Bread Buns and Overfilling

In recent years, Overfilled Syndrome and the associated “Bread Bun” phenomenon have garnered significant attention in the field of aesthetic medicine, particularly among younger populations. The causes of overfilling involve technical, patient, and physician-related factors: technical factors include improper injection dosage, depth, and point design; patient factors primarily stem from the excessive pursuit of “perfect” facial features and unrealistic expectations; while physician factors are related to insufficient experience, lack of technical proficiency, and misinterpretation of aesthetic standards. The consequences of overfilling include aesthetic imbalance, health risks, and psychological issues.

The emergence of these phenomena is associated with multiple factors.

Firstly, the widespread use of social media and the popularity of influencer-driven beauty standards have led many to pursue “perfect” facial features, such as full apple cheeks, a pointed chin, and a high nasal bridge. This has driven an increased demand for excessive filler treatments. Secondly, some unregulated institutions or practitioners, driven by profit motives, may recommend excessive filler use, including the injection of large volumes of fillers in a single session.

Additionally, some practitioners lack a comprehensive understanding of facial aesthetics and proportions, over-emphasising localised filler injections while neglecting overall facial harmony. Improper selection and application of fillers also play a significant role. Different facial regions require specific types of fillers (e.g, hyaluronic acid, collagen), and inappropriate choices or incorrect injection techniques can easily lead to the “Bread Bun” phenomenon. Another common cause of overfilling is repeated filler application within a short time-span.

Some patients, after partial absorption of the initial filler, frequently undergo additional injections to maintain an extreme level of fullness, resulting in the accumulation of fillers and eventual overfilling. Alternatively, an impatience for immediate results may lead to multiple injections within a short period, causing the face to appear excessively full.

Excessive aesthetic demands are a significant contributor to overfilling Influenced by social media and internet celebrity culture, many patients pursue extreme “fullness” or “youthful” appearances, such as overfilled apple cheeks, a high nasal bridge, or a pointed chin. This homogenised aesthetic trend drives patients to request excessive filler injections, often neglecting natural facial proportions and dynamic beauty. Secondly, patients often hold unrealistic expectations for facial filler treatments, hoping to achieve dramatic and long-lasting changes in a single session, or even striving for a “flawless” appearance. Such unrealistic expectations may lead patients to frequently request touch-up injections or one-time excessive filling, resulting in facial swelling, stiffness, and other signs of overfilling.

Insufficient experience or lack of technical proficiency among some is a significant cause of overfilling. Facial filler procedures require precise control over injection dosage, depth, and point design. Inexperienced practitioners may inadvertently distribute fillers unevenly or administer excessive amounts due to improper technique, leading to complications such as facial swelling, irregularities, or asymmetry. Secondly, misinterpretation or misapplication of aesthetic standards can adversely affect filler outcomes. Some practitioners may overemphasise localised fullness (e.g, apple cheeks or nasolabial folds) while neglecting overall facial proportions and dynamic aesthetics, resulting in an unnatural appearance post-treatment.

Overfilling can lead to significant health risks, with vascular embolism being the most dangerous. When filler material is accidentally injected into blood vessels or compresses surrounding vessels, it can obstruct blood supply, leading to local tissue ischemia and hypoxia, which may result in tissue necrosis. This is particularly common in high-risk facial areas (e.g, glabella, nose, nasolabial folds). If not promptly addressed, it can cause permanent damage, including vision loss or extensive skin necrosis. Additionally, vascular embolism may trigger thrombosis, further increasing the risk of systemic complications. Overfilling can also cause skin surface irregularities or the formation of nodules. When excessive filler material is injected or unevenly distributed, it may accumulate locally under the skin, leading to uneven surfaces and a stiff texture. These nodules not only compromise aesthetic appearance but may also be accompanied by pain or discomfort, especially during facial movements, Furthermore, the formation of nodules may be related to the properties of the filler material, improper injection techniques, or inadequate postoperative care. In severe cases, surgical or pharmacological intervention may be required for correction.

For cases of overfilling caused by excessive hyaluronic acid injections, hyaluronidase serves as an effective corrective tool. Hyaluronidase specifically degrades hyaluronic acid and hyaluronic acid related filler, rapidly reducing the volume in the overfilled area and restoring natural facial contours.

For skin surface irregularities caused by uneven distribution of filler materials, massage and physical therapy can serve as adjunctive corrective measures. Gentle massage techniques can help promote even distribution of the filler material, reducing localized accumulation. Additionally, physical therapies such as radiofrequency or ultrasound can stimulate collagen regeneration, improve skin texture, and further address surface irregularities. However, these methods have limited efficacy and are typically suitable for mild cases of overfilling.

For overfilling caused by non-hyaluronic acid fillers (e.g, poly-L-lactic acid or permanent fillers), surgical removal may be necessary. Through minimally invasive procedures, physicians can precisely locate and remove excess filler material, restoring natural facial contours. Surgical correction is particularly suitable for cases where the filler material is difficult to degrade or has formed nodules. However, careful management of surgical trauma and postoperative recovery is required. For facial proportion imbalances caused by overfilling, liposuction or contour surgery can serve as effective corrective methods. Liposuction can reduce localized excess fat or filler material to some extent. Surgical approaches are suitable for severe cases of overfilling or when non-surgical methods are insufficient for correction.

Portable ultrasound technology has emerged as a significant tool in the correction of facial overfilling, offering notable advantages in the field of plastic and reconstructive surgery. Its high-resolution real-time imaging capability allows for precise localization of subcutaneous filler distribution, enabling physicians to avoid blind procedures and enhance the accuracy of corrective interventions. During the correction process, portable ultrasound can assist in the injection of hyaluronidase by guiding the injection points and dosage, while simultaneously monitoring the dissolution of hyaluronic acid in real time.

Overfilling is a common complication in facial filler procedures, with complex causes involving technical, patient, and physician-related factors. This article summarises some of the causes, consequences, and management strategies of overfilling, highlighting its multifaceted negative impacts on aesthetics, health, and psychological well-being. Through detailed preoperative assessment, personalised treatment plans, precise intraoperative techniques and diligent postoperative management, practitioners can effectively prevent and correct overfilling, ensuring natural and harmonious aesthetic outcomes for patients. Prevention is key to reducing the incidence of overfilling. Physicians should enhance patient education, helping them develop realistic aesthetic expectations and avoid excessive pursuit of facial fullness. In conclusion, the management of overfilling requires the joint efforts of physicians and patients. By implementing scientific preventive strategies, precise treatment plans, and ongoing research and innovation, we can minimise the occurrence of overfilling and advance facial filler procedures toward greater safety and naturalness.

NOT MY OWN WORK. Taken from:

Peng, C. X., Xv, W., & Ao, Y. J. (2025). A Review: Causes, Consequences, and Management Strategies of Facial Overfilling. Clinical, Cosmetic and Investigational Dermatology, 18, 1857–1864. https://doi.org/10.2147/CCID.S539888

Department of General Surgery Ward 3, Plastic Surgery and Medical Cosmetic Center, Yichun People’s Hospital, Yichun, People’s Republic of China and Plastic Surgery and Medical Cosmetic Center, Yichun People’s Hospital, Nanchang, People’s Republic of China