Is Filler Going Out of Fashion? The Shift to Regenerative Treatments

By Dr Paris Acharya MBChB BDS (Hons) MFDS RCS (Ed) MRCS (Ed)

Filler is not disappearing, but the way it is being used is changing. As treatments evolve, they optimise skin quality and work with the body's own regenerative processes, building collagen over time, for example, rather than simply adding volume to facial features.

What we're witnessing right now isn't the end of filler, it's the end of overuse.

Is filler still worth having?

As we age, the face gradually loses volume, definition and structural support: collagen declines, the fat pads shift, and the bone changes beneath the skin. Filler became a valuable tool for restoring that lost volume and definition. What has changed is that both our treatments and our understanding of the ageing process have grown more sophisticated.

Yes, filler is still worth having, when it is used well. Filler still has an important role, but it must be used with far greater restraint and anatomical respect. My approach has always been to deploy it sparingly, typically as a final step once skin and underlying tissue health have been addressed. Used this way, it remains highly effective for restoring lost volume in a considered, precise manner.

The problem was never filler itself. It was filler used first, used heavily, without a mindful approach, and often used to chase volume rather than restore it. The broader shift we're seeing is towards regenerative strategies: improving skin quality, supporting collagen, optimising inflammation, and then reaching for filler only where it's truly needed to support structure. That, I believe, is how it should always have been used, and a principle I've always stuck to.

Why are people moving away from the "done" look?

There is far more interest in subtlety and little demand for obvious correction. My philosophy has always been one of subtle, biologically-led rejuvenation, designed with precision and restraint, enhancing features in harmony with the underlying structure of the face rather than overriding it.

The aim is refinement rather than transformation: a face that looks rested and like itself, with its natural features preserved.

What about weight-loss treatments like Ozempic?

This is another prompt to rethink how we use filler. With the rise of GLP-1 medications such as Ozempic, we are seeing patients whose faces have changed after rapid weight loss. As facial fat is lost, often quickly, the face can begin to look hollow, deflated or older, with volume loss revealing changes in structure and definition that were not noticeable before.

This is a genuine volume and structural concern, and a situation where considered volume restoration may have a role. Depending on the degree of change, that might mean carefully placed filler, a biostimulator to rebuild collagen and support, or fat grafting where the loss is more significant. The skill lies in restoring what has been lost without overfilling, so the face remains natural-looking rather than altered.

What does this mean for lips?

This principle particularly matters with lips, because they are the area most commonly associated with the overdone look. I am passionate about changing the way lip augmentation is perceived.

My approach is tailored to what the lips need. At its core is my Nanolip Booster, which is not a filler but a lip boost: rather than enlarging the lips, it improves shape, hydrates and addresses the fine lines that creep in as we hit midlife. I use very small amounts, injected as nano-droplets into the lips and the tissues around the mouth, to target concerns such as dehydration, lines, loss of elasticity and age-related skin changes. It's particularly suited to patients who feel their lips have become flatter or more lined over time.

Where a little volume genuinely helps, I may add a small, considered amount of filler, or use it on its own where that is what the lips call for. If you have more extensive signs of ageing, or if you're trying to address volume and lines, I'd recommend a lip booster in addition to polynucleotides for optimal results. The aim throughout is to work with the lip rather than reshape it: a lip that looks more defined, but never overdone.

What's replacing high-volume filler?

Increasingly, regenerative approaches that work with the body's own repair pathways rather than simply adding material. They suit the patient who wants gradual, natural improvement over time.

The growing interest in fat grafting reflects a broader, meaningful move towards regenerative aesthetics. Fat is not simply a filler material. It is living tissue, rich in stem cells, offering both volumisation and genuine regenerative potential. That said, it is a significantly more invasive procedure, and not appropriate for every patient or every context. For many people, a combination of regenerative injectables, carefully placed filler and energy-based devices can achieve equally refined, natural-looking results with considerably less downtime.

Whatever the approach, the principle is the same: no device or injectable should be used in isolation. The most effective outcomes come from layering technologies alongside a holistic approach, one that considers general health, hormones, injectables and skincare together, not in silos.

Do fillers stimulate collagen?

Some do, by design. Dermal fillers, including hyaluronic acid fillers and Radiesse (calcium hydroxyapatite), both offer immediate lift and corrective volume to the skin tissues while also stimulating your body to create its own collagen.

Beyond this, a distinct category of biostimulators is designed specifically to stimulate the skin's own collagen rather than simply to volumise. Some are fillers, such as Radiesse (calcium hydroxylapatite) and Sculptra (poly-L-lactic acid), which add structure while prompting collagen over time. Other biostimulators are not fillers as such: polynucleotides, for example, which, instead of adding instant volume, rev up collagen production to restore natural volume over time. The plumper skin you are left with is largely the result of your body's own processes, which is what makes these treatments appealing to patients who want a more natural result.

What does diluting filler do?

Another evolution is the use of hyperdiluted filler. When a biostimulator such as Radiesse is heavily diluted, sometimes described as a collagen wash technique, it no longer volumises. Instead, it is spread thinly across the area to improve skin quality and stimulate collagen more widely.

It is the same initial product, used not to add volume but to support the skin from within.

Emerging research suggests this support may be broader than collagen alone. This type of treatment appears to help regenerate the wider support structure of the skin: the collagen and elastin fibres, and the deeper matrix, or scaffold, that holds everything together and gives skin its strength. Recent findings even point to improvement in deep structural sun damage, which is notoriously difficult to reverse.¹

So how do you know what you need?

This is really the heart of it. The modern approach is less about choosing a treatment and more about identifying the need, then matching the right treatment to it. The question to ask is no longer "how much filler do I need?" but "what would my face really benefit from?"

Different treatments do different things. Some restore volume, some rebuild collagen and structure, some improve skin quality, and some do more than one. Sometimes the right answer is a filler, chosen precisely because of what that particular product does, whether that is restoring lost volume, supporting structure or stimulating collagen. Often it is a combination. My advice is always to be strategic, not reactive. These treatments work best as part of a longer-term skin-health plan, chosen to suit the structure and needs of your individual face.

So, is filler going out of fashion?

No. Filler is not going anywhere, and for the right concern, used well, it remains an effective tool. What is changing is its place: no longer the automatic answer, but one considered option among many, chosen for what it specifically offers and used as part of a fuller, more regenerative approach.

Increasingly, the goal is not simply to add volume, but to improve the quality, health and resilience of the tissue itself, and to work with the natural architecture of your face, restoring balance and harmony with a mindful, combination treatment protocol.

¹ Journal of Cosmetic Dermatology, 2026

Dr Paris Acharya MBChB BDS (Hons) MFDS RCS (Ed) MRCS (Ed) is a dual-qualified aesthetic doctor and dentist and former maxillofacial surgeon. Founder and Medical Director of Clinic Dr Paris in Marylebone, she focuses on evidence-based approaches to skin quality, hormonal health and long-term wellbeing.