Overfilled Face Syndrome: A Narrative Review and Proposal for a New Classification Framework

Background: Overfilled Face Syndrome (OFS) is an emerging aesthetic concern resulting from excessive or inappropriate use of dermal fillers. Despite growing recognition of its clinical and psychological consequences, no universally accepted classification or pathophysiological framework currently exists to guide the diagnosis or management of this condition. Methods: This narrative review synthesises current literature on anatomical, procedural and patient-related contributors to OFS. Expert insights, clinical observations and anatomical analysis were incorporated to develop a new classification system based on filler depth, anatomical layer involvement, and etiological mechanisms. The review was structured according to SANRA (Scale for the Assessment of Narrative Review Articles) guidelines to ensure scientific rigour and clarity. Results: A five-type anatomical classification of OFS is proposed to support clinical recognition and staging. Type I represents focal superficial overfill; Type II involves global superficial overfill; Type III denotes deep volumetric overfill; Type IV describes myomodulatory overfill due to interference with mimetic muscles; and Type V includes chronic layered overfill associated with fibrosis and pseudo-ageing. This anatomy-based, aetiology-driven classification is likely to enhance the understanding of filler-induced facial distortions and support more targeted reversal and prevention strategies. Conclusion: A structured classification of OFS can provide a clinically relevant foundation for diagnosis and management. Recognising OFS as a spectrum disorder allows for a personalised, layer-specific and aetiology-informed corrective approach in aesthetic practice.