How often should dermal filler treatments be done?
What if I overfill?
Best doctor for dermal filler treatments
Dermal fillers in Singapore have become a popular treatment amongst both men and women.
It is no longer a taboo subject for people to get filler treatments done to combat the effects of ageing or to contour their face.
With that said, here are some of the common questions that we get:
What kinds of dermal fillers are there, and which are the best treatments?
The skill of the doctor is most important. Not the product.
Never approach an unqualified person to inject your filler. You don’t want to risk an infection. Your dermal filler treatment should be done by an experienced doctor and in a clean, sterile environment.
A good filler result should be imperceptible. Your friends and family should only notice the beautiful features you have, brighter eyes, and the confidence in your face.
What are dermal fillers?
Dermal fillers are medical products that can help to restore skin and facial contours to their former youthful appearance, and sculpt the face for better definition.
There are different kinds of dermal fillers and they are made of various kinds of ingredients that have been developed for injection into the skin. Some examples of dermal fillers in Singapore include:
What do dermal fillers do and what are their benefits?
Dermal fillers can be used to treat age-related skin sagginess and wrinkles that occur due to skin laxity and the loss of facial volume.
As we age, we start to lose facial volume because of bone resorption or decrease in our bone mass, which makes our skull smaller. 
Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg, 2007: 119: 675–681.
Therefore, the scaffolding for skin reduces in mass. With nothing to hold up our skin, our skin will hang down, and that’s how we will see saggy skin on the exterior.
Skin sagging will also worsen because of:
Exposure to ultraviolet (UV) rays
Loss of skin moisture
Reduced collagen and elastin production as we age
Our skin loses elasticity and becomes less supple as we age. When that happens, we will have saggy and lax skin, creating a tired and aged appearance.
Dermal fillers restore volume to our face. I typically treat the following areas to reverse age-related changes:
Smile lines or nasolabial folds
Dermal fillers can also sculpt your face to give more definition and improve our appearance.
It is possible to sculpt and enhance our facial features with 3D projection. Using a combination of filler techniques for nose, chin, cheeks, and other parts of the face is a very effective way to create the sculpted v-shape look.
Besides that, we can also combine dermal fillers with other treatments like Botox and Ultherapy for greater effect.
Areas that can be sculpted or enhanced with dermal fillers include:
Marionette lines (the lines that run down from the outer corner of the lips to the outer corners of the chin)
What are the different types of dermal fillers?
Dermal fillers can be grouped into two types :
hyaluronic acid (HA) fillers
non-HA or collagen-stimulating fillers
For those who are worried about the pain factor during fillers treatment, fret not. Most facial fillers (e.g. Juvederm) contain lidocaine, an anaesthetic, which will numb the treatment area to make the experience a comfortable one for patients.
I prefer to use these fillers over those that do not contain lidocaine or mix lidocaine with the filler before treatment.
Another important point to note, dermal fillers used for treatments in Singapore have to be approved by the Health Sciences Authority (HSA). Do not proceed with any filler treatment should you think that the fillers are from a dubious source.
HA Dermal fillers
HA as an ingredient is safe for most people, and HA fillers are most commonly used in my clinic.
Why do I choose HA fillers over the others? That’s because HA is a natural compound found in our skin, and is responsible for many functions in our body like hydration and lubrication of joints.
Besides that, HA also stimulates the production of the connective tissue that plumps our skin (i.e. collagen) and aids tissue repair.
The different brands of HA fillers include:
Each dermal filler brand contains a line of different dermal fillers. They are differentiated based on the firmness and viscosity (thickness and stickiness) of the gel.
Your doctor will advise you on the type of filler to use, and whether you need a firmer or softer dermal filler will depend on the area that requires treatment, the condition of your skin, and the desired result. For example, if you have looser skin, your doctor may give you a softer filler for a more natural look.
Examples of softer dermal fillers include:
On the other hand, a firmer filler that is higher in viscosity will provide a good underlying foundation that will help to fill up volume loss and support sagging skin. If you are looking to sculpt or enhance your facial features like your nose or cheekbones, a firmer filler will also give you an optimal effect.
Example of firmer dermal fillers include:
Halley Medical Aesthetics has a wide range of hyaluronic acid (HA) fillers to treat various skin concerns.
How do doctors determine what the prices for HA dermal fillers are in Singapore?
The table below lists a range of HA dermal fillers available in the market and its recommended usage by pharmaceutical companies.
