Plastic surgeon shares his unpopular opinion about fillers - from how they can last DECADES to how it's not as easy to dissolve as you think
- Washington-based surgeon Dr. Chesnut shared his thoughts in a TikTok video
- He explained why filler could actually last decades and was not easily dissolved
- The doctor even revealed that filler could change makeup of the body's tissue
A plastic surgeon has uncovered three 'unpopular' opinions about cosmetic filler — and you might want to think twice before getting it injected.
Dr. Cameron Chesnut, a dermatologist and surgeon based in Spokane, Washington, who has a background in facial plastic surgery, oculoplastic surgery, dermatologic surgery and general plastic surgery, shared his take on fillers in a TikTok video.
Dermal fillers are a type of cosmetic injection that are meant to smooth out wrinkles and fine lines, plump up the face and add some volume to sagging skin.
There are many different types of dermal fillers than can be used for injection, like Restylane, which is a kind of hyaluronic acid filler, as per Cleveland Clinic.
![Washington-based surgeon Dr. Cameron Chesnut gave his unpopular opinions about filler in a recent TikTok video](https://i.dailymail.co.uk/1s/2023/12/15/15/78934747-12861087-Washington_based_surgeon_Dr_Cameron_Chesnut_gave_his_unpopular_o-a-37_1702653610895.jpg)
Washington-based surgeon Dr. Cameron Chesnut gave his unpopular opinions about filler in a recent TikTok video
![He claimed that filler can actually last for decades, and isn't easily able to be dissolved, contrary to popular belief](https://i.dailymail.co.uk/1s/2023/12/15/15/78934727-12861087-He_claimed_that_filler_can_actually_last_for_decades_and_isn_t_e-a-41_1702653611504.jpg)
He claimed that filler can actually last for decades, and isn't easily able to be dissolved, contrary to popular belief
'Starting with filler and unpopular opinions about filler, number one, filler lasts decades,' Dr. Chesnut began in the video.
'It does not last a year or two,' he continued. 'It does not need to be touched up all the time. It lasts decades.'
He explained that this phenomenon had been something that was shown in multiple studies, including MRI studies, as well as direct observation of patients with filler.
The plastic surgeon claimed that he often saw patients who insisted that their injector promised them that the filler wouldn't be left over and would naturally dissolve on its own.
But he still managed to find it, even years or decades after it was first injected.
The doctor also referenced a study that he performed with one of his fellows a few years ago, which studied 50 women with 'consecutive lip lifts.'
They found that in the subnasal region of their excision, filler was still present on 49 out of 50 patients.
'That filler is migrating through that muscle, and does not stay where it's put,' Dr. Chesnut said.
He then explained that the kind of fillers he was referencing were hyaluronic acid fillers, the type that were supposed to dissolve the fastest.
![Dr. Chesnut stressed that filler did not need to be touched up a lot as it lasted an extremely long time](https://i.dailymail.co.uk/1s/2023/12/15/15/78934741-12861087-Dr_Chesnut_stressed_that_filler_did_not_need_to_be_touched_up_a_-a-38_1702653610897.jpg)
Dr. Chesnut stressed that filler did not need to be touched up a lot as it lasted an extremely long time
![He cited a study he performed in which they studied 50 women with 'consecutive lip lifts.' They found that in the subnasal region of their excision, filler was still present on 49 out of 50 patients](https://i.dailymail.co.uk/1s/2023/12/15/15/78934731-12861087-He_cited_a_study_he_performed_in_which_they_studied_50_women_wit-a-42_1702653612056.jpg)
He cited a study he performed in which they studied 50 women with 'consecutive lip lifts.' They found that in the subnasal region of their excision, filler was still present on 49 out of 50 patients
Next up on Dr. Chesnut's list of unpopular filler opinions had to do with the process of dissolving the injections.
The agent used to dissolve filler is called hyaluronidase, which is an enzyme that is supposed to 'magically dissolve' the hyaluronic acid kind, the expert explained.
'Hyaluronidase works, but it doesn't work that well,' Dr. Chesnut said. 'It's certainly no magic bullet, and it certainly doesn't come without a bit of a price to your tissue.'
He explained that although some of his colleagues might say that the hyaluronidase had 'no issues with tissue whatsoever,' there were a few studies that proved otherwise.
'In animal models, hyaluronidase is shown to dehydrate tissue, and change the biomechanics of tissue, it is not different in our skin,' he said.
'It does change the way that our skin and soft tissue fat pads behave, it changes their biomechanics, and it changes how they function during surgery, we see that all the time.'
Dr. Chesnut also referenced the history of how hyaluronidase was used in local anesthetic.
'It was used to to break down the extracellular matrix and allow that anesthesia to spread faster,' he said.
