SkinCare Physicians

Avoiding unnatural results with cosmetic injections

Published on Feb 1st, 2022 by Michael Kaminer, MD

Dr. Kaminer injecting Botox on woman's foreheadAs we begin 2022, the popularity of injectable cosmetic procedures such as neurotoxins (Botox, Dysport, Jeuveau, Xeomin), and fillers (Restylane, Juvederm, Teoxane, Belotero, Sculptra, Radiesse) continues to expand.  Patients are drawn to the immediacy and the non-invasive nature of these powerful interventions. When performed by skilled injectors, they are safe, effective and produce beautiful natural results for a wide range of patients of all ages and skin types. Yet we still see many people with overdone faces. This blog attempts to understand why, and offers advice on how to ensure you get the natural looking results you deserve with fillers and neurotoxins.

Unnatural looking results are not an accident

Despite the popularity of fillers and neurotoxins, questions remain:  why do we see so many people who have unnatural results from injectable cosmetic procedures?  Do they like the way they look?  Did their injector make a mistake?  Was it avoidable?  Has society lost its collective mind when it comes to the perception of beauty?

Fortunately, all of us are credible evaluators of cosmetic results.  We know when something looks good.  We know when something looks “off”.  We might not know exactly why, but we see it and we recognize it. As a result, the societal standard for beauty is fairly well established, so it is unlikely that a paradigm shift has occurred where unnatural or overdone is attractive. Which ties directly to cosmetic results…if we know what unnatural looks like, why does it happen?

There are several reasons to consider:

  • In some cases, patients seem to want to have a “statement face”, with large lips, overdone cheekbones, or a frozen “Botox” look. The overdone look becomes a conversation piece, a calling card, but it doesn’t actually look good. This is (unfortunately) rampant in Hollywood.
  • The injector has a “style”, or a preferred look that s/he thinks is uniquely attractive. Think of this like an artist who wants to create something unique, pushing the boundaries of natural. It can work beautifully on a canvas, but often not so well on your face.
  • The injector lacks the proper skill set (training, natural ability, etc.) to achieve consistent natural results

Unnatural results are not an accident, and a skilled injector can usually identify a) what looks wrong and b) why it happened. It’s a bit of a head-scratcher as to why some injectors and patients gravitate towards unnatural, so let’s talk about how it can be avoided.

All cosmetic injectors are not equal

A fascinating study sponsored by Allergan, The Harmony Study, evaluated 100 patients treated by 10 highly skilled injectors (including one from Skincare Physicians).  Several direct outcomes of that study guide injectors to produce more attractive and natural results, by a) using less filler, b) focusing more on the lateral rather than central face, and c) performing smaller procedures over several injection sessions to see how the patient responds and ultimately tailor the result to that patient’s unique anatomy.

Patient before and after being treated for Allergan's Harmony Study

Participated to Allergan’s Harmony Study treated at SkinCare Physicians – Before and after treatments

Injectors also have over a dozen filler options to choose from, and 4 different neurotoxins. You can imagine that choosing the proper combination of dose, amount, and location of injection is important.  There are literally hundreds of treatment combinations that will impact the final result, layered on top of the fact that every face is unique.  Although filler and neurotoxin injectables are relatively easy to perform in a short outpatient visit, there is a world of complexity that lives just below the surface of your face.

In some ways, the best natural result is when nobody knows that you have had a procedure performed. Of course you will want to see a benefit, but it shouldn’t scream “look at me”!

You’ll also notice that we have used the term “injector” rather than doctor in this blog.  The proliferation of non-physician injectors has created a unique challenge for the cosmetic marketplace.  They usually offer a less expensive option, but the trade-off is often less training (they do not attend medical school), and in many cases less experience.  To be fair, there are many poorly trained doctors and dentists who have jumped on the cosmetic surgery bandwagon for obvious financial gain.  Why is this important?  Two reasons:  SAFETY and EFFICACY.  A sub-optimally trained injector can damage blood vessels and nerves, create lopsided results, and even cause blindness. Published manuscripts in the medical literature have supported these conclusions, and inadequate training is a risk factor for poor outcomes.

Last, the ultimate differentiating factor between injectors is the ability to “see natural beauty clearly”.  It may seem obvious, but the lure of these injectables is their ease of use.  Not all injectors with proper training, however, can “see” the path to a natural and attractive result.  Of course skilled injectors can treat safely, but can they inject “beautifully”? Literally every face is different, requiring a unique approach to treatment:  Inject more filler in the cheek? Place less neurotoxin in the forehead? Enhance the chin? Lengthen the jawline? Touch up the nose and lips?  Each small decision comes together to impact beauty as a whole.  At Skincare Physicians, we obviously focus on safety and training, but we really shine when it comes to the ability to “see beauty”.  We train for it, we review it as both individuals and as a group during our monthly scientific journal clubs, we lecture and teach about it, and we prioritize it.

Tips for choosing your injector

Importantly there are things that you can do when choosing your injector:

  1. Evaluate his/her training, and make sure it is extensive.
  2. Get recommendations from friends who have had great results and a positive experience.
  3. Make sure the injection setting (doctor’s office vs. medspa, etc.) has the necessary equipment to handle any complications that might occur. Ask if they have hyaluronidase on hand (it is used to reverse complications with fillers)… if they don’t, walk away.
  4. When push comes to shove, find a board-certified dermatologist or plastic surgeon (whether general, facial, or oculo), which guarantees a minimum level of appropriate training.
  5. Don’t skimp…it’s your face.
  6. Try not to be lured into being overdone…more is often not better when it comes to injectable cosmetic procedures.
  7. Trust your instincts!

Tempted to get fillers or neurotoxins, but worried about being overdone? Fear no more, but choose your cosmetic injector wisely. These procedures remain both a science and an art form. If in doubt, come visit us for a consultation.

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SkinCare Physicians®
1244 Boylston Street (Route 9)
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Phone: (617) 731-1600 Fax: (617) 731-1601


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SkinCare Physicians®
1244 Boylston Street (Route 9)
Chestnut Hill, Massachusetts 02467

Phone: (617) 731-1600 Fax: (617) 731-1601

Learn more about your rights and protections related to the No Surprises Act (HR133).

Medical Website Design & Marketing by Etna Interactive

The dermatologists and other medical professionals at SkinCare Physicians specialize in a wide range of dermatology treatments and services, including laser hair removal, laser skin treatment, hair transplant, eyelid surgery, body contouring, psoriasis, skin cancer, BOTOX® Cosmetic, fillers, and Thermage®. From their offices in Chestnut Hill, they serve Boston, Brookline, Cambridge, Newton and Wellesley.