Natural-Looking Fillers? What You Need to Know with Dr. Jacqueline Watchmaker
Posted posted on June 12, 2025
On This Week's Episode:
Are your beauty treatments making you look better—or just more obvious? Dr. Jacqueline Watchmaker, Board-Certified Dermatologist at U.S. Dermatology Partners – CALM Scottsdale, breaks down the truth behind cosmetic dermatology. From the contrasting aesthetic trends between the East Coast and Scottsdale to the real reason your filler may look “off,” she dives deep into what works, what doesn’t, and why natural-looking results take skill and strategy.
You’ll learn about the misunderstood role of hyaluronidase in dissolving filler, the rising popularity—and complications—of biostimulatory fillers, and why sunscreen remains the most underrated skincare essential. Dr. Watchmaker also tackles pervasive myths, like whether filler makes you puffy, and shares what every patient should know before sitting in the chair.
Guest Bio:
Dr. Jacqueline Watchmaker is a Board-Certified Dermatologist who practices general and cosmetic dermatology. Dr. Watchmaker won numerous awards and honors throughout her medical training at Medical College of Wisconsin, where she attended medical school, and Boston University, where she completed her dermatology residency. During medical school, she was elected to the prestigious Alpha Omega Alpha Honor Society. After medical school, she was selected as the “Best Intern” for her internal medicine class and was ultimately selected as the chief resident for her residency program. Following her medical training, Dr. Watchmaker completed a one-year fellowship at Skincare Physicians in Chestnut Hill, Massachusetts where she focused on cosmetic dermatology and laser medicine. There, she developed expertise in the use of lasers for the treatment of a variety of skin conditions and cosmetic procedures. During her fellowship she trained on the newest devices and worked on numerous clinical trials. Through this work, she developed an expertise in the use of injectable fillers, neuromodulators, lasers and other energy-based devices. Dr. Watchmaker is passionate about research, is widely published and has presented at a number of national conferences. She has written multiple book chapters and contributed many research papers to peer-reviewed medical journals, with the majority of her research focused on the use of lasers in dermatology. In addition, she is the co-director of cosmetic clinical trials at Southwest Skin Specialists. Dr. Watchmaker has presented at national meetings including the American Academy of Dermatology, the International Society of Dermatology Meeting, the Mexican Academy of Dermatology Meeting, Conversations and Controversies and the American Society for Dermatologic Surgery and the American Society for Laser Medicine and Surgery.
Episode Transcript:
DR. ROSSI: Social media is having a moment with filler myths. People are now even vilifying hyaluronidase, the enzyme we use to dissolve hyaluronic acid.
DR. WATCHMAKER: I know. They are vilifying tools we rely on and spreading misinformation. It is wild. Everyone has a platform now, which can be good and bad.
DR. ROSSI: Let’s zoom out. Aesthetics in general looks very different from coast to coast. You trained on the East Coast. What feels different now that you practice in Scottsdale?
DR. WATCHMAKER: In Boston and New York everything was subtle. People had work done, but they rarely talked about it. In Scottsdale it is the opposite. Bruises from filler are almost a badge of honor. The vibe is more, more, more. I still practice with my East Coast eye though. I aim for natural and quiet work.
DR. ROSSI: Same. We both care about how the skin looks, moves and feels, not just about “big” results. And we are definitely in the “no filler filler” era. People want the benefits without an obvious look.
DR. WATCHMAKER: Exactly. The biggest myth I hear now is that filler automatically makes you puffy. Patients either say they are scared of filler or they say they do not want to look swollen.
DR. ROSSI: How do you answer that?
DR. WATCHMAKER: I tell them you never notice good filler. With the right injector, the right product and a stepwise approach, you will not look puffy. I like one or two syringes at a time, let it settle, then reassess. Puffiness usually comes from too much filler, the wrong product and the wrong placement.
