It seems like they create some kind of inflammatory response in some patients, creating nodules or inflammation.
What I Have Been Doing All Year
Fillers over time have started to come out of favor, as we are now noticing that the filler really never dissolves. The results can last about a year, but the filler does not dissolve, it just disperses. I have seen cases where it blocks the lymphatic drainage, and patients start having bags under the eyes, which are worse in the mornings, or they have discoloration or lumpiness. Sometimes they can also get inflamed. So I have dissolved a lot of under-eye fillers in order to improve all these complications, and that is why I am more inclined to use fat rather than hyaluronic acid fillers.
Why Fat
I think fat grafting has been rising for many years. It’s an essential component of almost all facial procedures. I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight.
We have been using the patient’s own fat, because we have the benefit of using however much volume we really need, as the number of fat CCs does not increase the cost of the procedure, and the patient’s own fat is free. This gives a very natural, soft result, which is of course long lasting. For some patients that don’t want as much downtime, we’ve been using Lipoderma, which is a donor fat graft that gives us very similar results to the patient’s own fat grafting.
The Catch, Because There Is One
Now, the main factor that disappoints people with fat injections is that the amount of retention is really unpredictable. Even though we know the patient is going to keep fifty to eighty percent of the volume, that percentage is quite unpredictable, so we are always overfilling. Patients that lose fifty percent of the volume we inject are sometimes disappointed, and we have to go back and inject more fat.
The good thing is that whatever does stay is going to be quite permanent.
The table, the Botox line and the hand numbers are in the full post on the Agullo Plastic Surgery site.
Why Me
Double board-certified, Mayo Clinic trained, Clinical Associate Professor of Plastic Surgery at Texas Tech, Castle Connolly Top Doctor 2014 through 2026. Fat in almost every facial operation I do, and a lot of other people’s filler dissolved this year.
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