I’ve Been an Esthetician for 26 Years. Here’s Why I Believe Less Is More With Botox and Filler
I’ve been a licensed esthetician for 26 years. My career began working alongside a highly conservative plastic surgeon in the early 2000s, just as Botox was entering the aesthetic world in a big way.
She was deliberate about everything she did. She would not inject young patients simply because they wanted to prevent wrinkles, because we didn’t yet have decades of research showing what repeated treatment beginning at a young age might mean for their faces later in life.
That caution shaped me. I carried it through every treatment room and every conversation I’ve had with clients since.
Back then, a typical spa day meant a facial, a massage, and maybe getting your nails done. The focus was care, relaxation, and setting aside a little time for yourself, sometimes with a few close friends.
Over the following decade, the landscape changed. Injectables and “lunchtime” procedures moved closer to the center of the beauty industry. Treatments once used primarily to restore lost volume or soften established signs of aging increasingly became something younger people sought before those changes had even occurred.
More than two decades later, I still think the question my first mentor implicitly asked is the right one: What happens after you do this repeatedly for 20, 30, or 40 years?
We still don’t fully know.
What We’re Learning About How Long Facial Filler Really Lasts
Hyaluronic acid fillers have traditionally been described as temporary, with their longevity often discussed in terms of months rather than years. Newer imaging research is complicating that picture.
A 2024 review examined MRI scans from 33 patients who had received hyaluronic acid filler in the mid-face. Researchers detected filler in every patient who had gone at least two years without another injection. Some hadn’t been injected for considerably longer, and filler was detected as far as 15 years after injection in one patient. The researchers themselves stressed that larger studies and continued imaging are needed.
More recently, a 2026 study used three-dimensional MRI to examine 14 patients with documented filler histories. Researchers found that the volume visible on MRI was substantially greater than the recorded amount originally injected, with an average ratio of approximately 2.8 to 1. The authors noted that some hyaluronic acid fillers may undergo significant volumetric expansion rather than simply diminishing predictably over time.
That doesn’t mean everyone who gets filler will eventually have a problem. It does mean the old assumption that every trace simply disappears on a predictable timetable deserves another look.
Researchers and clinicians are also increasingly discussing “facial overfilled syndrome,” a complication associated with excessive or inappropriate filler use that can result in distorted contours and unnatural facial movement. A 2026 clinical review emphasized cumulative treatment, anatomy, individualized planning, and prevention rather than simply adding more volume.
After watching this industry evolve for more than two decades, that emphasis on restraint sounds very familiar.
Botox Raises a Different Long-Term Question
Botox works differently from filler. Botulinum toxin temporarily interrupts the nerve signals responsible for muscle contraction. When the targeted facial muscle isn’t contracting normally, dynamic lines soften.
Reduced muscle activity can also cause the muscle to lose volume. That’s not some newly discovered side effect. Muscle atrophy is part of the biological response to botulinum toxin.
What interests me is how long those muscular changes can persist.
In a small 2013 MRI study examining the procerus muscle, researchers found measurable muscle volume loss that persisted beyond the period during which patients could still see Botox’s cosmetic effect. The authors concluded that the muscular effects of a single injection could last substantially longer than the visible clinical results.
That study doesn’t prove that decades of cosmetic Botox cause permanent facial muscle damage. We shouldn’t pretend it does.
But that’s also my point.
We have an entire generation beginning injectable treatments considerably younger than previous generations did. Yet we cannot pull up robust independent studies that follow people who started frequent cosmetic injections in their twenties and show exactly what their faces and facial muscles look like at 50, 60, or 70.
For me, uncertainty has always been a reason for moderation, not a reason to assume there can be no long-term consequences.
I Watched the Beauty Industry Become Something Different
There’s another part of this conversation that rarely gets discussed: money.
A traditional facial occupies a treatment room and a professional’s time for an hour and might generate around $100. A single injectable appointment lasting just 15 minutes can generate $1,000 or more, depending on the products and amounts used. Over the course of an hour, injectables can generate thousands of dollars. The financial incentive is dramatically different.
As demand exploded, so did the number of people offering aesthetic procedures. And somewhere along the way, I watched an industry that had once emphasized caring for the skin increasingly focus on changing the face.
I became deeply disillusioned with that direction.
Not because I believe injectables have no place. Used conservatively, by appropriately qualified medical professionals, for the right patient and at the right time, they can be valuable aesthetic tools.
What troubled me was the cultural shift from restoration and restraint toward continuous enhancement, particularly in faces that had barely begun to age.
The caution I learned from that plastic surgeon all those years ago still feels relevant: When we don’t know what decades of treatment will do, there is value in not doing too much too soon.
One of My Clients Taught Me More About Anti-Aging Than Any Trend Ever Could
In June, one of my dearest clients passed away at 83.
She was the first client to walk through my doors when I opened my business 26 years ago, and I had the privilege of caring for her skin for decades.
She never injected her face. She never chased radical treatments or whatever procedure happened to be fashionable that year.
She got a facial every month. She took care of her skin every day. She protected it from the sun.
And her skin was extraordinary.
People who met her for the first time noticed it. Clients who hadn’t seen her in years would see her again and immediately comment on how beautiful her skin looked.
But I don’t think the answer was hiding in a jar of moisturizer.
She ate well. She stayed active. She traveled. She enjoyed good food and a good glass of wine. She spent time with people she loved. She enjoyed her life.
Maybe there’s something important in that.
Perhaps aging well isn’t about desperately trying to prevent your face from showing you’ve lived. Maybe it’s about taking care of yourself, protecting the skin you have, spending time with people you love, and appreciating the life happening around you while you’re so busy worrying about the next wrinkle.
Maybe Beauty Needs To Become a Little More Old-School
I’ve retired from the industry since moving to Florida, although I still maintain a small group of longtime clients whom I visit regularly. I have absolutely no desire to own another spa.
But I would love to see part of that old spa culture make a comeback.
We spend the day together. We laugh. We relax. We talk. For a little while, phones, obligations, and the constant pressure of the modern world become less important. And our skin gets some attention, too.
There’s nothing wrong with wanting to look good. There’s nothing inherently wrong with Botox or filler, either. This isn’t an argument for abandoning aesthetic medicine.
It’s an argument for perspective.
Twenty-six years in this business have made me much less interested in whatever promises to make someone look younger overnight and much more interested in what helps someone look and feel good over a lifetime.
Maybe the future of beauty doesn’t need another extreme treatment.
Maybe it could use a little more of what we had at the beginning: good skin care, thoughtful treatment, realistic expectations, restraint, and an hour every now and then to take care of yourself.
And after 26 years, that’s still the beauty philosophy I believe in.
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Selected Sources & Further Reading
Master M, Azizeddin A, Master V. Hyaluronic Acid Filler Longevity in the Mid-face: A Review of 33 Magnetic Resonance Imaging Studies. Plastic and Reconstructive Surgery – Global Open. 2024. Read the study
Longevity and Volume Expansion of Hyaluronic Acid Dermal Fillers: A Cross-sectional 3-dimensional Magnetic Resonance Imaging Study. 2026. Read the study
Zhou C, et al. Facial Overfilled Syndrome: A Narrative Clinical Review. Clinical, Cosmetic and Investigational Dermatology. 2026. Read the review
Koerte IK, et al. Muscle Atrophy Beyond the Clinical Effect After a Single Dose of OnabotulinumtoxinA Injected in the Procerus Muscle: A Study with Magnetic Resonance Imaging. Dermatologic Surgery. 2013. Read the study
