A year-old Letterboxd clip, a few side-by-sides, and the internet had a name for it: Megan to Megatron. One of the most shared photos is tagged AI-generated by the account that posted it. No doctor is quoted. IBTimes UK has the timeline.
I do not diagnose a face from a screenshot. Here is what I do instead, with the patient in the chair.
Puffy or Migrated? The Thumb Test
“Normal puffiness or swelling, typical in the mornings or after a late night and heavy salt intake, is soft. We can usually make some of it disappear with cold pressure, and it dissipates during the day.”
“Filler migration requires a history of filler. You have added volume in an area close to where the filler was placed, so it has, in quotations, migrated. It is palpable; filler can be felt outside of where it was originally injected.”
Soft and gone by lunch, salt. Firm, next to where it was put, filler that moved. A photo cannot press on anything.
Why Filler Swells Long After It Was Injected
“Fillers can create a type of inflammation. It may not be constant, but the tissue around the filler itself may swell up.”
“Filler can also block lymphatic drainage and make morning swelling in the injected area even worse.”
“When patients use fillers, they see that they have to have this redone anywhere from every six months to one year. And what we’re also seeing is that not all of that filler goes away, but it’s migrating and flattening out, so it’s not giving us the volume exactly where we want it.”
What Overfilled Actually Looks Like
“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. And of course, the feel of a filler is not quite like natural fat, which is squishy and soft, something whose borders you wouldn’t be able to identify the way you can with a filler.”
“Really, what I think is that there has been a huge tendency to overfill faces with fillers, and maybe that’s why it’s difficult to count.”
Megan Fox said on a podcast last year that she has had Botox, fillers and laser, and that she does not see the point of shaming people for getting things done. Neither do I.
“Frozen” Is a Technique Problem, Not a Botox Problem
“I myself get botulinum toxin in the forehead, crow’s feet, and glabella lines every three to four months, just to maintain the wrinkle free appearance with a dose that still lets me express my face without looking abnormal.”
“Dose, dilution, injection placement, and product choice matter more than whether you are active or inactive. These are all customized depending on each patient’s consultation. For example, patients with very strong frontalis muscles, glabellar muscles, or masseters will require a higher dose than others.”
“I do ask patients not to exercise for twenty-four hours after a botulinum toxin injection, but this is not because it is going to wear off sooner. It is because I want the solution to stay exactly where I injected it, and strenuous exercise immediately after an injection could increase the risk of the product migrating, complications, and swelling.”
Where My Patients Went Instead
“In my practice, I’ve seen more than a twenty to thirty percent decrease in the use of fillers, and a shift toward biostimulators and donor fat grafts instead.”
“Filler cannot really give us a natural feel. When properly done it can give us a natural look, but it’s often overdone. It can also not give us a long lasting result, and this is where fat has its benefits.”
More: fat grafting overtakes the filler era, under-eye filler does not dissolve, Kristen Wiig photos, a surgeon reads the face, and when the answer is a lift, the facelift you can’t see. The injectables version of this post is on the Southwest Plastic Surgery post; the surgical version is on agulloplasticsurgery.com.
Why Choose Dr. Agullo
Dr. Agullo is certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at the Mayo Clinic, and serves as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He has been a Castle Connolly Top Doctor for thirteen consecutive years, 2014 through 2026. Facial fat grafting, filler dissolving and revision, and botulinum toxin dosed to keep expression are everyday work in his El Paso practice.
Ready to Talk?
If you are not sure whether what you see is filler, swelling or the light, come in and let me press on it. It takes a minute.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful
Find me at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.