Doctors, however, may vary the area of usage or even combine filler brands/lines depending on the patient’s requirements and desired outcome. This in turn affects the cost.
How do doctors determine what the prices for non-HA dermal fillers are in Singapore?
Non-HA / Collagen-stimulating dermal fillers
Non-HA, or collagen-stimulating dermal fillers use ingredients that stimulate our body’s collagen for long-lasting effects. They are also commonly known as bio-stimulating fillers.
These fillers contain safe and synthetically produced compound. When they are injected into the skin, the fillers volumise the treated area and stimulates the body’s fibroblasts to produce collagen, resulting in a natural-looking and long-lasting volumisation.
Such dermal fillers include:
Algeness is another type of non-HA filler. It is a filler brand that uses natural and biodegradable compounds made from purified agarose gel.
Algeness is biocompatible with your body and is non-allergenic. Therefore, patients who prefer fillers made with natural ingredients will find it appealing.
There are different types of non-HA/collagen-stimulating dermal fillers:
The table below lists the range of non-HA/collagen-stimulating dermal fillers available in the market and its recommended usage by pharmaceutical companies.
Doctors, however, may vary the area of usage or even combine filler brands/lines depending on the patient’s requirements and desired outcome.
Why do clinics charge different prices for dermal fillers in Singapore?
Call up a few different aesthetic clinics in Singapore and you would realise that different clinics price their dermal filler treatments differently.
Some clinics would price their dermal filler treatment on a price per syringe basis, other clinics prefer to price it on a per-area basis (e.g. nose, chin).
As a consumer, you have to be sure that the aesthetic clinic is transparent with all the costs involved with the treatment. You don’t want to be caught by surprise when you see all the hidden costs charged to your credit card later on.
When clinics price their dermal filler treatment on a per syringe basis, it will allow the clinic to be clear and upfront with the patient on how many syringes are required for treating the patient’s area of concern during the consultation.
Besides, paying for the treatment on a price per syringe would minimise the chance of underfilling.
However, if you are concerned about overfilling (and therefore, overpaying), you must let your doctor know your concern, and discuss it with your doctor before going ahead with the treatment.
If you are more comfortable with clinics that price the dermal filler treatment on a per-area basis, do speak to your doctor and clarify if the amount given is enough to fill the area of your concern.
Halley Medical Aesthetics also has a range of non-HA, collagen-stimulating dermal fillers for patients who may prefer more natural and long-lasting results.
What dosage is needed for different parts of the face?
I get this question a lot, and I totally understand why. People are firstly concerned about the cost, and at the same time, people do not want to overfill and end up looking unnatural.
All my patients want a natural-looking result, and to look fresher and better without people asking them if they had done “something to your face”. But at the same time, patients also want the treatment to address their skin concerns.
We need to communicate to our patients that while we can estimate the amount of filler needed, different people have different expectations.
Different people also have different volume requirements for dermal fillers. In general, one syringe of dermal filler is enough to treat one area on both sides.
Depending on patients’ requirements, if their face needs more volumising or they desire a more dramatic lift, more dermal fillers may be needed. But the good thing about fillers is that we can see its effect immediately during the treatment, so we can add more and do the necessary adjustments, or stop at any time.
Every patient is unique, and again, depending on the patients’ needs, sometimes, we may need to combine a dermal filler treatment with another face lifting treatment like Ultherapy to achieve optimal results.
Which is the best dermal filler for me?
How do we decide on which fillers to use then? HA fillers or collagen-stimulating fillers? Those who want fast results and precise volumisation would opt for the HA filler, which will fill up the area by itself.
But for those who don’t mind waiting a little for the collagen to be stimulated and like the idea of having the body generate collagen for volumisation, or natural-looking volumisation, then they should go for collagen-stimulating fillers.
Collagen-stimulating filler is natural, gives long-lasting volumisation, and it is great for people who like the concept of having the body generate collagen naturally for volumisation.
However, both are natural in that hyaluronic acid is found in the skin while bio-stimulating fillers generate collagen to volumise.
That’s why different patients will require different fillers, and that will largely depend on the area that it will be injected in and the preference of the patient.
In my opinion, the technique that is being used to apply the filler is more important than the type of filler used.
Instead of using needles to apply dermal fillers, more and more doctors are now using cannulas. A micro-cannula is a blunt flexible wire that doctors insert and slide under the skin to apply the filler.
