The old adage about aesthetic treatments and plastic surgery is true: you see only the bad work. And whether we’re scrolling through Instagram or walking down the street, we’ve all seen plenty of it. The most obvious instances are overdone faces, the kind that cause you to stop dead in your tracks and do a double take. “There are general proportions to the face that fall within an acceptable range to the eye,” explains Dr. Catherine Chang, a board-certified plastic surgeon in Beverly Hills, California. “When these normalized values become distorted, that is when the face can start to look strange.”
Chalk it up to morbid curiosity—or fear of making the wrong investment—but after spending too much time analyzing unnatural looks, we decided to ask the experts what exactly we’re seeing when we notice bad cosmetic work. The alarming truth is that there are a lot of treatments and procedures that could potentially cause a weird-looking face. Thankfully, much of it can be avoided by seeing a skilled, experienced, and credible provider, but it’s always best to be informed. Here, nine plastic surgeons and derms from around the country break down what can make faces look strange, from overdoing under-eye filler to obsessing over a single facial feature.
Neurotoxins
“The number of units of and the location and depth of injection can be the difference between a rested, gorgeous look or a frightening look. It takes experience and consistency of the same injector to track your response to injections. Start with one [area] at a time and have a very detailed and patient injector perform it each time. I am the only one who injects in my clinic. I prefer to inject without gloves on—with sterile, washed hands—so I can feel the muscle and discern the thickness of the skin and plane of injection of my clients.” —Dr. Michele Koo, a board-certified plastic surgeon in St. Louis
“Bad [neurotoxin injections] are hard to ignore—it can cause the face to look strange and unnatural, [both] at rest and during expressions. Poor placement can lead to unnatural brow positions and motions, most commonly known as ‘Spock brow.’ It can also be placed too low on the cheek and hit the smile muscles, affecting how the muscles lift the corners of the mouth and causing a strange smile. When used in the lower face, adjacent muscles can accidentally be injected, causing lip motion to be asymmetric. If [a neurotoxin] is only placed in one area of the muscle, this can lead to strange muscle motion. Too much can cause the blunting of all facial expressions.” —Dr. Chang
“Weirdness occurs when one side is paralyzed and the other is not—when a patient and doctor use [a neurotoxin] to treat something that should have been addressed with another tool, such as filler, fat, or skin resurfacing or when muscles that are critical in conveying an image we expect to see [such as a smile] are inadvertently paralyzed. The human eye is exquisitely sensitive at picking up asymmetries, so even a millimeter’s difference can be noticeable. Go to someone who knows facial anatomy well.” —Dr. Evan Garfein, a board-certified plastic surgeon in New York City
Under-eye filler
“In small quantities, hyaluronic acid fillers do a good job of improving volume loss, but once the volume loss starts to span the entire eye area, practitioners have to use way too much filler to fill that region. Too much filler in the under-eye region can result in the Tyndall effect, an optical effect caused by the way light transmits through a clear liquid underneath a thin tissue, emitting a bluish discoloration around the eyes. Additionally, the water-loving properties of hyaluronic acid fillers makes them absorb a lot of water. [When injected] in high quantities, that area becomes very puffy, and between the puffiness and the Tyndall effect, it starts to look very unusual and unnatural.
“Typically, tear troughs shouldn’t be filled with more than 0.2cc to 0.3cc of filler per eye—definitely not a whole cc, which is, unfortunately, common practice. Coming in every six months to a year to refill that region is totally unnecessary, since fillers last a long time in that area, and it further adds to puffiness.” —Dr. Amir Karam, a board-certified plastic surgeon in San Diego
Fillers
“If volume loss is the problem, fillers throughout the midface [can provide] an effective correction. Less is more—the nuance is in the volume and plane of injection. This requires surgical knowledge, respect of the anatomy, and a diagnosis to assess the perfect intervention. In my opinion, the problem arises from injectors underestimating the nuance of the anatomy and how to correct it to a ‘natural’ return to fullness without distortion and disproportion. No amount of filler will replace the need to remove excess skin in the neck, jawline, or cheek/marionette area.
