October 14, 2026 | Facial Procedures, Fat Transfer, Plastic Surgery News
There is certainly a tendency currently to go away from fillers and use biostimulators, or the patient’s own fat, or a donor fat graft.
I said that when the American numbers came out. The International Society of Aesthetic Plastic Surgery’s survey of procedures performed in 2025, released at the end of September, now says it for the whole world. Hyaluronic acid filler fell 25.2 percent in one year. Poly-L-lactic acid fell 33.7 percent, calcium hydroxyapatite 25.7 percent, botulinum toxin 7 percent. Fat grafting to the face held at 944,410 procedures, the number seven surgery on earth, up 60.2 percent since 2021. Hand rejuvenation with fat rose 22.2 percent.
| Worldwide 2025 (ISAPS) | Procedures | Change vs 2024 | Change vs 2021 |
|---|---|---|---|
| Hyaluronic acid filler | 4,737,957 | minus 25.2% | minus 10.3% |
| Poly-L-lactic acid | 426,019 | minus 33.7% | not tracked |
| Calcium hydroxyapatite | 310,525 | minus 25.7% | plus 7.0% |
| Botulinum toxin | 7,333,647 | minus 7.0% | plus 0.3% |
| Fat grafting to the face | 944,410 | minus 0.3% | plus 60.2% |
| Hand rejuvenation | not broken out | plus 22.2% |
Source: ISAPS International Survey on Aesthetic/Cosmetic Procedures Performed in 2025. ISAPS says 42.1 percent of surgeons now use biostimulators.
Why Patients Are Leaving Filler
I think we have seen that facial fillers have been quite overdone, and patients are really getting away from looking overfilled and want to look more natural. We have seen that these hyaluronic acid fillers may not dissolve completely, and they do tend to migrate. It seems like they create some kind of inflammatory response in some patients, creating nodules or inflammation. And of course, the feel of a filler is not quite like natural fat, which is squishy and soft, something whose borders you wouldn’t be able to identify the way you can with a filler.
When patients use fillers, they see that they have to have this redone anywhere from every six months to one year. And what we’re also seeing is that not all of that filler goes away, but it’s migrating and flattening out, so it’s not giving us the volume exactly where we want it.
Under the eyes in particular: Fillers over time have started to come out of favor, as we are now noticing that the filler really never dissolves. The results can last about a year, but the filler does not dissolve, it just disperses. I have seen cases where it blocks the lymphatic drainage, and patients start having bags under the eyes, which are worse in the mornings, or they have discoloration or lumpiness. Sometimes they can also get inflamed. So I have dissolved a lot of under-eye fillers in order to improve all these complications, and that is why I am more inclined to use fat rather than hyaluronic acid fillers.
Why Fat Is Holding
I think fat grafting has been rising for many years. It’s an essential component of almost all facial procedures. I incorporate fat grafting into lower eyelid surgery, I incorporate it into all my facelifts, and I incorporate it in any facial procedure where the patient has lost a considerable amount of weight. So the GLP-1 wave has certainly increased the demand, but just normal aging is comprised of loss of fat and volume in the face, as well as skin laxity and quality.
We have been using the patient’s own fat, because we have the benefit of using however much volume we really need, as the number of fat CCs does not increase the cost of the procedure, and the patient’s own fat is free. This gives a very natural, soft result, which is of course long lasting. For some patients that don’t want as much downtime, we’ve been using Lipoderma, which is a donor fat graft that gives us very similar results to the patient’s own fat grafting.
The Honest Limit of Fat
Filler cannot really give us a natural feel. When properly done it can give us a natural look, but it’s often overdone. It can also not give us a long lasting result, and this is where fat has its benefits. Now, the main factor that disappoints people with fat injections is that the amount of retention is really unpredictable. Even though we know the patient is going to keep fifty to eighty percent of the volume, that percentage is quite unpredictable, so we are always overfilling. Patients that lose fifty percent of the volume we inject are sometimes disappointed, and we have to go back and inject more fat.
The good thing is that whatever does stay is going to be quite permanent, and of course maintaining your weight is going to help with that. We know that with aging, fat will decrease in the face regardless, so it is a procedure that we probably have to repeat in the future.
Botox Is Different
Yes, botulinum toxin is half of all minimally invasive treatments. I think it’s probably more than half in reality in our practice. This doesn’t mean that it’s the safest bet; it means that it’s something that’s tried and proven. It really is a maintenance therapy. I myself get botulinum toxin in the forehead, crow’s feet, and glabella lines every three to four months, just to maintain the wrinkle free appearance with a dose that still lets me express my face without looking abnormal.
Worldwide it slipped 7 percent. In my office it did not.
Why Choose Dr. Agullo
I am certified by the American Board of Plastic Surgery and the American Board of Surgery, trained in plastic surgery at the Mayo Clinic, and teach as Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly has named me a Top Doctor every year from 2014 through 2026. Fat grafting is part of nearly every facial operation I do, and I have spent a good part of this year dissolving other people’s filler.
Ready to Talk?
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. Pricing is on the fees page. #StayBeautiful
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