Filler and Botulinum Toxin Injections: Dr. Jennifer Harrington Explains When Less Is More and More Is Too Much

When it comes to filler, neuromodulator injections, and similar aesthetic procedures, some people prefer subtle changes that highlight their natural beauty, while others go for a more pronounced look. Dr. Jennifer Harrington, founder of Harrington + Associates Plastic Surgery, strives to help her clients achieve their desired outcomes while warning them against overdoing it.

Although filler and botulinum toxin injections are often mentioned in the same sentence, the two treatments work very differently. Dermal filler is a gel-like substance (frequently made from hyaluronic acid) injected under the skin to add fullness. Hyaluronic acid draws water toward itself, creating a lasting plumping effect.

Botulinum toxin–based injectables are neuromodulators derived from botulinum toxin, a neurotoxin that’s injected directly into select facial muscles. The injection temporarily paralyzes those muscles. When they can’t contract like normal, the skin above them flattens, reducing the appearance of wrinkles.

Both treatments are popular alternatives to plastic surgery, and Dr. Harrington sees year-round demand for both.

“Injectable fillers are FDA-approved to restore lost facial volume and minimize deep lines and wrinkles,” she says. “Many of my clients gravitate toward fillers when they have deep wrinkles, asymmetrical facial features, prominent laugh lines, or fine lines around the mouth.” Some clients also seek out fillers to improve lip fullness.

In skilled hands, neuromodulator injections and fillers can act as real-world touchups, smoothing over minor imperfections and helping clients attain the looks they want. Unfortunately, it’s extremely easy to overdo both.

“When using filler and botulinum toxin injections, I opt for a ‘less is more’ approach,” Dr. Harrington explains. “Too much filler can cause a client’s face to look puffy or distorted. It can also form noticeable lumps that migrate to other areas of the face.”

These complications can deliver a serious blow to the client’s self-esteem, especially if they weren’t looking to make a radical change.

Neuromodulator injections come with their own set of potential complications. “Too much botulinum toxin can make someone’s face look frozen,” says Dr. Harrington. “If the injection spreads to unintended muscles, it can cause drooping eyelids or eyebrows.”

Sometimes, too many neuromodulator injections cause the opposite effect. In some clients, excessive or poorly done injections can result in high eyebrows and a perpetual look of surprise.

Some clients start with a conservative dose of botulinum toxin injections, see that it works, and then decide they want to smooth out all of their wrinkles. This approach often leads to the telltale “frozen” look: They can barely change their facial expression, and their skin looks eerily smooth.

These effects might sound off-putting enough to convince some people to avoid neuromodulator treatments altogether. However, Dr. Harrington stresses the fact that these undesirable effects are associated with improperly administered botulinum toxin injections, not botulinum toxin injections as a whole.

“When your neuromodulator injections are done by a skilled professional, your face shouldn’t look obviously ‘done,’” she explains. “Because your wrinkles will be reduced, you’ll probably look well-rested or refreshed. Ideally, these treatments should make you look like an optimal version of yourself.”

Having too much dermal filler or too much botulinum toxin may make clients look unnatural or distorted. But is it actually dangerous? You may be surprised to learn that the answer is yes.

Excess filler in particular can cause major complications. When you have too much filler in your face at one time, it can compress blood vessels, ultimately causing tissue death. In extreme cases, complications from excess filler may give rise to blindness or pulmonary embolisms.

The good news is that if you have a dangerous amount of filler, you can take steps to correct it. “For fillers primarily made up of hyaluronic acid, we can inject a specialized enzyme into the area,” says Dr. Harrington. “That enzyme starts breaking down the filler so your body can absorb it.”

Receiving too much botulinum toxin is unlikely to lead to serious complications. However, if you receive neuromodulator injections regularly for an extended period of time, your facial muscles may start to atrophy. Your body could also start to become resistant, making future treatments less effective.

“I usually recommend that clients space out their neuromodulator treatments or even take breaks from time to time,” says Dr. Harrington.

Whether a client has been getting botulinum toxin injections and filler for decades or they’re considering trying it for the first time, understanding the potential risks of these treatments is crucial.

“The best thing you can do for yourself is to seek out a qualified plastic surgeon,” Dr. Harrington says. “The right practitioner can help you achieve your goals while looking out for your safety, too.”

This article is for informational purposes only and does not substitute for professional medical advice. If you are seeking medical advice, diagnosis or treatment, please consult a medical professional or healthcare provider.

BDG Media newsroom and editorial staff were not involved in the creation of this content.