2025 AAD: Drs. Shino Bay Aguilera, Michael Somenek Face Off Over Filler Treatments

A ticketed session at the 2025 American Academy of Dermatology (AAD) Annual Meeting brought together leading experts in the field to debate some of the hottest injectable controversies from an evidence-based perspective, helping attendees choose the most appropriate treatments and achieve natural-looking outcomes while maximizing patient safety. 

Are fillers obsolete? This was the first topic of the “Face Off: Evidence-Based Debates on Today’s Hottest Injectable Controversies” session. Doris Day, MD, FAAD, moderated as fellow Modern Aesthetics Editorial Board members Shino Bay Aguilera, DO, FAAD, and Michael Somenek, MD, were the "proposition" and the “opposition,” respectively. 

Drs. Aguilera and Somenek each were given 10 minutes to present data to support their argument before the debate.

“One of the questions I have for you [involves] showing those fibroblasts that seem to be suffering and being the hero and the advocate for those fibroblasts; where is the actual data showing that those fibroblasts were really suffering?” Dr. Day said. “Because we’ve had fillers since the early 2000s. Having seen fillers over the decades, I don’t see those fibroblasts suffering. I don’t see increased collagen breakdown from the fillers being done for over a decade. Where is the connection between what you see under the skin to the claim you’re making that the fibers separate? Because you’re very convincing.

Dr. Aguilera responded that he only has data from Merz Aesthetics, but that he plans on publishing a paper about it.

“In the lab,” Dr. Aguilera said, “if you want to disrupt cell communication, they will use hyaluronic acid to achieve that; so, just by having that statement, understanding that there is cell discommunication of this trafficking, if you put this barricade of gel between the tissue that does not belong there, there has to be a problem long-term. I think that’s the reason why it is safe. That’s the reason why sometimes we’ve seen, for those who use it for boosting, it solves the problem. I go by what [Merz Aesthetics] said to me because this is something that I conceptualize, right? I feel like the quality of the skin, clinically, for people that are only dependent, it is different. It is translucent. I think that chronic abuse of HA in any human tissue will disrupt the physiology.”

While Dr. Day complimented the explanation, she said she did not think it explained what she had seen clinically, adding that “we need more data and more science to match what we see under the skin.” 

Dr. Day then asked Dr. Somenek how he would debate back about fillers being here to stay, and how they can work with the regenerative element that is developing? 

“I do think the more you do something, the more you learn,” Dr. Somenek said. “So, the more procedures that are performed, the more complications will arise, and we need to learn from those complications. But the problem, to your point, is that as the portfolios start increasing and the rheology starts getting mixed, we are seeing an increasing interchange within the soft tissues that these fillers can play. That leads to probably more research, understanding how they work together. Because all the companies say they should be interchangeable—and they’re all equally good—but we know clinically that’s not the case. I think it comes down to the amount of filler that’s injected, the quantity and quality of what you’re choosing to do. I think the end result is we need more research. I feel I say that all the time, but we do.”

Other debates that took place during this session included “Lip Injection Techniques,” “Temple Approaches: What Reigns Supreme?,” “Favorite Off-Face Indications,” and “Skin Boosters vs Lasers/Devices for Skin Quality: What's Best?”

The goal of this session was to address the field of injectables as it rapidly evolves with new techniques, products, and data entering the space. The amount of information available in the literature and on social media often makes it difficult to discern hype from reality.