DR. ROSSI: Placement is huge. People are putting filler where there is no true fat compartment, or too superficially, and these gels can hold a lot of water. That is where the bloated look comes from. We all remember the puffy under eye look that sparked the migration panic.
DR. WATCHMAKER: Migration is another myth that is blown out of proportion. After injection, filler draws in water and looks its best in a few weeks. That is normal. Social media makes it sound like it keeps pulling water for years and then grows “legs” and travels all over the face. That is not how it works.
DR. ROSSI: True migration is usually just misplaced filler.
DR. WATCHMAKER: Yes. Could it spread within the compartment if you massively overfill an area? Maybe a bit. But with properly placed filler in the right plane, using products with the right level of water attraction for that area, migration should not be a real concern. I have patients with beautiful, natural lips who insist they “must” have migration because they saw a TikTok. There is no issue. We are creating problems where there are none.
DR. ROSSI: These gels integrate into tissue. In the dermis or in the subcutaneous fat, they sit where you put them if you know your planes and anatomy.
DR. WATCHMAKER: Exactly. So I tell people, pick an experienced injector and stop letting social media scare you.
DR. ROSSI: Another myth is once you start, you can never stop.
DR. WATCHMAKER: I hear that nonstop with neuromodulators. Patients say they do not want to start Botox or Dysport because “what if I want to stop.” If you do your upper face once, your skin is three months smoother and then it simply goes back to baseline. You do not age faster. I have patients who realistically only come twice a year. That is still better than nothing.
DR. ROSSI: Same with filler. It often lasts longer than the box says. You can do your lips once, like the result and never touch them again.
DR. WATCHMAKER: And there is a bioregenerative effect from the needle itself and from the filler. You create controlled trauma, lay down new collagen. That is why you do not need to “top up” every six months exactly. The myth that you must refill on a clock is what pushes people into the puffy zone.
DR. ROSSI: I love that you push back when patients show up like clockwork.
DR. WATCHMAKER: I do. I have inherited patients who walk in every six months and say “I am due for my filler.” I tell them you are due when your facial structure shows changes that need support. Not because the calendar flipped. If you keep topping up without reassessment you train the eye to like a more and more overfilled look. That perception drift is real.
DR. ROSSI: Faces need a little shadow and contour. If you erase every hollow, you start to look like a blob.
DR. WATCHMAKER: And doctor shopping makes it worse. If no one says no, you end up overfilled.
DR. ROSSI: Which brings us to dissolving. You mentioned hyaluronidase earlier. Social media is now scared of the fix.
DR. WATCHMAKER: Yes. I use hyaluronidase all the time in Scottsdale. Often weekly, sometimes daily. Old tear trough filler, bad product choice, wrong placement. I have used it hundreds of times without a serious adverse event. I often dilute it so we can dissolve gradually, just like I build gradually with filler. We might space sessions a few weeks apart.
DR. ROSSI: And the myth is that it dissolves everything.
DR. WATCHMAKER: Right. People think one treatment melts all their normal structures and leaves them hollow and gaunt. With finesse, that does not happen. It is safe and predictable in experienced hands.
DR. ROSSI: We also make hyaluronidase in our own bodies.
DR. WATCHMAKER: Exactly. We constantly break down our own hyaluronic acid and collagen to rebuild it. Skin is dynamic. It turns over, just more slowly with age. Hyaluronidase is part of that biology. It is not some toxic foreign agent.
DR. ROSSI: Let’s get into biostimulatory fillers. They are all over social media.
DR. WATCHMAKER: People hear “biostimulatory” and think it is something brand new and superior. Technically lots of things are biostimulatory. Even the needle is. But when people say it now they mean products like poly L lactic acid and calcium hydroxyapatite. These have been around for decades. Poly L lactic acid has been used for more than twenty years and was first approved for HIV lipoatrophy, when patients had severe facial wasting from older antiretrovirals.
DR. ROSSI: And they work. We used them in HIV lipoatrophy clinics. You saw dramatic improvements.
