The Paraffin Pioneer: A 1904 Case of Facial Atrophy and the Birth of Cosmetic Fillers

Medical aesthetics often feels like a fast-paced, future-focused discipline — from regenerative skincare and exosomes to AI-driven diagnostics. But sometimes, it’s worth looking back to where it all began, and we all know that I adore a bit of medical history. Often, I’m surprised at how closely the ethical issues and concerns of yesterday mirror what we are facing today.

Over a century ago, one fascinating case marked the dawn of cosmetic intervention as we know it today — and it involved paraffin wax. This is a material that I have covered before in the Edit, in our of our most popular posts: Botched!

In 1904, Dr. Benjamin T. Burley published a case report in the Boston Medical and Surgical Journal (now known as the New England Journal of Medicine) detailing the use of paraffin injections to restore facial volume in a young woman suffering from bilateral facial atrophy.

This is more than just a curious footnote in the history of injectables — it’s a reminder of the human drive for aesthetic restoration, the early efforts to balance safety with innovation, and the long road we’ve walked from paraffin to the safe use of hyaluronic acid fillers today.

What Is Facial Atrophy?

Facial atrophy — also called progressive hemifacial or bilateral lipoatrophy — is a rare condition that causes gradual loss of subcutaneous fat and soft tissue in the face. The result is a hollowed, gaunt appearance that can dramatically impact the individual’s sense of self.

While hemifacial atrophy is more commonly documented, Dr. Burley’s case stood out because it involved bilateral loss of volume. His patient, referred to as Miss B., presented with striking facial emaciation despite being otherwise healthy, athletic, and robust.

The Case of Miss B: A Victorian-Age Aesthetic Concern

“Her face, instead of regaining its fullness, became progressively thinner and her cheeks more sunken… her family and her physician withdrew her from school, kept her out of doors, and plied her with tonics, cod liver oil, and prepared foods.”

Miss B’s volume loss began following repeated episodes of childhood pneumonia. From the age of 11, her facial tissues began to wither symmetrically. Despite numerous attempts at treatment — including massage, electrotherapy, and various “fattening” protocols — the facial wasting persisted.

What’s striking is that her case was not only clinically notable, but cosmetically extremely distressing. Strangers often assumed she had tuberculosis, a stigmatised and feared diagnosis at the time as it was often a death sentence.

While her body remained strong and unaffected, her appearance became a source of concern — both to her and to those around her.

Enter: Paraffin Wax

In a move that would foreshadow the modern dermal filler era, Dr. Burley proposed subcutaneous paraffin injections to mechanically replace the lost fat. Yes — paraffin wax, derived from petroleum, was injected beneath the skin as a filler.

“At the first sitting 1.5cc of paraffin was injected below each malar process… at the third sitting, 2cc were injected between the buccinator and masseter muscles on each side to replace the fat globus.”

Before treatment.

After nine treatment sessions with paraffin wax.

In total, Miss B underwent nine treatment sessions, with careful shaping and layering of the paraffin to restore facial contour and symmetry. Despite the primitive tools and techniques, the result was considered a success — at least in the short term.

“The result at the end of this time is so satisfactory that no further treatment is likely to be necessary, at least for some months.”

Aesthetic Innovation… But At What Cost?

At the time, paraffin was seen as an inert and safe material. With a melting point just above body temperature, it could be injected in semi-solid form to provide structure and support under the skin.

However, as we now know, paraffin injections come with significant long-term complications, including:

• Migration of material

• Chronic inflammation and paraffinomas

• Granuloma formation

• Tissue necrosis

• Risk of embolism

I’ve explored these consequences in previous posts and in The Aesthetics Edit, where we take a deeper dive into historical and contemporary treatments — and the science that underpins them.

This case is a stark reminder of how cosmetic medicine has evolved — and why biocompatibility, reversibility, and safety profiles are now non-negotiables in filler development.

Lessons from 1904: What This Case Teaches Us Today

While we’ve come a long way since paraffin wax, the story of Miss B holds several enduring lessons for modern aesthetic clinicians:

1. The Desire for Restoration Is Timeless

This was not about vanity — Miss B’s facial atrophy was misinterpreted as illness, social stigma followed, and she sought help to feel more like herself. Cosmetic medicine has always been about more than just looks. It’s about identity, confidence, and control.

2. Innovation Often Precedes Regulation

Dr. Burley’s paraffin technique was thoughtful and meticulously documented — but it preceded any formal safety testing or clinical trials. Today, we are fortunate to practice in a landscape where evidence-based treatments, pharmacovigilance, and peer review safeguard our patients and our practice.

3. Technique Matters — But So Does Material

Paraffin might have seemed inert at first, but its long-term tissue interactions proved problematic. This underlines why product science — from crosslinking technology to degradation profiles — is just as critical as practitioner skill.

Final Thoughts

Miss B’s journey sits at the intersection of medicine, aesthetics, and human psychology. It reflects how deeply our outward appearance can affect our internal world — and how the desire for facial harmony has been part of our medical narrative for well over a century.

Today, with robust safety data, advanced materials, and a deeper understanding of anatomy and skin science, we can offer solutions that honour both the art and science of aesthetic medicine — without the risks of paraffin.

Want to Read the Original 1904 Case Report?

Find it here.

References

BURLEY, B. T. (1904). Bilateral Facial Atrophy, with Report of a Case and Its Treatment by the Subcutaneous Injection of Paraffin. The Boston Medical and Surgical Journal, 150(15), 391–397. doi:10.1056/nejm190404141501501