%0 Journal Article
%A Lee, Kar Wai Alvin Lee
%A Chan, Kwin Wah Lisa Chan
%A Lee, Cheuk Hung Lee
%A Wong, Tin Hau Sky Wong
%D 2026
%J Journal of Cosmetic and Regenerative Medicine

%@ 3107-2933

%V 1
%N 2
%P 21

%T Facial Overfilled Syndrome: An Update and Critical Review
%M doi:10.65381/jcrm.2026.01010021
%U https://jcrm.jams.pub/article/1/2/31
%X Background: Facial overfilled syndrome has emerged as a significant complication in aesthetic medicine, driven by the exponential increase in the use of soft tissue fillers. Characterized by anatomical distortion, loss of natural facial contours, and dynamic impairment, this syndrome poses profound physical and psychological challenges. Despite its growing prevalence, standardized definitions, diagnostic criteria, and management protocols remain insufficiently codified. Methods: A comprehensive evaluation of peer-reviewed literature was conducted using MEDLINE, PubMed, and Ovid databases to identify studies published from 2022 to 2026. A total of 46 publications were included, encompassing clinical trials, observational studies, imaging reviews, and expert consensus guidelines. These studies were critically appraised and classified according to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence (March 2009). Results: Recent evidence demonstrates a paradigm shift toward recognizing the multifactorial etiology of overfilled syndrome, involving mismatched rheological properties of fillers, practitioner misjudgment, and patient body dysmorphic tendencies amplified by social media. Advanced imaging modalities, particularly high-resolution ultrasound and magnetic resonance imaging, have proven pivotal in objective diagnosis and image-guided treatment. Management strategies are evolving from empiric hyaluronidase administration to precision, ultrasound-guided enzymatic dissolving, combined with surgical interventions for non-hyaluronic acid fillers or severe anatomical distortions. Conclusions: Facial overfilled syndrome represents a complex iatrogenic entity requiring a multidisciplinary approach. The integration of meticulous anatomical knowledge, targeted imaging, and ethical patient counseling is paramount for prevention. Future research must prioritize standardized diagnostic frameworks and longitudinal safety data to refine corrective protocols and restore facial identity.