DR. WATCHMAKER: They can be beautiful in very gaunt patients or in very specific situations. They are not new. They just got a marketing refresh. And they are not risk free. I see almost every nodule from these products in Scottsdale. Nodules from biostimulatory fillers are under discussed.
DR. ROSSI: How are you managing them?
DR. WATCHMAKER: They are notoriously tough. In the acute phase, if they are inflamed, I may use oral steroids or oral anti inflammatories, then intralesional steroids or five fluorouracil. Sometimes we make progress. Sometimes we do not. I have an older man who got calcium hydroxyapatite at a med spa and now has rock hard nodules in his face. We improved things, but our plastic surgeon still has to surgically cut some out. With hyaluronic acid filler I can always dramatically improve or fully resolve a nodule because I have hyaluronidase. I cannot say that for these products.
DR. ROSSI: And the technique is different too.
DR. WATCHMAKER: Completely. You cannot inject biostimulatory fillers the way you inject HA. And you do not get instant gratification. You need multiple sessions and months to see the full effect. It has a niche, especially in post cancer patients or severe fat loss cases, but it is not for everyone.
DR. ROSSI: Social media makes it sound like everyone in their twenties should start “biosimulating.”
DR. WATCHMAKER: Yes, and that is how you end up over biostimulated. We have all seen colleagues and patients who went too far. The effect is real, which is why it needs respect.
DR. ROSSI: Switching gears, you mentioned maintenance. I like your analogy.
DR. WATCHMAKER: I tell patients all the time, nothing in the body is one and done. You do not work out once, brush your teeth for one year, or shower a few times and call it done. Everything takes maintenance. Skin treatments, lasers, hair loss therapies, all of it. Hair patients often say “I will just get a transplant and never think about it again.” It does not work like that. If you move hair to the front and never treat the rest, you keep receding behind the transplant. You still need medical maintenance.
DR. ROSSI: And even simple tools like topical minoxidil can work if you are consistent.
DR. WATCHMAKER: They can. People dismiss it because it feels “old” or like an infomercial. But five percent topical minoxidil used daily for six months can be very effective and safe. You just have to be diligent.
DR. ROSSI: Let’s close on sunscreen myths, because they are everywhere.
DR. WATCHMAKER: My favorite patient line is “I do not go outside.” I always ask how they got to the office. You accumulate sun damage in tiny doses every day. Walking to the car, driving, errands. You do not need a beach chair to get UV damage.
DR. ROSSI: Especially in Scottsdale.
DR. WATCHMAKER: Yes. I tell patients I do not even check the weather app. It is sunny. If you invest time and money in resurfacing and then skip sunscreen, you are not protecting that investment. And now we have this myth that sunscreen causes skin cancer.
DR. ROSSI: It has really taken hold.
DR. WATCHMAKER: Sunscreen does not cause skin cancer. It is one of the few things proven to prevent it and to prevent photoaging. I tell people if you do not care about skin cancer, at least do it for vanity. The aging difference between sunscreen users and non users is dramatic. Face versus neck photos tell the story.
DR. ROSSI: I like the habit framing.
DR. WATCHMAKER: Me too. Some colleagues say only wear it when the UV index is high. In real life, most people will not check an index every morning. I prefer “like brushing your teeth.” Keep it by your toothbrush. Put it on every morning. That is how you get consistency.
DR. ROSSI: Thoughts on mineral versus chemical?
DR. WATCHMAKER: I love mineral sunscreens. They are usually less irritating. They can be a bit whitening on deeper skin tones, so sometimes chemical makes more sense. There are great tinted and sheer mineral options now. At the end of the day the best sunscreen is the one you like and will use. Mineral is ideal for many, but any sunscreen is better than none.
DR. ROSSI: That is a good myth to end on. Jacqueline, I am so glad we finally got you here.
DR. WATCHMAKER: I am glad too. This was great.
DR. ROSSI: Thanks for listening to Give Good Face. Please subscribe, leave a review and follow along wherever you listen to your podcasts.
