February 6, 2024

Fillers: The Good, The Bad and The Ugly

  • What are dermal fillers?
  • How do dermal fillers work?
  • Where can dermal fillers be used on the face?
  • Popular types of dermal fillers
  • Common side effects and healing process
  • Serious risks of dermal fillers
  • Minimising risks
  • Avoiding too much fillers
  • What to do with filler gone wrong?
Dermal fillers have become increasingly popular in the world of aesthetic enhancement, offering a non-surgical solution to restore youthfulness and vitality to the skin. 

What are Dermal Fillers?

Dermal fillers are injectable gel-like substances designed to restore volume, smooth wrinkles, and enhance facial contours. Dermal fillers are made of different materials and have different applications. They are injected into the skin to achieve the desired effects.

How Do Dermal Fillers Work?

Dermal fillers work by replenishing lost volume in the skin, addressing fine lines, wrinkles, or sagging. This section explores the science behind dermal fillers and how they interact with the skin's natural processes.

Popular Types of Dermal Fillers

Not all dermal fillers are created equal, as they have different attributes and indications. A wide variety of applications can be achieved with different fillers. When the correct type is chosen and appropriately administered, it can fill lines, add volume, enhance facial features and optimize skin hydration. Here are some common types of dermal fillers along with notable brands:

  1. Hyaluronic Acid (HA) Fillers
    Known for their versatility and natural-looking results, hyaluronic acid fillers are widely used to address various concerns, from smoothing wrinkles to enhancing lips and restoring facial contours. Hyaluronic acid fillers attract and retain moisture, contributing to a rejuvenated and youthful appearance. Some examples of established filler brands include Restylane, Juvederm, Profhilo, Belotero, Teosyal, to name a few.

  2. Poly-L-lactic Acid (PLLA) Fillers
    Ideal for treating deeper facial wrinkles or to restore lost volume of very hollowed or sunken faces, PLLA fillers like Sculptra stimulate collagen growth over time, offering a gradual improvement. They are also known as biostimulators for this reason.

  3. Polycaprolactone (PCL) Fillers
    Another biostimulator is PCL fillers. Known for their long-lasting and natural effects, PCL fillers like PCL Biostimulating Filler stimulate collagen and offer a semi-permanent solution for facial rejuvenation.

  4. Calcium Hydroxyapatite (CaHA) Fillers
    Calcium hydroxylapatite fillers such as Radiesse stimulate collagen production and may achieve longer-lasting results.

It's important to note that the choice of filler depends on factors such as the area being treated, the desired outcome, and individual patient characteristics. Consulting with a qualified and experienced practitioner is crucial to determine the most suitable filler for specific needs and achieve optimal results. 

Where Can Dermal Fillers Be Used on the Face?

Dermal fillers can be used on various areas of the face to address signs of aging, enhance features, and restore volume. 

Common areas for dermal filler applications include:

  • Nasolabial Folds (Smile Lines): Fillers can soften the lines that run from the sides of the nose to the corners of the mouth.
  • Marionette Lines: These lines extend downward from the corners of the mouth and can be filled to reduce the appearance of downturned mouth corners.
  • Cheeks: Dermal fillers can add volume to the mid-face, restoring cheek contours and providing a lifted appearance.
  • Under-Eye Hollows/Tear Troughs: Fillers can address dark circles, hollows, and bags under the eyes, creating a more refreshed look.
  • Lips: Enhancing lip volume, defining the lip border, and reducing fine lines around the mouth are common indications for fillers in the lip area.
  • Chin: Fillers can be used to augment the chin, improving its projection and balancing facial proportions.
  • Jawline: Filling along the jawline can achieve better definition and a more youthful contour.
  • Temples: Adding volume to sunken, gaunt temples can restore a fuller, more youthful appearance to the upper face.
  • Forehead Lines: Fillers can be used to soften horizontal lines and improve hollowing on the forehead, resulting in a smoother, youthful forehead..
  • Nose: Fillers can be used to reshape and contour the nose, like sharpening the nose tip, enhancing the nose bridge for a more refined, projected effect.

Similar to any cosmetic procedure, dermal fillers come with potential side effects and complications. Understanding the factors influencing outcomes, recognizing normal healing processes, and being aware of potential risks are crucial aspects of a successful aesthetic journey.

