Full cheeks, flawless skin, plump lips: Some people get them naturally, while some have some support with fillers from their aesthetic doctor.
It has become just as normal and quick to get fillers as heading to a GP appointment. People of all ages treat their faces, lips, and other areas of the body with treatments and fillers — whether because of ageing or merely to achieve better looks.
Kylie Jenner? The Kardashians? Katy Perry? Gweneth Paltrow? These people have been frank about their filler experiences.
If you are wondering about fillers, here are the things you should learn before you get pumped up!
What are fillers?
Fillers, also referred to as dermal fillers or soft tissue fillers, are chemicals which are meant to be inserted under the skin surface to provide volume and fullness.
The FDA has approved dermal fillers made of absorbable or temporary material for the treatment of mild to extreme facial wrinkles and skin folds, such as smile lines, which are the wrinkles at the sides of the mouth that stretch into the nose sometimes referred to as "smile lines." .
What do fillers do?
The main three things of what fillers do:
If you want a more defined chin, jawline, or nose, then you want some sculpting done. It changes or rather improves, your original anatomy.
Fillers are essentially put in certain points on your face to help lift saggy skin to give a more rejuvenated appearance.
If you have a loss of volume at your temple, cheeks, mid cheeks or even lower cheeks due to weight loss for instance, fillers can help volumize and make you appear better
What areas can fillers treat?
You can look tired with these lines, even when you are not. A lack of volume in the field, a lack of tissue elasticity, or a small decrease of bone density may all be causes of tear troughs.
Smile lines (nasolabial folds)
They are deep lines going down the sides of the nose . When you're troubled by your smile lines and are wondering what to do to enhance the area then fillers are ideal to fill these folds. Your face will be much younger looking with cheek fillers.
The corners of your mouth can drop, often making you look, and sometimes feel, unhappy. A small volume of filler may be inserted into the corners of the lips under the corners of the mouth to counteract this.
These are deep, thick wrinkles on the face, located under the smile lines, beginning from the corners of the mouth and extending downwards as far as the outer corners of the chin or the jawline. When we grow, our facial bones get thinner resulting in the development of lines like these. Filler fills in these lines and makes them less prominent.
When you age, you lose some subcutaneous fat which can result in volume loss and face elasticity. This, in turn, leads to hollow cheekbones and excess skin, resulting in sunken cheeks. You may look gaunt and exhausted. Fillers should be injected, with a soft lift, to plump the face out.
This filler is a celebrity's favourite and perhaps the most well-known use of filler. The lips can be injected with dermal filler to improve fullness, or at the lip’s borders to enhance depth. This treatment is best used to fix thin lips but can also help overcome issues with a downward smile and give you a longer mouth.
A great alternative to a chin implant surgery is a non-surgical chin augmentation that is accomplished with fillers. Fillers will help clarify your jawline and is a temporary treatment, which is perfect if you feel uncertain about permanent modifications.
They are vertical lines over the lip when you pout. These are often caused by frequent movement of the lips but are also called smoker’s lines since daily smoking involves pushing together the lips. If the lines are deep enough, then even a small dose of injectable filler will be needed to create a smoother appearance.
Fillers can now be used to straighten out any lumps or bumps around the nose without any surgical downtime required. Fillers are injected into the nose to smooth out small bumps in the nose bridge, or rectify a crooked nose line (particularly in profile view) and even nose tip cartilage defects in less than 15 minutes!
Besides the face and neck, hands are the most visible part of the body  . Cosmetic patients note that their ageing hands have a contrasting look with their rejuvenated face  and demand for rejuvenation treatments are increasing .
Ageing hands will lose thickness and the skin will look thinner. Inserting a filler into the skin at the back of the hands will make it look plumper and less veiny.
What are the different types of fillers?
Hyaluronic acid (HA) fillers
Over the past few years, hyaluronic acid fillers have become common soft-tissue filler augmentation agents . Hyaluronic acid is a natural material that already exists in your skin. This helps keep the skin hydrated and plump.
Typically, HA fillers are soft and gel-like. Most HA fillers are treated with lidocaine to reduce pain during and after treatment.
The various HA fillers brands, including:
Calcium hydroxylapatite is commonly present in human bones and is a substance similar to minerals. It is produced in a biosynthetic way, meaning no animals or animal products are used. This reduces the chance of an allergic reaction, and no skin tests are required.
This form of filler is considered to deliver a very natural outcome, it doesn't migrate, meaning it doesn’t spread throughout the body, and side effects are rare. This dermal filler was first used in dental and reconstructive surgery and has a long record of success. Radiesse is an example of a Calcium Hydroxylapatite brand.
Polyalkylimide is a semi-permanent filler. It has relatively little reaction with human tissue, which means it is biocompatible and does not trigger allergies. Polyalkylimide is radio transparent, so it does not interact with x-rays.
A thin layer of collagen gradually forms around and fully surrounds the area after the injection throughout the month. Your doctor might inject a large volume in a single procedure. This material can also be removed if necessary and is considered to be very stable over time. Aquamid is an example of a Polyalkylimide brand.
Polylactic acid is a synthetic filler that is injected into your skin and causes collagen production in your own body. This type of filler is referred to as a stimulant. This non-toxic, biodegradable material has been used as a suture material for more than 40 years.
Unlike other dermal, this material doesn't achieve instant effects. Instead, it induces the development of collagen in your own body, so that improvements slowly appear over a period of a few months.
You will typically require about three monthly treatments to produce the optimal effects. There is re-stimulation of your collagen with every treatment. The full impact will take 4 to 6 weeks to see. Because this type of filler is semi-permanent, occasional touch-ups might also be needed. Sculptra is an example of a Polylactic acid brand.