Natural-Looking Fillers? What You Need to Know with Dr. Jacqueline Watchmaker
On This Week's Episode:
Are your beauty treatments making you look better—or just more obvious? Dr. Jacqueline Watchmaker, Board-Certified Dermatologist at U.S. Dermatology Partners – CALM Scottsdale, breaks down the truth behind cosmetic dermatology. From the contrasting aesthetic trends between the East Coast and Scottsdale to the real reason your filler may look “off,” she dives deep into what works, what doesn’t, and why natural-looking results take skill and strategy.
You’ll learn about the misunderstood role of hyaluronidase in dissolving filler, the rising popularity—and complications—of biostimulatory fillers, and why sunscreen remains the most underrated skincare essential. Dr. Watchmaker also tackles pervasive myths, like whether filler makes you puffy, and shares what every patient should know before sitting in the chair.
Guest Bio:
Dr. Jacqueline Watchmaker is a Board-Certified Dermatologist who practices general and cosmetic dermatology. Dr. Watchmaker won numerous awards and honors throughout her medical training at Medical College of Wisconsin, where she attended medical school, and Boston University, where she completed her dermatology residency. During medical school, she was elected to the prestigious Alpha Omega Alpha Honor Society. After medical school, she was selected as the “Best Intern” for her internal medicine class and was ultimately selected as the chief resident for her residency program.
Following her medical training, Dr. Watchmaker completed a one-year fellowship at Skincare Physicians in Chestnut Hill, Massachusetts where she focused on cosmetic dermatology and laser medicine. There, she developed expertise in the use of lasers for the treatment of a variety of skin conditions and cosmetic procedures. During her fellowship she trained on the newest devices and worked on numerous clinical trials. Through this work, she developed an expertise in the use of injectable fillers, neuromodulators, lasers and other energy-based devices.
Dr. Watchmaker is passionate about research, is widely published and has presented at a number of national conferences. She has written multiple book chapters and contributed many research papers to peer-reviewed medical journals, with the majority of her research focused on the use of lasers in dermatology. In addition, she is the co-director of cosmetic clinical trials at Southwest Skin Specialists. Dr. Watchmaker has presented at national meetings including the American Academy of Dermatology, the International Society of Dermatology Meeting, the Mexican Academy of Dermatology Meeting, Conversations and Controversies and the American Society for Dermatologic Surgery and the American Society for Laser Medicine and Surgery.
Episode Transcript:
DR. ROSSI: Social media is having a moment with filler myths. People are now even vilifying hyaluronidase, the enzyme we use to dissolve hyaluronic acid.
DR. WATCHMAKER: I know. They are vilifying tools we rely on and spreading misinformation. It is wild. Everyone has a platform now, which can be good and bad.
DR. ROSSI: Let’s zoom out. Aesthetics in general looks very different from coast to coast. You trained on the East Coast. What feels different now that you practice in Scottsdale?
DR. WATCHMAKER: In Boston and New York everything was subtle. People had work done, but they rarely talked about it. In Scottsdale it is the opposite. Bruises from filler are almost a badge of honor. The vibe is more, more, more. I still practice with my East Coast eye though. I aim for natural and quiet work.
DR. ROSSI: Same. We both care about how the skin looks, moves and feels, not just about “big” results. And we are definitely in the “no filler filler” era. People want the benefits without an obvious look.
DR. WATCHMAKER: Exactly. The biggest myth I hear now is that filler automatically makes you puffy. Patients either say they are scared of filler or they say they do not want to look swollen.
DR. ROSSI: How do you answer that?
DR. WATCHMAKER: I tell them you never notice good filler. With the right injector, the right product and a stepwise approach, you will not look puffy. I like one or two syringes at a time, let it settle, then reassess. Puffiness usually comes from too much filler, the wrong product and the wrong placement.
DR. ROSSI: Placement is huge. People are putting filler where there is no true fat compartment, or too superficially, and these gels can hold a lot of water. That is where the bloated look comes from. We all remember the puffy under eye look that sparked the migration panic.
