Lunchtime rejuvenation procedures are fast gaining popularity amongst Singaporean in recent years. These procedures are dubbed as "lunchtime procedures" because they take very little time to perform and do not have any recovery period.
Most of the times, you'll be able to see improvements in just a short period of time and return to your daily routine immediately.
I often get patients asking me if a filler lift or a thread lift is better. In my opinion, both are good and effective if done properly and for the correct indications. In some cases, one or the other may be more preferable.
Therefore, I’ve decided to write this article to help those of you who are keen on getting fillers or thread lifts to improve the signs of ageing.
In this post, I will explain in detail the differences and how to choose the most suitable one for yourself.
First up, what are dermal fillers?
Dermal fillers are also known as soft tissues fillers. They are smooth injectable gels used to fill facial depressions, skin folds, and volume loss. 
We've progressed a lot since these fillers were introduced more than 20 years ago. In the beginning, it was just an injectable procedure to correct wrinkles and folds.
Currently, we're able to use it for cheek, nose, and chin augmentation. We're also able to contour and enhance the face shape to produce a facelift-like effect.
The most commonly used type of fillers worldwide as well as in my clinic are the hyaluronic acid fillers. They are classified as temporary fillers.
Semi-permanent as well permanent fillers are not as popular. Reason being, there's a higher potential that complications might occur. Furthermore, these permanent fillers are not reversible once injected.
How do dermal fillers help to lift your face?
To answer this question, you have to first understand the ageing process of our face. I usually explain it in this way to my patients.
We lose three main things on our face when we age:
1. Loss of skin elasticity and hydro balance. This contributes to wrinkles, the appearance of deepening nasolabial folds, marionette lines, open pores, and uneven and dry skin texture.
2. Loss of facial volume. This is due to fat loss and migration downwards of certain facial fat pads causes sunken undereye, cheeks, temples, and jowling.
3. Loss of laxity of retaining ligaments. This causes sagging of lateral corner of the eye, flattening of the cheeks, drooping of the midface, deepening of the nasolabial folds and drooping of the corner of the mouth, and jowling.
Different filler gels have different viscoelastic and integration properties. When they are injected at the right places of the face, they give you a lifting effect which makes one looks younger. 
What are the most common fillers used in Singapore?
In Singapore, the most common fillers used in terms of brands are
- Restylane, Belotero, Teosyal, Juvederm (Hyaluronic Acid)
- Radiesse (Calcium Hydroxyapatite)
- Sculptra (Poly-L-Lactic acid)
- Ellanse (Polycaprolactone)
Sculptra is a bio-stimulating product that works by stimulating our own body to produce collagen. Hence, the results are not immediate. It takes about a month or more to take effect.
Ellansé, on the other hand, has two components to the filler:
- CMC gel that gives immediate lifting
- PCL component that acts as a biostimulant
For hyaluronic acid fillers, they can be dissolved with the use of an enzyme called hyaluronidase.
Both Sculptra and Ellansé cannot be reversed if improperly done or if there is lumpiness.
What are the different types of filler lifts techniques?
The term liquid facelift was used in the past to describe the facelift-like results that could be achieved with a combination of fillers and toxin.
Throughout the years, there have been a fair number of Filler Lift techniques that have been developed.
Examples of these include:
- MTV Filler Lift - This focuses on the midface and temple. It creates a V face effect.
- Juvederm 8 point Lift - Injection of fillers at 8 strategic points on the face. 
- Radiesse 3D Vector Lift - Injection of radiesse fillers like threads in vectors that will give a lifting effect.
- True Lift - Developed by Restylane Galderma using a filler of a high lifting capacity to target the true retaining ligaments of the face. 
These ligaments include:
By restoring these lax ligaments to a more youthful state, the face becomes better supported and thus lifted.
In my practice, I like to use the True Lift technique (for which I am a certified trainer) to refresh a person's appearance and if needed add in Volumizing fillers to create a better overall appearance.