There are many benefits when you choose micro-cannulas over needles for filler application. Firstly, it has fewer possible side effects since there is only one injection point rather than the multiple injection points when using a needle.
The advantages of using a cannula:
It gives a natural and more even fill
It lowers the chance of complications including bruising
Bleeding is minimised
What are the risks and side effects for dermal fillers?
Occasionally reactions can occur. Common side effects include :
Slight bleeding at the injection sites
These reactions are temporary and typically resolve within a week.
If patients experience bruising after a filler treatment, they should avoid aspirin, non-steroidal anti-inflammatory medications (i.e. painkillers), and alcohol consumption, since all these increases the chance of bruising.
Some may also experience mild swelling up to one week after treatment.
HA fillers work by absorbing water into themselves to create the volumising and smoothing effect. The whole process takes about one week to stabilise.
Patients may want to apply firm pressure or an ice pack to reduce the swelling, but generally, no treatment is required for this.
If patients experience any discomfort, they can take Paracetamol (Panadol). Although allergic reactions and vascular complications are very rare, we still adopt all safety precautions for all treatments.
Is there any downtime for dermal filler treatment?
For most patients, there is no downtime. You may return to most of your normal activities and go about your daily tasks shortly after treatment.
But one thing to note: Try not to apply pressure or massage the treated area within 24 hours of treatment.
To let the filler settle down and integrate into the tissue after treatment, patients should also avoid strenuous exercise within 24 hours of treatment. Risk of bruising will increase with vigorous massage of the treated area. However, gentle face washing is fine, and it is also ok to put on makeup over the treated area.
What can I expect during a dermal filler treatment?
The clinic therapist will first cleanse the face and numb the treatment area with a numbing cream. The numbing cream will be left on for about 15 minutes so that the treatment process will be comfortable for the patient.
Once the time is up, the therapist cleans off the numbing cream. The doctor will then clean the area to be treated with an alcohol wipe before inserting the micro-cannula.
The doctor will then insert the filler to the required area.
After that, the doctor will mould the filler and apply a firm pressure on the injection site to minimise swelling and bruising.
The clinic therapist will then apply some antiseptic to the injection point.
Treatment time may take 30 minutes to an hour, depending on the number of areas treated.
How should I prepare for the procedure?
It is recommended that you avoid taking blood-thinning over-the-counter (OTC) medications one week before your filler treatment. This includes products like Ibuprofen and Aspirin, which also increase the risk of bruising.
Avoid consuming alcohol 24 hours before your treatment because it may cause the blood vessels to dilate and cause bruising.
Am I suitable for dermal fillers?
Both males and females who are seeing facial volume loss and sagging of facial skin are suitable for the treatment.
Contrary to popular belief that fillers are meant for the older crowd, you don’t have to be 40 or even 50 to have dermal fillers to reverse the signs of ageing.
Those in the 20s and 30s commonly request for filler for facial contouring. i.e.to enhance their facial features like their nose bridge or the chin to give the face a nice projection.
Dermal fillers can be combined with other skin rejuvenation treatments like Ultherapy, botulinum neuromodulators (e.g. Botox), and lasers for a better and more natural result.
I would recommend filler treatments to those who want to look more rejuvenated and less tired-looking, and also to those who want to enhance their facial features to look more beautiful.
How often should I have dermal filler treatments done?
This will depend on the type of filler used and the treatment area, although most fillers last between one to two years. That said, some fillers, like the collagen-stimulating fillers are longer-lasting. They can last more than two years.
Most patients will come back for another filler treatment when they think that they need more volumising, or when they feel that they need more enhancements. It depends on the individual and it can range from one year to several years.
How do I know I have too much dermal fillers in my face?
It is unwise to inject too much filler. Too much of even a good thing is never good. My personal philosophy is that aesthetic doctors should inject just enough filler to make people look great. But if people are saying, “What did she do to her face?” That’s when you know you have too much filler injected in your face.
Most importantly, aesthetic treatments should help you to look good, yet natural. It should enhance your looks without a layperson realising that you’ve got an aesthetic treatment done to your face.
Terms like pillow face, “avatar” nose , duck lips, witch’s chin, “Luo Han” forehead have been trending for the past decade, and they all refer to overfilling.
To avoid situations like those mentioned above, I would go slow and reassess often during the treatment. This is especially important when we have a patient who may not be objective and requests for increasingly large amounts of filler over time. It is the doctor’s job to advise the patient accordingly.
