I tend to not use the Far Realm at all, and just assume that all monsters are actually more monstrous in nature than D&D often presents them. D&D suffers, I think, from having monsters be nearly routine (especially in a dungeoncrawling environment) which, of course, makes them not really very monstrous at all. The focus on regular human villains at more levels, of course, means that I can make monsters more rare, and therefore really play them up as monsters.
This made me think about the non-human monsters that have appeared in my 4e campaign so far (5 years and 25 levels of play):
* 4 beholders (1 of them undead)
* 2 hydras
* salamanders and other fire elementals (with one of the hydras, and also summoned by a mad wizard to destroy his hometown)
* 4 dragons (1 undead)
* 2 purple worms (1 of them undead)
* a carrion crawler and 2 gelationous cubes in an ancient ruin (the closest I think my game has ever come to a Conan-esque feel)
* stirges (although ostensibly they're animals)
* 2 T-Rexes and a triceratops (ostensibly also animals)
* plenty of giant spiders of various forms (more ostensible animals)
* lots and lots of undead - in tombs, under the control of evil shamans, in the Shadowdark, in temples to Orcus, anywhere really!
* lots of demons too - generally in ancient temples or summoned by mad wizards - and some devils running fiendish errands, and also angels and starspawn
* some puck-ish types (gnomes and dark creepers)
* some genuine witches (hags from the Feywild) and lots of evil priests, cult leaders etc
* tieflings, drow, duergar and kuo-toa (which play out, ultimately, as corrupted humans)
* lots of goblins, hobgoblins, bugbears, gnolls, dwarves and dragonborn (which play out as variant humans, like Star Trek aliens)
Putting together that list (from memory, so it probably has gaps) makes me suspect that I use more monsters than you! But I wouldn't say they're
routine - or rather, they're routine in play, but I think not routinized in the fiction. Within the fiction the PCs are repeatedly at the edge of magical/cosmological crisis - freeing the kidnapped homesteaders from the haunted forest, stopping the rededication of an ancient demonic temple, stopping the cultists seizing control of the town, defeating the devil that is leading the invading hordes from his dark temple, defeating the vampire exarch of Orcus that destroyed the drow outpost, etc.
I don't know if that makes sense. I would imagine it's not that unusual as a way of running D&D or similar fantasy RPGs. But I do see it as a bit different from the "mega-dungeon right here beneath us in Waterdeep" approach.