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Dermal Fillers, Botox, & Facelifts

Dermal Fillers, Botox, & Facelifts

A DxD Session with Dr K K Chew


Now Answering until Wed Jul 31 2019
Live | Now answering questions
Have a question to ask?

Get Dr K K Chew's opinions on your questions! Only approved questions are displayed.

Top Answers


I personally do not like to combine nose fillers together with nose threadlifts especially at the same setting because it is difficult to estimate how much is required after either one of the procedures as there will be usually some swelling after the procedure. 

However this does not mean that they cannot be combined. In cases whereby the nasal bridge is really flat some amount of fillers is required to give it some volume.

Threadlifts do give a good defined nasal bridge and a nice lifting profile but in some cases addition of a Filler can further enhance the contour .

It depends on what the patient needs and prefers before I recommend what procedure to be done first. A review can be done in one or two weeks time before deciding if another procedure needs to be done.

The issue with nose fillers however is the potential risk of blindness due to retrograde flow of the Filler to the retinal artery. The other issue is that with repeated Filler injections it can lead to some broadening of the nasal bridge.

These issues have led to the more widespread use of nose threadlifts nowadays.

Hope this helps and please discuss your preferences with your doctor.

 

14 Dec 2018

I hope you had taken time to read through the answers provided and hopefully found a doctor to solve your problem.

I would just like to share my  opinion regarding this problem as this is something that I come across quite frequently in my practice.

Undereye and tear trough depression is usually associated with Aging process although I have seen a fair number of cases which are probably genetic in nature as they are present from an early age.

The undereye area is especially delicate and represents the thinness part of the facial skin. As such it is especially prone to wear and tear and Aging changes.

We now understand that there is a tear trough ligament which is like an extension of the orbicularis retaining ligament (ORL ) . When the ligament becomes lax it is unable to support the structure above it and a depression occurs. Any volume loss in this area either due to fat loss or bone resorption makes the depression worse. This can also result in the appearance of dark undereye circles.

If we can appreciate the cause then any treatment that gives support to this area and at the same time restore volume would improve this problem . Hence the most common treatment would be to inject a HA Filler usually deep along the tear trough depression to "lift" it. Superficial injections are sometimes needed to further improve it but must be done with caution and with a soft filler to reduce a sausage shape appearing and the so called "Tyndall Effect" which is like a bluish tinge. We are unable to treat the bone resorption at this point in time but there are developments underway to produce a bone filler.

You would need to see a doctor experienced in treating this area to obtain a good result.  Best wishes and good luck.

15 Dec 2018

Thanks for asking this question and providing the photograph as well. This is indeed a very common request in my practice partly due to the popularity of the Korean V face concept . 

It is important during the consultation to let the doctor know what your desired aesthetic outcomes are . The doctor will also need to assess what are the actual problems and then recommend the appropriate treatment options 

From your photograph you appear to be fairly young with minimal amount of jowling . The issue could be due to your hypertrophied masseter ( jaw ) muscle . If this is the case the doctor can administer some butolininium toxin to relax and slim the muscle bulk. This will result in a slimmer lower face and results takes about 3 weeks to show and last an average of 3-6 months . 

In addition the doctor can also inject a filler to augment your Chin giving it a more V shape look . This can be done together with the muscle slimming to enhance the result .

Other possible treatment options especially if skin laxity and jowling is the issue would be to do a facial contouring procedure with a HIFU ( high intensity focused Ultrasound) device .

In some cases although not usually done because of the downtime is the use of PDO threads to contour the lower face.

In some patients especially where the mid face appears wider relative to the lower face due to high cheekbones and or deflated cheeks a filler placed in the anterior cheek would create a better overall profile .

In some cases but probably not in yours the problem could be due to squarish bony jaw in which case only surgery can help.

Hope this helps 

Regards

Dr Chew

15 Dec 2018

Fillers have traditionally been used as a non surgical option for nose augmentation in what has been commonly referred to as injection rhinoplasty. In recent years the popularity of fillers for this indication has declined due to the reported potential complication of blindness as well as the emergence of the popularity of nose Threadlifts.

A detailed assessment of the nature of the deviated nose is important before deciding if it can be corrected with the use of fillers. If the deformity is fixed and extreme correction would probably be best served through a surgical rhinoplasty.

Assuming that correction is possible with fillers the choice of a correct filler is important as well as the skilll and experience of the doctor. The filler chosen should have a high lifting capacity and not easily subjected to deformation by pressure so that it stays in the correct position. The filler should usually last about 9- 12 months assuming a non permanent filler is used.

It is also important for the doctor to discuss with the patient whether the likelihood of a full correction is possible. In some cases combination with nose threads may lead to a better aesthetic outcome.

Hope this helps.

