A strange phenomenon is happening among young women. Some of them look older than a Real Housewife, but you'll struggle to find a single wrinkle. Their skin is as smooth as a Madame Tussauds figure, cheeks as plump as Baby George's. Their pout? Hello, Angelina. While the intention was likely sexy, the caricature-like proportions look neither young nor old. Just strange.

To blame: too much dermal filler, a substance injected into the skin to smooth lines and boost volume. While FDA-approved fillers have been available and used predominantly by women over 40 since 1981, they now have a fan club among those who need them least — women in their 20s.

The New Face of Filler

"The people who are coming to see me for filler now can be as young as 19," says Anne Taylor, M.D., a plastic surgeon in Columbus, Ohio. According to stats from the American Society of Plastic Surgeons, filler usage among twentysomethings has spiked by nearly one-third since 2009 to more than 64,000 procedures in 2014. While injections aren't surgery, they can be painful … and pricey. So what's the appeal? Celebrities, according to every doctor interviewed for this article.

"Girls in my office have repeatedly said, 'I want lips like Kylie Jenner's,'" says Norman Rowe, M.D., a New York City plastic surgeon.

"I'd be lying if I said she wasn't the inspiration," says Kara, 28, a Minnesota-based writer who got injections in both lips last year.

Like glossy hair or perfect abs, these hyper-smooth, sexualized features are seen as aspirational. And now, they're increasingly accessible.

When Did Needles Become NBD?

One of the biggest reasons for fillers' popularity: ubiquity.

"There are more FDA-approved fillers on the market than ever," says Sachin Shridharani, M.D., a Manhattan-based plastic surgeon, referring to products like Juvéderm Voluma, Restylane Silk, and Belotero Balance.

"Dentists, ob-gyns, and other medical professionals are offering fillers because they see how lucrative it can be," he says.

"I had my upper lip plumped by a physician's assistant," says Kim, 32. "I work at a pharmacy in Queens, and she did it for a bunch of the girls there."

To Dr. Shridharani, going to anyone other than a board-certified derm or plastic surgeon for injectables is "about as wise as seeing me if you're having a heart attack." Last year, the FDA issued an alert about soft-tissue fillers. If they're improperly injected, potential side effects can be blindness and stroke, among others.

In the right hands, fillers are generally safe and increasingly less of a commitment. Certain older collagen versions required allergy testing (as they were made with animal by-products), and liquid silicone (which has never been FDA-approved for cosmetic purposes) is permanent. But today, most fillers are made with hyaluronic acid, a natural compound that usually dissolves between 6 and 12 months.

"It's the gold standard," says Dr. Shridharani. It has less potential for irritation, and mistakes can be "erased" with injections of a (pricey) enzyme. With its modern user-friendly rep, filler seems more like a throwaway beauty treatment than a risky medical procedure. And it doesn't hurt that many experts position filler like they do Botox: as preventative medicine. While Botox inhibits you from making the expressions that create wrinkles, some fillers are proven to help spur collagen production. Suddenly, a Big Ang–approved beauty regimen sounds almost sensible. No wonder filler has about as much stigma as getting your hair colored.

Too Much of a Good Thing

There's a certain logic to filling the 40-plus crowd. "They've lost collagen and fat over the years, so they're looking for allover fullness in the face, sometimes lips," says Dr. Shridharani.

Here's the trouble: Some docs tend to use the same amount of filler on a young patient as they would on older ones, he says. What may be a bit of filler on a 60-year-old is "like a drop in the ocean," but on a 25-year-old? Chipmunk City.

Too much filler doesn't just make a young person look bizarre, it can also make her look older. When someone's face has zero contour because it's practically inflated and her lips are pumped like bike tires, it looks, well, like work. Historically, "older women are the ones who get these procedures," says Dr. Shridharani, so we're conditioned to think someone with similar features looks middle-aged.

Of course, this OTT aesthetic isn't always an accident. Often enough, it's at the patient's request.

"For some, it's a status symbol," says Dr. Shridharani. "It shows you have your Louis Vuitton bag and your lips — obvious fillers can complete the look of affluence."

And for some patients, it can be a slippery slope. "The mind has an incredible way to recalibrate itself," says Dr. Shridharani. He often sees this with patients who get breast augmentation. After the initial procedure, they're on a high. Once their eyes adjust, the buzz wears off … and they want to go bigger. The same attitude applies to fillers, "which is why they have an addictive nature." Call it fillerexia.

His advice? Ask yourself if you're really upset with your natural face or if you're just chasing a trend. If it's the latter, "keep these procedures in your back pocket for when you've actually lost volume — they're not going anywhere."

This article was originally published as "What's Happening to Women's Faces?" in the February 2016 issue of Cosmopolitan.

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