Changing course
Evolving safety concerns and emerging trends arise in injectable fillers.
C011 – Face Off: Evidence-Based Debates on Today’s Hottest Injectable Controversies
1-4 p.m. | Sunday, March 29
Mile High 2A
Amidst the rapidly evolving field of injectable techniques, products, and data, dermatologists are sounding the alarm on new controversies, shifting best practices, and rising patient expectations.
Dermatologists are seeking evidence-based guidance in determining the most appropriate treatments to achieve natural-looking outcomes while maximizing patient safety. In the upcoming session, C011 – Face Off: Evidence-Based Debates on Today’s Hottest Injectable Controversies, a panel of experts will tackle the increasingly complex landscape of facial rejuvenation as well as the role social media plays in driving misinformation and creating anxiety among patients and injectors alike.
“Over the last few years, we’ve seen a necessary recalibration in how injectors approach filler safety, longevity, and long-term tissue behavior,” said session co-director Melanie D. Palm, MD, MBA, FAAD, founder/medical director of Art of Skin MD, and an assistant clinical professor of dermatology at the University of California San Diego. “Social media has accelerated trends, but it has also amplified complications and created confusion. Our session aims to cut through that noise and return to data, anatomy, and clinical reasoning.”
Hot topics
According to session co-director Vince Bertucci, MD, FRCPC, FAAD, one of the most debated issues today is whether hyaluronic acid (HA) fillers should be dissolved and biostimulatory fillers delayed prior to facial surgery. Dr. Bertucci is co-director of the Dermatology Laser Surgery & Aesthetic Dermatology Fellowship at the University of Toronto in Canada.
“Questions have arisen about injection timing, indications and contraindications, and impact on surgical outcomes. This is a controversial area that warrants an informed discussion,” Dr. Bertucci said. “Biostimulators are surging in popularity as they stimulate the body’s own ability to produce collagen and elastin, for example. Many patients and physicians like that they are a ‘natural’ way to restore and enhance skin health. Having said that, controversies exist around their role, effects, and timing in the context of plastic surgery. During this session, we will look at the evidence around these controversies to help inform the decision-making process.”
Another hot topic, Dr. Bertucci said, is the use of injectables to address medically driven weight loss due to GLP-1 receptor agonists such as semaglutide. The session will break down the effects of these drugs on fat, muscle, and skin quality as well as the “right time” to start injectable treatment in the context of this type of weight loss, which can sometimes be rapid and significant.
“With the advent of an increasing number of aesthetic weight loss solutions, should dermatologists be prescribing these drugs?” Dr. Bertucci said.
Another evolving topic, said Dr. Palm, is the role of ultrasound in evaluating filler placement, migration, and complication management. Although it’s not universally adopted, it’s rapidly becoming a valuable adjunct in complex cases, she said. Conversely, others argue it’s too cumbersome, training-intensive, and unnecessary for routine injections.
Additionally, many dermatologists are confronting controversies around infraorbital rejuvenation, including whether fillers should still be first-line treatment, how to approach patients with herniated fat pads, and when dissolving is superior to camouflaging. Surgeons, Dr. Palm said, increasingly push for surgery in cases of herniated fat pads, while injectors debate whether subtle filler can still provide a safe, effective alternative.
“Each of these themes underscores a shift toward a more individualized assessment and a deeper understanding of facial anatomy, aging patterns, and procedural sequencing,” Dr. Palm said.
Advanced techniques are becoming more nuanced
Dr. Palm stressed that dermatologists must understand why certain techniques work — not just how to perform them. Current considerations should include:
- Needle versus cannula selection
- Deep versus superficial injection planes
- Management of previously migrated fillers
- Attention to biostimulatory products already in tissue
“We frequently see filler in unintended compartments, altered fat-pad dynamics, or previously placed biostimulatory products that affect contouring,” Dr. Palm said. “Recognizing these factors changes a treatment plan from ‘filling a deficit’ to orchestrating a thoughtful, multilayered rejuvenation.”
Future roadmap
Going forward, both Drs. Bertucci and Palm agree that dermatologists can’t treat injectables as simple, one-off procedures. Facial rejuvenation has become a complex discipline that requires synthesizing anatomy, aging biology, patient psychology, and device knowledge, all while navigating a rapidly expanding evidence base and heightened awareness of complications, Dr. Palm said.
“This session is designed to help injectors move beyond trends and return to data-driven, anatomy-anchored clinical reasoning,” she said. “Understanding the ‘why’ behind controversies will help injectors make informed, individualized decisions and develop the confidence to navigate nuanced, real-world scenarios rather than textbook ideals. It will also help them achieve safer, more natural, more durable outcomes through thoughtful patient selection and technique refinement.”