Although we see a lot of scary pictures from overfilling on the internet, overfilling is less common than we think. Just keep in mind that bad news travel much faster and get noticed much more than good news. Always remember to find a doctor who is responsible, and more often than not, it would be fine!
How long do I have to wait for the next filler or other facial treatments?
I would advise waiting for at least two weeks before getting a facial. It takes a while for dermal fillers to “settle in”.
And in case you want to do a top-up because you think that the filler result isn’t dramatic enough, wait for a week before going back to the doctor because you need to let the first round of filler settle down first to have a better gauge.
One week will give the filler enough time to fully bind with your skin tissue. It will allow your doctor to better assess the result, advise, and plan for the next course of action.
What happens if I do not like the outcome after dermal filler treatment?
This circumstance is uncommon if an appropriate filler treatment was performed.
Many a time, this boils down to expectation. While doctors have a good idea of what treatment is appropriate for the patient, the patient may have very different ideas of what treatment is best for himself or herself.
As doctors, we should respect our medical acumen but we should also respect the wishes of the patient. We should align the patient’s concerns with what we can and should do medically as much as possible.
It is also very common for patients to bring celebrity photos and tell me that this is how they want to look like.As much as we should strive to meet the patient’s expectations, it is also important to let the patient know if it is not a good idea.
It is the doctor’s responsibility to advise the patient and let you know if the result can be achieved with dermal fillers. The doctor should also inform you on what you should expect from the treatment.
Making an informed choice is important. If you are agreeable and comfortable with the doctor and the treatment prescribed, then I think you don’t have to worry too much about filler correction.
However, rarely, if things do not go as planned, there are measures that a doctor can take to address the issue.
Fillers can be dissolved and broken down should you not like the results of the filler treatment. With hyaluronic acid fillers, doctors will use hyaluronidase to dissolve the filler. Hyaluronidase is a class of enzymes found naturally in the body that breaks down hyaluronic acid.
It takes a few hours for the hyaluronic acid to break down. Dissolving the filler will allow the doctor to reverse the result. However, do remember that hyaluronidase does not work on collagen-stimulating fillers.
How can I find the best doctor in Singapore for dermal fillers?
Do your research, ask around. Approach an experienced doctor whom you are comfortable with.
During the consultation, tell the doctor all your concerns, what is it that you hope to achieve, and ask them all the questions you have. A good aesthetic doctor will be open and objective when they are answering your questions, and be frank with you on what is aesthetically pleasing, to create a harmony on your facial features.
You should decide if you are agreeable and comfortable with the doctor and the treatment prescribed before deciding on whether that’s the doctor for you.
Out of all the three points that I have written in my introduction, I want to emphasise that a good filler result should be natural and fresh looking.
No one should be commenting on the thick lips you have, the plump apple cheeks, or the filled-up hollow under your eye. They should be commenting about the glow on your fresh-looking face, the confidence in your eyes, the spring in your step, after you have stepped out of your doctor’s office.
Dr Terence Tan obtained his Bachelor of Medicine and Bachelor of Surgery as well as his Master of Medicine (Surgery) from the National University of Singapore. In 2003, he became a member of the Royal College of Surgeons (Edinburgh). He furthered his training with medical aesthetic specialists. Happily married, he is a father to two boys. When not in his scrubs, he loves cooking for the family and planning their next holiday.References:
Shaw RB Jr, Kahn DM. Aging of the midface bony elements: a three-dimensional computed tomographic study. Plast Reconstr Surg, 2007: 119: 675–681.
Office of the Commissioner. Filling in Wrinkles Safely. U.S. Food and Drug Administration. https://www.fda.gov/consumers/consumer-updates/filling-wrinkles-safely. Published 2019. Accessed June 2, 2020.
Liu K. Dermal fillers: The good, the bad, and the dangerous – Harvard Health Blog. Harvard Health Blog. https://www.health.harvard.edu/blog/dermal-fillers-the-good-the-bad-and-the-dangerous-2019071517234. Published July 15, 2019. Accessed June 2, 2020.
Injectable Fillers Guide. ABCS. https://www.americanboardcosmeticsurgery.org/procedure-learning-center/non-surgical/injectable-fillers-guide/. Published July 11, 2014. Accessed June 2, 2020.
Johl SS, Burgett RA. Dermal filler agents: a practical review. Current Opinion in Ophthalmology. 2006;17(5):471-479. doi:10.1097/01.icu.0000243021.20499.4b