![The surgeon also admitted that hyaluronidase, which was used to dissolve filler, was not a magic fix for getting rid of the injection](https://i.dailymail.co.uk/1s/2023/12/15/15/78934735-12861087-The_surgeon_also_admitted_that_hyaluronidase_which_was_used_to_d-a-39_1702653610900.jpg)
The surgeon also admitted that hyaluronidase, which was used to dissolve filler, was not a magic fix for getting rid of the injection
!['Hyaluronidase works, but it doesn't work that well,' Dr. Chesnut (pictured right) said. 'It's certainly no magic bullet, and it certainly doesn't come without a bit of a price to your tissue'](https://i.dailymail.co.uk/1s/2023/12/15/15/78965481-12861087-_Hyaluronidase_works_but_it_doesn_t_work_that_well_Dr_Chesnut_pi-a-43_1702653612209.jpg)
'Hyaluronidase works, but it doesn't work that well,' Dr. Chesnut (pictured right) said. 'It's certainly no magic bullet, and it certainly doesn't come without a bit of a price to your tissue'
'It was doing what many people think it doesn't do, it was breaking down that tissue allowing the anesthesia to spread faster,' he continued. 'That's the point. The hyaluronidase has a detrimental effect on the local tissue.'
However, he reserved that there was still a way to use filler dissolver safely.
He normally sees problems with the dissolving agent in people who have gotten it injected very frequently and in extremely high doses.
'If we can manage the dose and we can manage the frequency, we can still use hyaluronidase very safely, but we have to be very cautious about it,' Dr. Chesnut explained.
Last but not least, he dished on what he called his 'total counterculture, unpopular opinion,' which had to do with the management of filler before undergoing surgery.
'I don't dissolve filler before surgery on a regular basis,' the plastic surgeon revealed.
'The reason I don't do that is because I can manually remove so much of that filler during our procedure that I can get a very excellent visualization as to how much filler is left behind, how much I was able to remove manually.'
'I know exactly where it's at, I visualized it, and I can really minimize the amount of hyaluronidase that I need to use,' he divulged.
![The doctor explained that he also often saw 'encapsulated areas of filler' in people that were impossible to get out without hyaluronidase](https://i.dailymail.co.uk/1s/2023/12/15/15/78934733-12861087-The_doctor_explained_that_he_also_often_saw_encapsulated_areas_o-a-40_1702653611045.jpg)
The doctor explained that he also often saw 'encapsulated areas of filler' in people that were impossible to get out without hyaluronidase
However, he noted that this didn't take away from the fact that hyaluronidase was 'not perfect' and did 'not work that well,' and that some filler would still be leftover despite careful removal.
'That is one of the issues regarding filler around surgery, it causes tissue changes, from a tissue expansion effect,' he said. 'It causes a change in the way our lymphatics drain, it plugs our lymphatics.
'We don't even know for sure if hyaluronidase can really improve the way that our lymphatics drain by getting rid of the hyaluronic acid that's in those lymphatics, but we do know that people have longer durations of swelling after surgery, they just tend to have a little bit more downtime, and that's something we need to plan for....'
Dr. Chesnut explained that taking out the filler manually during surgery allowed him to not only limit the dose, but accurately and precisely target the filler that may have been left behind.
As a result of the tissue-expanding effects of filler, the doctor said he liked to use regenerative medicine in patients who were getting filler dissolved, claiming it had benefits that improved tissue quality.
'That filler does quite a bit to our native tissue,' he said. 'It integrates into that tissue, it expands that tissue, it changes the way that it looks and feels and functions surgically,' he said.
It can even end up in different areas of the body, too.
'We call it hyalinized,' he said. 'Oftentimes I'll find these little encapsulated areas of filler that are like a breast implant stuck in the fat pads around the eye or stuck in the cheek, these nodules that are not going anywhere with hyaluronidase.'
![](https://i.dailymail.co.uk/1s/2023/12/14/21/78934739-12861087-image-a-339_1702589992576.jpg)
![](https://i.dailymail.co.uk/1s/2023/12/14/21/78934737-12861087-image-a-340_1702589997603.jpg)
![In the comments section of his video, many users shared their own personal experiences with filler](https://i.dailymail.co.uk/1s/2023/12/14/21/78934729-12861087-In_the_comments_section_of_his_video_many_users_shared_their_own-a-341_1702590000412.jpg)
In the comments section of his video, many users shared their own personal experiences with filler
The doctor explained he had to cut into these pockets in order to get rid of them, and there was 'no way' that the hyaluronidase would be able to dissolve the filler that was stuck in these capsules.
'The filler changes the tissue dynamics as well,' he concluded.
In the comments section of his video, many users shared their own personal experience with filler injections.
'I had this strange crease under my left eye,' one person wrote. 'I got filler injected into it once, and never had to get it done again. Filler never went away.'
Another typed, 'I had chin filler 2 years ago and I can confidently say filler lasts for a while. People just get used to their face and think they need more.'
'100% true from personal experience,' someone else lamented. 'Still puffy after 3 years of no filler. I had 3 sessions of dissolver and filler is still there.'