Regards

Dr Chew

16 Dec 2018

This is a interesting question as most people are not aware of the hollowness in the temple area and how it affects their looks . This could also be due to the fact that this is not entirely due to aging and some have it since young and think that it cannot be treated.

The other possible reason for this especially in females is that their hair covers this area quite well. It is only when they start pulling their hair back or when the hollowing becomes worse and associated also with facial volume loss in the anterior and lateral cheeks that they noticed how aged or tired they look.

Loss of volume in all these areas pulls the face down and creates a tired looking face. Going back to the temple hollow , the easiest way would be to replace the volume loss through the use of a filler. Most Doctors would prefer to use a hyaluronic acid ( HA) Filler or a Calcium Hydroxyapatite Filler like Radiesse.

There are 2 ways to administer the Filler , either

1. injection of a bolus dose deep down to the bone with a sharp needle or

2. the use of a cannula to distribute the filler in a intermediate plane.

Both methods have their pros and cons and different Doctors would have their own preference . The choice of an appropriate filler is important as different filler gels are suited for deep or intermediate planes of injection.

One of the common issues associated with deep injection is the occurrence of headaches which is temporary. Also deep injections in theory would also require more volume of the filler to be used which may make it more costly .

Use of a cannula to inject in this area is technically more challenging so the doctor needs to be more experienced. If injected too superficially surface irregularities becomes a problem .

Hopefully you can have the treatment done and look more refreshed.

16 Dec 2018

Hi Si Hui 

This is a common question asked by many of my patients. There are a few factors to consider when answering this question.

1. The severity of your eyebags. As you are 35 years of age and from your photos it appears that your eyebags are mild to early moderate in severity, Filler might be a good choice. The doctor will need to assess whether your eyebags can be adequately concealed with the fillers before offering this option. In my opinion if the fillers are not able to achieve a aesthetic outcome of at least 80% then this might not be the best option .

2. Whether the eyebags are associated with a tear trough depression which is commonly the case and if there are associated dark eye circles in your case. This makes you a good candidate for fillers especially if point no 1 can be fulfilled . Fillers are good option for treating the tear trough and dark eye circles.

3. The longevity of the results. Filler treatments would usually last from 6 to 12 months only. So if you considering something that has a more permanent result than surgery might be a better choice. However surgery does have a longer recovery period and the potential complications may be more . 

4. For some patients seeking an alternative non surgical solution I also offer the NILER procedure where a 0.6mm fibre optic laser is used to destroy the fat that causes the eyebag to bulge. The results do last longer up to 3 years but if there is an associated tear trough that is quite severe fillers may also need to be used 

5. For eyebags that do not seem to be adequately corrected with fillers alone, combination treatment with HIFU or Exilis RF may be beneficial.

Hope this helps and best of luck in finding the right treatment .

Regards

Dr KK Chew

27 Dec 2018

In order to answer this question , a consultation and evaluation of the actual cause of the saggy cheeks must be done first .

The common causes would be loss of skin elasticity and collagen , loss of facial volume due to facial fat pads deflation , migration of fat pads downwards or increase in fat and ligament laxity ( especially the mandibular retaining ligament ) . Of course these causes could also coexist to a certain extent. 

Treatment options should then be directed to the underlying causes.

1. Loss of skin elasticity and collagen — use of energy and light based devices . These include the monopolar RF devices like Thermage , Exilis Elite , HIFU devices like Ulthera, Ultraformer III and to a lesser extent lasers for collagen remodeling like Laser Genesis or the newer Picosecond lasers .  We can also used Threadlifts to reposition the sagging skin using either the Korean PDO threads or the Silhouette threads with cones. 

2. Loss of facial volume due to deflation of facial fat pads—-  replacement of the fat loss through use of dermal fillers or fat grafting . Fillers of appropriate viscoelastity to replace volume and create a Lift can be injected in a subcutaneous or deep plane to corrrct the saggy cheeks 

3. Heaviness of the lower lateral cheeks due to fat volume increase or increase of buccal fat can be addressed by use of HIFU devices to reduce the subcutaneous fat or as in the case of buccal fat  through surgical buccal fat removal. 

4. Combination of the above plus laxity of the retaining ligaments like mandibular , buccal maxillary and to some extent the zygomatic ligaments . These ligaments laxity can be corrected using the True Lift technique through the use of filler gel ( Restylane Lyft ) with high lifting capacity .

Hope this helps .

Regards

Dr KK Chew

3 Jan 2019

It would seem from the photo provided that you have what is referred to as solar lentigine or sun spot which is due to UV damage. 

There are several options in terms of treatment 

1. Topical creams/ serums  — the commonly used ones include Vitamin C 10/ 15 % , hydroquinone 4% or in a triple formulation that also includes retin A and a steriod, various combinations of whitening agents like Kojic acid , azelaic acid and the lastest product called cysteamine. However the use of topical agents do have some limitations and sometimes there may not result in complete clearance of the spot.