Common Side Effects and Healing Process

It is normal to have mild bruising, swelling, lumps and bumps after a filler injection procedure. These symptoms should resolve within a week.

With care and experience, the doctor will significantly lower the chances of bruising, pain and swelling. After the injection, post-care instructions include not wearing makeup for 24 hours, drinking alcohol or coffee to reduce the swelling and redness. 

Serious Risks of Dermal Fillers

  1. Infection
    There is a higher risk of infection if the procedure was not performed properly under strict aseptic techniques or was not carried out in a clean environment. Be sure to choose a clinic or doctor who has a strong track record in performing such procedures to minimise the risk of an infection.

  2. Filler placement problems
    If the filler was injected at the wrong depth or the wrong product was used, it can cause suboptimal outcomes, such as an unnatural appearance, uneven results that appear like lumps and bumps, etc. An experienced doctor with the proper training in anatomical knowledge and filler placement will significantly avoid such issues. 

  3. Blocked blood vessels
    There are a lot of blood vessels under your skin. If the dermal filler is inadvertently injected into the blood vessel, it can lead to skin tissue damage, vision loss and even a stroke. 

A practitioner with experience and knowledge of facial anatomy and proper injection techniques will be able to greatly reduce such risks. 

Minimising Risks

Going to a medically trained and experienced doctor is the first step to a safe and beautiful outcome.. Medical doctors receive intensive training in facial anatomy and injection techniques so they can ensure that your procedure is done safely. They are also equipped with modern tools such as canulas, cooling devices and anaesthetic numbing creams for a very comfortable and smooth procedure.  

In addition, medical practitioners follow a set of strict professional standards and a code of ethics. This means that they are committed to act in the best interest of clients. Cosmetic treatments are complex and should be catered to each individual's needs and aesthetic goals. There is no one size fits all approach to beautification and rejuvenation.

Avoiding Too Much Filler

Make sure you always discuss in advance with your practitioner what you are looking to achieve. An experienced doctor with a keen aesthetic eye and understanding of beauty and proportions will customize treatment plans based on your look, your goals and achieve them without making you feel like you've had "too much work done".

Some injectors have "a look" that they give to all patients. There is a danger of “over-filling” in the name of eradicating all wrinkles and sagging. Examples are when the cheeks that are too full, or lips that are way too plump or even creating eye bags from injecting too much fillers. This is not a good result to achieve as it is very obvious and may even look strange to observers. In our opinion, a subtle change with natural-looking results is the most ideal. More fillers doesn't always equate to better results. 

An Initial Consultation is a Must

An experienced practitioner will always offer a consultation before the treatment. The consultation allows the doctor to assess and examine your condition, understand your concerns and goals, and then discuss the look you want to achieve. 

One way to choose your doctor is to read the doctor’s website or CV. Even better is to arrange a consultation and have a good conversation with him or her. Be sure to raise any concerns and clarify andy doubts you may have. Below are some questions that you can start with:

  1. What is your level of experience and qualification?
  2. What brands of fillers you are using?
  3. How often do you perform the procedure? How do you handle the side effects?
  4. Can I see some filler before and after photos?

What to Do with Filler Gone Wrong?

If you have had your filler procedure and are unhappy with your results, we would advise notifying your original practitioner. They would be in the best position to handle the issue, failing which, you should ask to be referred to another doctor for a second opinion. 

If that is not possible, seek help from a reputable clinic with experienced doctors. In many cases, a small amount of product can be added to smooth the unevenness, restore proportions, and resolve your dermal filler concerns. As a last resort, fillers can be reversed by using products such as Hyalase to break down the hyaluronic acid. 

When to Seek Medical Attention

If you develop any of the following symptoms, immediately seek medical attention:

  • unusual and increasing pain after the procedure
  • changes in vision
  • white (blanching) or increasing redness of the treated area
  • signs of stroke (sudden difficulty speaking, numbness or weakness in face and body areas, face drooping, severe headaches, dizziness, or confusion) shortly after the procedure.

At Freia Medical, our aim is to provide a safe, reliable and optimised treatment for every skin concern. To find out more, schedule a consultation with our experienced doctors today.

Medically reviewed by Dr. Joanna Chan and Dr. Harold Ma

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