The downside to all these Filler Lift techniques is that a minimum of 2-3 syringes of fillers is required which can push up the cost of the procedure.
Do you have your own filler Lift technique?
I cannot claim that the technique I use is exclusive to me. However, it's indeed based on a concept that I developed over the years.
I call this a Structural Filler Lift or SFL (Skin/Fat/Ligament). This is an anatomical concept based on the rheological properties of the different filler gels and how these properties affect the performance of the fillers when injected in different layers of the face.
When these are combined together, they give a nice 3D lifting effect.
How long do dermal fillers last?
Most dermal fillers will last from 6-12 months on average, depending on the characteristics of the filler gel. These fillers are usually hyaluronic acid fillers although other types of fillers may have a longer lifespan.
However in my experience, if a filler is repeatedly injected in the same area over a period of time, it can last longer (up to 18 months).
How much do dermal fillers cost?
Dermal fillers are administered by injection, therefore it depends on the number of syringes you need. Most of the syringes come in 1 cc formulation.
There're also some exceptions where fillers are available in 1.4 to 1.5 cc syringe. The price of these fillers ranges from $600 to $1,400.
Other factors that affect the price are:
- The brand of filler used
- The amount of experience your doctor has
What are the possible side effects of dermal fillers?
The common side effects are:
All these side effects are temporary with no long-term complications. There may be cases of delayed hypersensitivity or inflammation. In those cases, oral antibiotics and anti-inflammatory drugs may be prescribed. So far, cases of granuloma formation following HA fillers are rare.
However, there have been reported cases of skin necrosis. Some of the more common areas are:
- Glabella (the smooth part of the forehead above and between the eyebrows)
- Nose region
Cases of blindness following injections into the nose have also been reported. Most of the times, these are usually due to inexperience or improper choice of filler product. Nonetheless, it can also occur in the hands of experienced injectors.
How do thread lifts work?
The popularity of thread lifts has increased considerably over the past few years. It's largely due to the desire to achieve face lifting without surgery. I'd also attribute the increase to the improvements to the design and materials used for the threads.
Most of the threads are designed with barbs or cogs that are inserted in a planned trajectory to create a suspension effect on the overlying skin and subcutaneous fat layer and thus create Lift. Essentially, it's akin to “hooking” the skin upwards and then "pinning" it down. 
The threads used also have a collagen stimulating effect. As a result, it will lead to new collagen formation and remodelling. This will further enhance the "lifting" effect.
What are the different types of thread lifts available in Singapore?
The most common types of thread lifts would be the Korean PDO threads and Silhouette threads which are US FDA approved. 
The difference among these threads would be:
- Type of thread material used
- The tensile strength of the threads
- Design of the threads
- The method of introducing the threads (either by cannula or sharp long needles)
I'll admit that it can get quite confusing for yourself to determine what threads are best. There are just so many different variations with each claiming to be the better alternative.
My advice to you would be to speak to your doctor about this. You should sit down and discuss with your doctor the pros and cons of the different types.
It's important that your doctor is well trained to perform this procedure. Reason being, the results tend to be technique dependent.
What are the different types of thread lift materials?
The most common material used would be PDO or polydioxanone. This is a material used in sutures that has a long history of safety. 
Other newer materials would be the PLLA or Poly-L Lactic acid. These are of the same material as that used in the Sculptra filler.
The newest material would be the PCL or Polycaprolactone threads. They are supposedly stronger than the PDO threads. However, at this point, they are largely limited to use as Nose Threadlifts.
How much does a thread lift procedure cost?
The cost of a face thread lift in Singapore depends on a variety of factors.
- Brand and type of thread used
- The area that is being treated and hence the no of threads that needs to be used
- Experience of the doctor
Generally, face thread lifts can cost from $1,000 - $5,000.
“My friend told me that leaving the threads inside might cause plenty of complications! Is it true?”
In my opinion, if the threads have been correctly positioned inside the skin, there shouldn't be complications.