2. Medical Grade Devices like IPL and pigment specific lasers that include the Q switched lasers and the latest Picosecond laser . In my practice I utilise Cutera Pico Genesis Laser which I find quite effective with minimal risk of PIH ( post inflammatory hyperpigmentation) 

In my opinion you should discuss the pros and cons of the various treatment options with your doctor and make an informed decision . Whatever treatment option you choose you must bear in mind that the sun spot can recur so must have in place a preventive regime that includes a sunblock of SPF 30 or more that can be combined with oral supplements like Crystal Tomato or Heliocare Pure White Radiance . Routine use of topical Vitamin C is also encouraged .

Hope this helps .

4 Jan 2019

I can understand your concern regarding the pain and discomfort especially if the injections are done manually using the sharp needle. 

To minimise the discomfort of the Rejuran procedure, I prefer to use an injector gun which can be calibrated to deliver a precise amount at a precise depth.

The needles used are also superfine 31G. To make it more comfortable most doctors will also mix it with a very small amount of lidocaine. This is unlikely to affect the efficacy of the product.

Hope this helps.

7 Jan 2019

Hi,

That is a really interesting question. There has been much talk in the medical circles as well in social media about this issue. This has led to the creation of the term “the overfilled facial syndrome" or “the pillow face".  

It is not that uncommon nowadays to see such faces gracing the covers of magazines and high society events . So what are the tell-tale signs of this syndrome? 

1. The face expression looks unnatural and there is loss of the normal facial topography. Although this sort of face is commonly taught to be due to the overuse of Botox resulting in a frozen look, overfilling of the face with dermal fillers can also produce an unnatural look, or it may also be due to a combination of both.

2. The cheeks look extremely unnatural and plump and any attempt at smiling produces inflated ball like cheeks. This has also been described as “chipmunk cheeks". 

3. The forehead looks broadened and overprotruded.

4 . The nose is broadened or has been likened to an "avatar nose".

5 . The chin is over-augmented giving rise to the description of a “witch's chin" in the female . 

6 . The lips can be overfilled resulting in “sausage" or “duck" lips.

Hope this helps.

11 Jan 2019

The occurrence of a receded chin can either be genetic ( from birth ) or due to aging changes.

From your description it would seem like it is due to aging changes. The chin can recede with age due to bone loss / resorption and soft tissue volume loss .

The treatment options will either be surgical or non- surgical.

Surgical options would include a chin implant or genioplasty. It is not within my expertise to discuss these options in detail as they are better explained by a plastic surgeon. 

For non surgical options I would normally recommend the use of a dermal filler which is made of hyaluronic acid gel of a high lifting capacity which does not migrate . In my practice the gel of choice would be Restylane Lyft . 

The procedure in itself is quite straightforward and can be performed under topical anaesthesia either with a sharp needle or with cannula. Each doctor would have their own preferences and technique but they are usually quite similar . Following the procedure there is usually minimal swelling and no social downtime . There might however be a sore sensation over the injected area that typically can lasts a few days to one week. 

The advantage of choosing a hyaluronic acid filler is that if the injection is done not to the patient satisfaction it can be dissolved with a enzyme injection of hyaluronidase. These HA fillers typically can last up to 12 months in the Chin although repeated injections in the same area can make the result last up to 2 years in some cases .

Hope this helps 

30 Jan 2019

With men nowadays putting more emphasis on their appearance, the male aesthetics and anti Aging segment sees a huge potential in growth.

However it is important to realise that the male patient has certain characteristics that differs from the female. 

Firstly the male patient is more likely to approve of non invasive treatments that offers gradual improvements with little or no downtime and minimal adverse effects. 
 
Secondly most males are more likely to request a procedure that is less painful and does not require that many visits to the clinic. 
 
I would like to divide the possible non invasive treatments into Face /Skin / Hair / Body.
 
For Face 
 
1. Botulinum toxin injections to improve the forehead/ glabellar and corow’s feet are commonly requested.
2. Filler injections for Chin and Nose Augmentation 
3, Filler injections for smile lines and marionette lines , under eye hollows and eyebags 
4. Filler and or energy based devices like RF/ HIFU for jawline contouring and skin tightening.
 
For Skin
1. Facials and Lasers to improve overall complexion and reduce pore size and acne scarring if present. 
2, Lasers to improve skin pigmentation 
 
For Hair
1, Treatments to improve male pattern hair loss either in the form of oral medication / topicals / vitamins 
2, Regenera Activa treatments that uses the Stromal Vascular Fraction ( SVF ) for Hair regrowth, 
 
For Body
1 Non invasive fat reduction treatments like cryolipolysis, RF , HIFU and laser .
2. Body shaping treatments like Trilipo and X wave and Exilis RF 
3, HIFEM devices that are supposed to build abdominal muscles .
 