Polymethyl-methacrylate microspheres (PMMA)
PMMA is considered a semi-permanent filler. An alternative to collagen replacement therapy or hyaluronic therapy, PMMA is mostly used where a more permanent solution to facial wrinkles is required.
PMMA has been in use in permanent surgical implants for many years. As a result, the surgeon is likely to under-fill on the first treatment, adding more later if necessary. Bellafill is an example of a PMMA brand.
What is the difference between botox and fillers?
Botox is a drug from a toxin produced by the Clostridium botulinum bacterium . It actually blocks the acetylcholine and it paralyses muscle. This paralysis relaxes the muscles and thereby reduces the appearance of wrinkles. If it is injected in the Masseter muscle (located in the cheek area), which is the chewing muscle, it will reduce the size of your chewing muscle and give you a slimmer face.
One of the tricks we do with botox is called a Macro Botox, which is also a dermal lift. It is injected more superficially and it can actually help with face lifting, sort of like a mini facelift with toxins. Depending on the problem being treated, the effect may last 3-6 months .
Fillers, on the other hand, are made of hyaluronic acid. When injected into tissue, it will attract moisture or water molecules to itself, giving an immediate filling effect. And also you can choose to have temporary and semi-permanent fillers.
What is the price range of fillers?
Type of Fillers
Hyaluronic acid (HA)
$500 - $1,000
$800 - $1,700
$650 - $750
$1,000 - $4,00
Polymethyl-methacrylate microspheres (PMMA)
$1,000 - $1,500
Why such a huge range? The major factor is the brand. Some brands are more expensive than the others and also depending on the clinic, on the doctor experience and to some extent, location. So those are some of the factors that affect the price of the fillers.
Who should I see if I want fillers?
There are a few specialities in general that do filler treatment but fillers are predominantly done by aesthetic doctors. Other specialities include dermatologists but they are usually focused mainly on skin conditions and energy-based devices like Lasers. Another speciality that uses fillers are plastic surgeons. However, they have a greater interest in permanent implants and more major reconstruction. Most fillers are usually still done by aesthetic doctors.
What can one expect from the first session? Maybe you can share with us the patient journey starting from a consultation?
- I will engage with your expectations and learn what you want out of this treatment.
- Then we will determine the treatment
- I will design and decide where to place the fillers by drawing on your face and plan ahead on where and how much filler to put in
- I will clean the area with chlorhexidine and then put on sterile gloves
- I will then insert the filler to the first area and pause.
- Next, I will show you if you like the results in one area. If you are satisfied, I will duplicate it on the other side, if not I will start adjusting how much filler is required.
- After I complete the procedure, I usually take a photo as a record.
- I will keep you in my clinic for around 10 to 15 minutes to make sure that everything is alright and that there are no complications.
- Then, I will give you post-treatment advice, what to expect, what can potentially happen and a contact number in the event they experience anything unusual.
- Lastly, I will follow up again after one month.
What are the risks and side effects? Is there any downtime?
Reactions can occur occasionally. Typical side effects include:
- Slight bleeding at the injection areas.
These responses are temporary and are usually resolved within one week.
How long do the results last?
Hyaluronic acid fillers are a temporary option and usually last 6 to 18 months. Lip injections wear out a bit faster than those on the smile lines. They are suitable for patients who are new to aesthetic treatments.
Synthetic fillers tend to last longer since the body doesn't absorb them. They may be a perfect choice for the right patient, but you will want to be sure about the expected outcome and pick an accomplished, professional aesthetic doctor whose aesthetic style you prefer.
What should I do to prepare for the procedure?
It's advised that you stop taking over-the-counter (OTC) blood-thinning drugs a week before the filler treatment. This includes products such as Ibuprofen and Aspirin which also increase bruising risk.
Stop alcohol intake 24 hours before the procedure because it can cause blood vessels to dilate and cause bruises.
Am I suitable for fillers?
The procedure is appropriate for both males and females who suffer facial volume loss and skin sagging. To reverse the symptoms of ageing you don't have to be 40 or even 50 to get fillers. Many in their 20s and 30s usually get fillers to improve the bridge of the nose or chin, resulting in a good profile projection.
Is the procedure done on the consultation day or do I have to return on an alternative day?
We schedule enough time for patients, new or not, who are willing to undergo treatment on the same day. We can also give you time to return on another day if you need time to think about undergoing the procedure.
How often should I have the treatment done?
Most of the filler's longevity depends on the type of filler used and the area of the procedure. Some patients want to revisit the procedure because they consider they like additional volumes or enhancements. This can range from a year to several years.
What happens if I do not like the outcome?
Your doctor can take steps to fix problems when things don’t go as expected. Doctors will use hyaluronidase to dissolve the filler.
Hyaluronidase is a class of enzymes that break down hyaluronic acid naturally found in the body. It takes a few hours for the hyaluronic acid to break down, enabling the doctor to reverse the procedure.
How do I find the best doctor for fillers?
Do your research and find an experienced doctor with whom you feel comfortable with. Tell him or her what you plan to do and raise questions during the appointment about the products and the procedures.
When discussing all the questions, a good aesthetic doctor should be frank about what is aesthetically pleasing, open, and honest. If you are comfortable and happy with the doctor and the recommended treatment, then you can proceed with confidence.
Are you ready to get pumped up? You have learned about both temporary and more permanent fillers. Getting this treatment is as easy as making an appointment, so feel free to reach out to me for a quote.
Dr Vincent Tan is fully accredited by the Singapore Medical Council’s Aesthetic Practices Oversight Committee (APOC) to perform a variety of aesthetic procedures such as Botulinum Toxin injections. He has an interest in injectables and practices evidence-based aesthetic treatment.