DR. WATCHMAKER: Migration is another myth that is blown out of proportion. After injection, filler draws in water and looks its best in a few weeks. That is normal. Social media makes it sound like it keeps pulling water for years and then grows “legs” and travels all over the face. That is not how it works.
DR. ROSSI: True migration is usually just misplaced filler.
DR. WATCHMAKER: Yes. Could it spread within the compartment if you massively overfill an area? Maybe a bit. But with properly placed filler in the right plane, using products with the right level of water attraction for that area, migration should not be a real concern. I have patients with beautiful, natural lips who insist they “must” have migration because they saw a TikTok. There is no issue. We are creating problems where there are none.
DR. ROSSI: These gels integrate into tissue. In the dermis or in the subcutaneous fat, they sit where you put them if you know your planes and anatomy.
DR. WATCHMAKER: Exactly. So I tell people, pick an experienced injector and stop letting social media scare you.
DR. ROSSI: Another myth is once you start, you can never stop.
DR. WATCHMAKER: I hear that nonstop with neuromodulators. Patients say they do not want to start Botox or Dysport because “what if I want to stop.” If you do your upper face once, your skin is three months smoother and then it simply goes back to baseline. You do not age faster. I have patients who realistically only come twice a year. That is still better than nothing.
DR. ROSSI: Same with filler. It often lasts longer than the box says. You can do your lips once, like the result and never touch them again.
DR. WATCHMAKER: And there is a bioregenerative effect from the needle itself and from the filler. You create controlled trauma, lay down new collagen. That is why you do not need to “top up” every six months exactly. The myth that you must refill on a clock is what pushes people into the puffy zone.
DR. ROSSI: I love that you push back when patients show up like clockwork.
DR. WATCHMAKER: I do. I have inherited patients who walk in every six months and say “I am due for my filler.” I tell them you are due when your facial structure shows changes that need support. Not because the calendar flipped. If you keep topping up without reassessment you train the eye to like a more and more overfilled look. That perception drift is real.
DR. ROSSI: Faces need a little shadow and contour. If you erase every hollow, you start to look like a blob.
DR. WATCHMAKER: And doctor shopping makes it worse. If no one says no, you end up overfilled.
DR. ROSSI: Which brings us to dissolving. You mentioned hyaluronidase earlier. Social media is now scared of the fix.
DR. WATCHMAKER: Yes. I use hyaluronidase all the time in Scottsdale. Often weekly, sometimes daily. Old tear trough filler, bad product choice, wrong placement. I have used it hundreds of times without a serious adverse event. I often dilute it so we can dissolve gradually, just like I build gradually with filler. We might space sessions a few weeks apart.
DR. ROSSI: And the myth is that it dissolves everything.
DR. WATCHMAKER: Right. People think one treatment melts all their normal structures and leaves them hollow and gaunt. With finesse, that does not happen. It is safe and predictable in experienced hands.
DR. ROSSI: We also make hyaluronidase in our own bodies.
DR. WATCHMAKER: Exactly. We constantly break down our own hyaluronic acid and collagen to rebuild it. Skin is dynamic. It turns over, just more slowly with age. Hyaluronidase is part of that biology. It is not some toxic foreign agent.
DR. ROSSI: Let’s get into biostimulatory fillers. They are all over social media.
DR. WATCHMAKER: People hear “biostimulatory” and think it is something brand new and superior. Technically lots of things are biostimulatory. Even the needle is. But when people say it now they mean products like poly L lactic acid and calcium hydroxyapatite. These have been around for decades. Poly L lactic acid has been used for more than twenty years and was first approved for HIV lipoatrophy, when patients had severe facial wasting from older antiretrovirals.
DR. ROSSI: And they work. We used them in HIV lipoatrophy clinics. You saw dramatic improvements.
