In the world of noninvasive cosmetic treatments, injectables reign supreme. And while Botox may be the king of the castle, fillers continue to grow in popularity. According to the American Society for Dermatologic Surgery, filler injections increased 78% between 2012 and 2019. (This is compared to only a 60% increase for wrinkle relaxers such as Botox.) Dermal fillers have a 94% Worth It Rating among RealSelf members, and new types of filler continue to hit the market year after year. Yet not everyone is sold.

The belief that fillers will “ruin” your face is widespread—Googling the term yields no shortage of fear-mongering content. There are scary before-and-afters on social media (not to mention cartoonish filler filters) and entire Reddit threads devoted to the topic. “Before fillers were popular, people would see someone like Jocelyn Wildenstein and say, ‘Oh, she had a bad facelift.’ They would blame plastic surgery. Now they blame fillers,” says Dr. Sarmela Sunder, a board-certified facial plastic surgeon in Beverly Hills, California. But why? We asked top doctors to weigh in on why fillers can’t seem to shake their bad rap—and why it’s undeserved.

Where does the idea that fillers ruin your face come from?

The doctors we spoke with call out several contributing factors. Public enemy number one: social media. “It definitely plays a role in our definition of beauty and aesthetics. People are doing too much because they want to look good in photos. The reality is that you can look great in person, but there are certain lines or folds that will still show up on camera,” explains Dr. Sunder. These are the people who then end up looking overfilled in real life.

Dr. Sunder also puts some of the blame on some plastic surgeons, who she says may not be as facile with fillers and are threatened by them, so they push a negative agenda. “A lot of it stems from surgeons who aren’t performing filler injections and really aren’t aware of just what fillers can do,” she explains. “It’s a little bit of a turf battle.”

Dr. Heidi Waldorf, a board-certified dermatologist in Nanuet, New York, points out that the fillers themselves are often a scapegoat— it’s the injector who’s actually to blame. “Patients will often point to a celebrity or mention a friend who had filler and say how unnatural or freaky they look. I stress that it isn’t the paint or the brush but the painter who creates a masterpiece,” she explains.

The realities—and limitations—of fillers

Dermal fillers have a wide variety of applications, but it’s also important to keep in mind that they’re not the be all, end all. “Fillers don’t ruin your face. They just can’t fix everything—and attempting to do so by injecting more and more can look strange,” says Dr. Waldorf.  Yes, where the filler is injected is extremely important, but the quantity of filler is what impacts the overall end result most, says Dr. Sunder. You can do a small amount in the wrong place, and it’s not going to be detrimental. But if you put too much filler in one spot or do too much too frequently, not only does the result start to look unnatural, but you also increase the risk for medical ramifications, she explains. (More on that point to come.)

That being said, with many different types of filler available—both in the hyaluronic acid and biostimulatory categories—the list of ways they can be used is lengthy, which is part of the appeal for injectors. “Fillers have revolutionized the cosmetic industry,” says Dr. Raja Mohan, a board-certified plastic surgeon in Irving, Texas. “They have the versatility to be used not only all over the face but also on certain parts of the body, and they can do everything from re-olumize, to fill in lines, to enhance features such as the jawline or cheeks.” They can also reshape or rebalance facial proportions, and biostimulatory options (Sculptra, Radiesse) can even improve skin quality over time, adds Dr. Waldorf.