Moreover, the present generation of threads is biodegradable. This means that they usually dissolve in 6-9 months. Hence, there are no long-term aftereffects.
With that being said, there might still be potential complications. They include:
Your doctor should document any preexisting asymmetries before the procedure. When using barbs and cogs, exact precision is very important when the threads are being released into the face.
2. Rippling and Puckering
This complication is also seen with barbs and cogs although the newer generation threads that feature 360 deg barbs ensure that the tissues are caught more evenly and hence this problem occurs less.
Over tightening can also result in rippling although if the thread has been placed in correct tissue plane, this will resolve within a week.
The risk of this happening is extremely low as long as aseptic technique and proper use of a sterile field are employed.
This occurs when the thread is placed in a more superficial plane and sticks out and irritates the skin.
5. Other potential side effects
Haematoma and nerve damage. However, they are rare.
What results should I expect from thread lifts, and are these effects permanent?
While the effects of thread lift are not permanent, it can last for approximately 1 to 2 years, depending on several factors.
These factors include:
- Type of thread used
- Skin laxity
- Facial movement patterns
In my opinion, realistic expectations are essential before the procedure can be done. From my experience, the maximum amount of Lift that can be achieved using barbs and cogged threads is around 1cm.
What is the downtime like for a thread lift?
Although this is a non-surgical procedure, it is still minimally invasive. Hence, there is usually some downtime in terms of mild swelling and occasional bruising that usually takes 1-3 days to resolve.
Thread Lift vs. Dermal Fillers: which is better?
There isn’t an absolute answer to this question because it depends on your individual goals.
As thread lifts are more invasive than fillers, it is important that the patient is able to tolerate a little more discomfort during a thread lift.
However, you have to bear in mind that pain thresholds and acceptance of treatment vary from person to person.
- Aim: You want the effects of your treatment to last longer
Thread lifts typically last a minimum of 12-18 months, while dermal fillers have a lifespan of around 6-9 months. For you to maintain your results, you would need regular top-ups. In this scenario, a thread lift might be more suitable.
- Aim: You’re looking to contour or add volume only to specific areas of your face
Dermal fillers are typically more effective at contouring or volumizing specific areas of the face. On the other hand, a thread lift tightens and lifts the whole face to create a more youthful appearance. In this case, dermal fillers would help you better.
From my 15 years of experience, it is perhaps better to consider thread lifting as a preliminary procedure which combines well with other non-surgical procedures rather than a surgical alternative.
Indeed the use of thread lifts in combination with dermal fillers or fat grafting provides superior results by addressing the issue of volume changes. They can also be combined with RF or HIFU in selected areas to enhance the results although this is not done at the same sitting.
Can you do dermal fillers and thread lifts at the same time?
Yes, these two procedures actually complement each other really well.
However, I usually do not combine them in the same setting. I usually would like to perform the thread lift first and then address any volume issues later with fillers after the swelling has subsided. The results are more evident in 1-2 months time.
How to find the best aesthetic doctor to perform my filler or thread lift procedure?
I would like to preface this by saying that there’s no such thing as the best aesthetic doctor.
When you are seeking an aesthetic doctor, the 2 main factors you should take into consideration are:
- How comfortable do you feel with the doctor?
You need to be comfortable enough to communicate all your thoughts and feelings well to your doctor. It's crucial that he/she understands what you want to achieve from the procedures. It’s also important that you develop a good working relationship with your doctor to ensure the right care.
- Your doctor’s experience in the type of treatment you’re seeking
You should take time to learn about your doctor expertise in the treatment you are seeking. Whenever possible, ask for examples/ photos of your doctor’s work before deciding to go ahead with the procedure.
Dr KK Chew is the founder and medical director of NU•U Aesthetics & Wellness Clinic. Highly skilled in the use of fillers, Dr Chew is a key regional trainer for the Restylane brand of dermal fillers, as well as a member of the Restylane Filler Advisory Board (Asia). Dr Chew believes in treatments that enhance and refresh your appearance without changing the essence of who you are.