DR. WATCHMAKER: They can be beautiful in very gaunt patients or in very specific situations. They are not new. They just got a marketing refresh. And they are not risk free. I see almost every nodule from these products in Scottsdale. Nodules from biostimulatory fillers are under discussed.
DR. ROSSI: How are you managing them?
DR. WATCHMAKER: They are notoriously tough. In the acute phase, if they are inflamed, I may use oral steroids or oral anti inflammatories, then intralesional steroids or five fluorouracil. Sometimes we make progress. Sometimes we do not. I have an older man who got calcium hydroxyapatite at a med spa and now has rock hard nodules in his face. We improved things, but our plastic surgeon still has to surgically cut some out. With hyaluronic acid filler I can always dramatically improve or fully resolve a nodule because I have hyaluronidase. I cannot say that for these products.
DR. ROSSI: And the technique is different too.
DR. WATCHMAKER: Completely. You cannot inject biostimulatory fillers the way you inject HA. And you do not get instant gratification. You need multiple sessions and months to see the full effect. It has a niche, especially in post cancer patients or severe fat loss cases, but it is not for everyone.
DR. ROSSI: Social media makes it sound like everyone in their twenties should start “biosimulating.”
DR. WATCHMAKER: Yes, and that is how you end up over biostimulated. We have all seen colleagues and patients who went too far. The effect is real, which is why it needs respect.
DR. ROSSI: Switching gears, you mentioned maintenance. I like your analogy.
DR. WATCHMAKER: I tell patients all the time, nothing in the body is one and done. You do not work out once, brush your teeth for one year, or shower a few times and call it done. Everything takes maintenance. Skin treatments, lasers, hair loss therapies, all of it. Hair patients often say “I will just get a transplant and never think about it again.” It does not work like that. If you move hair to the front and never treat the rest, you keep receding behind the transplant. You still need medical maintenance.
DR. ROSSI: And even simple tools like topical minoxidil can work if you are consistent.
DR. WATCHMAKER: They can. People dismiss it because it feels “old” or like an infomercial. But five percent topical minoxidil used daily for six months can be very effective and safe. You just have to be diligent.
DR. ROSSI: Let’s close on sunscreen myths, because they are everywhere.
DR. WATCHMAKER: My favorite patient line is “I do not go outside.” I always ask how they got to the office. You accumulate sun damage in tiny doses every day. Walking to the car, driving, errands. You do not need a beach chair to get UV damage.
DR. ROSSI: Especially in Scottsdale.
DR. WATCHMAKER: Yes. I tell patients I do not even check the weather app. It is sunny. If you invest time and money in resurfacing and then skip sunscreen, you are not protecting that investment. And now we have this myth that sunscreen causes skin cancer.
DR. ROSSI: It has really taken hold.
DR. WATCHMAKER: Sunscreen does not cause skin cancer. It is one of the few things proven to prevent it and to prevent photoaging. I tell people if you do not care about skin cancer, at least do it for vanity. The aging difference between sunscreen users and non users is dramatic. Face versus neck photos tell the story.
DR. ROSSI: I like the habit framing.
DR. WATCHMAKER: Me too. Some colleagues say only wear it when the UV index is high. In real life, most people will not check an index every morning. I prefer “like brushing your teeth.” Keep it by your toothbrush. Put it on every morning. That is how you get consistency.
DR. ROSSI: Thoughts on mineral versus chemical?
DR. WATCHMAKER: I love mineral sunscreens. They are usually less irritating. They can be a bit whitening on deeper skin tones, so sometimes chemical makes more sense. There are great tinted and sheer mineral options now. At the end of the day the best sunscreen is the one you like and will use. Mineral is ideal for many, but any sunscreen is better than none.
DR. ROSSI: That is a good myth to end on. Jacqueline, I am so glad we finally got you here.
DR. WATCHMAKER: I am glad too. This was great.
DR. ROSSI: Thanks for listening to Give Good Face. Please subscribe, leave a review and follow along wherever you listen to your podcasts.