“Marionette lines and cheekbones are the perfect areas for filler to fill in the lines and crevices or to soften and gently plump the cheek. The weird look occurs when there is simply too much skin and the cheek pad has dropped. This requires repositioning of the entire cheek pad and removal of extra skin. The second reason the cheek area can look weird is simply too much filler in the wrong place.” —Dr. Koo
“It is always better to be undervolumized—being overly volumized can cause issues with appearance. We tend to get a flatter, two-dimensional appearance as we age, losing both fat and bone. Where filler is placed, the amount of filler used, and the density of the product can cause or exacerbate heaviness issues and not rebuild the right 3D version of ourselves. Changing the location of filler placement and techniques can help to avoid the issue and the strange, heavy appearance.” —Dr. Raymond Douglas, a board-certified oculoplastic surgeon in Beverly Hills, California
Liquid facelifts
“People are using fillers with the idea that if you place a lot of volume in the upper face—like around the outer cheeks and along the cheekbone region—that somehow you’re going to get a volumetric lift of the face that can replace surgery. To do that, you’d have to add a tremendous amount of volume. Outer cheeks never look that big in person naturally, so they start to look very unusual—more alien than human. [Then] these fillers don’t ever completely go away, so you’re stacking fillers on top of fillers. Eventually, the fillers transform into collagen. The minute fillers are placed, an inflammatory process tries to break down these foreign bodies. That process results in scar formation, which is more or less permanent. In many ways, the face becomes permanently disfigured.” —Dr. Karam
“It is well understood by everyone who treats facial aging that sagging of the midface is a telltale sign of getting older—the full, youthful cheek becomes a more hollow, sadder midface. It seems rational to propose that by injecting volume into the cheek this change can be reversed. To some degree, that is true—but like with Botox, the key is in knowing what tool to use for what job. But some patients need [filler or fat grafting] and a facelift or that and skin tightening. If patients and their doctors go back to the well too many times—each time adding more substance to the area—eventually, something will look out of place. When cheeks are overfilled, our eyes tell us something is weird.” —Dr. Garfein
Silicone injections
“Silicone injected into the lips may initially look favorable, but as the lips deflate with age and the mouth tissue atrophies, silicone filler results in a lumpiness that is very visible during animation—and even at rest in some. Previously injected silicone is seen as an unnatural ‘ball’ or nodule. Removing these silicone beads can be dangerous, even in the most skilled hands. Additionally, since the silicone does not dissolve, it has a high propensity of migration from repeated movement of the oral and perioral muscles. Lastly, the act of injecting silicone into the body is something that is very dangerous, not only due to the risk of infection and inflammation but also due to the risk of vascular occlusion and/or thromboembolism, which can be deadly.” —Dr. Hardik Doshi, a board-certified plastic surgeon in New York City
Thread lifts
“I’m not a fan of the thread lift. The barbs from the threads can penetrate the skin and give a very indented ‘dotted-line’ look. Additionally, the effect may not last more than a year or two.” —Dr. Koo
“Studies have shown that the results of threads last three to six months at best and have complication rates of approximately 10% to 30%, including infection, contour irregularities, pain, nerve damage, and erosion. A thread lift is not an alternative to surgery—it will not give you permanent results, it comes with potential complications, and it is expensive. It’s exposing yourself to risk for very little reward.” —Dr. Karam
Buccal fat removal
“This is currently trending everywhere. This oversearched and overused procedure creates an unnatural hollowness to the cheeks. In addition, this procedure does not age well, so as the patient gets older, they often need to add volume back into the face. A youthful face is more round and full. We should not create an overly sculpted face on a young person.” —Dr. Jennifer Levine, a board-certified plastic surgeon in New York City
“Eliminating too much fat in places like the buccal fat pads in cheeks may cause hollows as we age. It also contributes to additional sagging later, which creates complications in the harmony of the face. Restoring the fat or using filler will not give a natural effect—cheeks may be overfilled, like on the Pillsbury Doughboy.” —Dr. Ava Shamban, a board-certified dermatologist in Beverly Hills, California
Cosmetic canthoplasty, aka “fox eye” surgery
“A canthoplasty refers to tightening the lower eyelid ligament. Tightening the lower eyelid will always result in a change of the eye shape. Unless performed for reconstructive reasons, [cosmetic canthoplasty] will often change the shape of the eye in an unnatural way, making the eye appear smaller and blunting the corner of the eye, creating an unnatural shape. The eye will also appear horizontally shorter.” —Dr. Chang
“Due to popularity of a certain face type, e.g., Bella Hadid, many patients flocked to get threads to lift the corner of their brows. However, threads are meant to dissolve over time and leave behind a ‘scar band’ in hopes that the elevation of the targeted tissue from these scar bands remains over time. The fox eye treatment, however, falls short—it unnaturally lifts the corner of the brow without properly releasing the ligamentous attachments of the brow to the underlying periosteum. As a result, a portion of the orbicularis oculi muscle is hiked up temporarily. This can result in paralysis of the muscle that helps to close the eye, dry eyes, infection, asymmetric elevation of the brows, paralysis of the muscle that elevates the brow, and risk of injury to the eyeball. I’ve had a handful of patients present to my office to have a reversal of their fox eye treatment [because] they experienced some of these unfortunate side effects.” —Dr. Doshi
Stand-alone fat transfer
“Fat transfer in a young face, to give more volume, is generally a bad idea, since the fat that is transferred is susceptible to weight changes the individual may incur over the years. Also, as the individual incurs changes to their skin, fat, muscle, and bone structure with age, these deposited fat transfer parcels can lead to the appearance of unnatural ‘bags’ or lumpiness, depending on where they were injected. Removing them can be tricky, since they often integrate into the surrounding tissue and sometimes cannot be excised. Judicious fat transfer in the appropriately selected patient, however, can be a powerful and effective treatment.” —Dr. Doshi
Focusing on one feature rather than considering holistic treatment
“Staying hyperfocused on one area of the face or body is one of the most common faults in the cosmetic industry. By overtreating one area, you not only call attention to it but also draw negative attention to the rest of the face or body. For example, if you are getting treatments to help keep your face refreshed and wrinkle-free but completely neglect your neck, it will be apparent that you’ve had work done.” —Dr. Kim Nichols, a board-certified dermatologist in Greenwich, Connecticut
“Many patients come in with concerns about hollowness or bags under the eye and want filler in this area. The exposure of the orbital rim is caused by descent of the cheek. The correction of the area must start with filler in the cheek. After that, filler under the eye may be placed if necessary. There are ligaments in this area that are not supported, which can lead to a ‘hammock’ effect. The undereye area also has poor lymphatic drainage, so overfilling the area can lead to swelling.” —Dr. Levine
“The lower face and neck are anatomically connected—underneath the skin, the soft tissue of the face extends down into and is connected to the neck. Therefore, when someone starts to notice that their neck is aging, the lower face is anatomically contributing to the neck sagging. When performing an isolated neck lift without addressing the lower face, this can cause facial disharmony, as the neck will be tight but jowls and sagging of the lower face will remain. Additionally, oftentimes there will be bunching around the lower earlobe, as excess skin will accumulate there. Furthermore, as the face continues to age, the neck and face will age at different rates, exacerbating the disparity between them, causing an unnatural appearance.” —Dr. Chang