Hope this helps.
4 Feb 2019
Hi

You are right in that facial structure/ bone, chubby cheeks ,hypertrophied jaw muscle, a weak Chin as well as Aging changes due to gravitational descent and volumetric changes in the facial fat Compartments can lead to a wider or broader lower face .

Depending on the assessment the following are possible 

1. Neurotoxin like Botox or Xeomin to the masseter to reduce the bulk causing the face to slim down. 

2. Chin augmentation with fillers to created a more pointed look and when combined with the above can create a V shaped effect in the lower face.

3. HIFU devices like Ultraformer III to shape and contour the jowls and lower face.

4. Fillers to contour and shape the lower face.

5 Threadlifts to create a V shape effect.

Hope this helps 

8 Mar 2019

Hi,

As the name implies smile lines are actually a natural part of our facial features and exist even in the young. It is natural for them to be more pronounced when we smile but if it appears deep even at rest then it makes one look aged.

The deepening of the lines is usually associated with development of a thickened nasolabial fold. The causes of this is usually twofold. A gravitational descent due to loss of skin elasticity and a volume displacement or loss of facial cheek fat.

Treatment options would be but not limited to the following:

1. Dermal fillers like HA fillers to correct the lines directly and or volume correction in the cheek 

2. Use of HIFU or RF devices to restore skin collagen and elasticity to enable a lifting effect.

3 . Threadlifts to lift and contour the midface.

Hope this helps

8 Mar 2019

Hi

The recent increased awareness and incidence that blindness is a possible complication following filler injections to the nose has led to many doctors as well as filler companies to revise their indications for this procedure. Therefore long lasting fillers are not recommended usually.

Having said that it is still okay to have the procedure done but seek out an experienced doctor. My advise is to stick to Hyaluronic Acid Fillers for this indication, as there is a chance of reversal if complications occur. 

The downside is that they typically last about 12 months although repeated touch ups at 6 - 8 months can potentially increased the longevity to 18 months 

Hope this helps.

8 Mar 2019

Thanks for your question. I presume that you have some volume loss on your face that makes you look tired and more aged.

The usual areas for volume loss concerns are the under eye areas, Temples, anterior cheeks and lower lateral cheek extension.  The cause for this volume loss is usually attributed to aging causing fat loss and or migration. 

Fillers especially the hyaluronic acid fillers are a good option to replace this volume loss and create a lifting effect.  There is technique developed by Restylane called True Lift which is able to create a lifting effect by targeting the true retaining ligaments of the face. These ligaments help support facial tissues but tends to sag with age . Filler injections into the base of these ligaments helps to restore them to a more youthful state enabling them to create support and lift the face. Additional fillers injected into the volume depleted areas of the face helps restore the support originally provided by these facial fat pads. 

The filler procedure can be complemented by a non invasive HIFU procedure about 2 weeks later if needed to provide more lift and facial contouring . All these can be further complemented by use of neurotoxin like Botox or Xeomin to relax the muscles and create a more youthful look.

Hope this helps 

Regards

Dr KK Chew

20 Mar 2019

The term "FDA" is usually associated with the US regulatory Food and Drug Administration.

Dermal fillers (also known as injectable implants), soft tissue fillers, or wrinkle fillers are classified as medical device implants by the Food and Drug Administration (FDA) for use in helping to create a smoother or fuller appearance in the face, including nasolabial folds, cheeks, and lips, and for increasing the volume of the back of the hands.

The majority of such fillers are classified as temporary as they are biodegradable and biocompatible, with hyaluronic acid being the most common type.

The main advantages of these FDA-approved fillers is that they usually have a good safety profile as well as proven effectiveness. This is because the FDA has a rigorous system in place that ensures that such devices have undergone clinical trials with good safety and effectiveness records.

In Singapore, the major brands that are FDA approved and registered with the local Health Sciences Authority are Restylane, Juvederm, Belotero, Teosyal, and Radiesse.

Regards
Dr Chew

3 Apr 2019

Top Questions


I noted the appearance of a dark patch on my lower lip. What is the best way to remove lip pigmentation? Are laser treatments effective at removing pigmentation on the lips? 

What is the difference between dermal fillers and hyaluronic acid fillers, eg. Ellanse vs Juvederm? Which is better, and is there any difference in their safety profiles? 

I would like to understand how safe Rejuran Healer is? Some websites state that the long term effects of Rejuran Healer is not well documented, and it is not US FDA approved.

In addition, who is and isn’t suitable for Rejuran Healer? For example, are people with acne-prone skin or closed comedones suitable for Rejuran?

I had a horrible eyebrow embroidery job performed 2 years ago. Was thinking (and hoping) it will fade in 1-2 years time but it did not. Hence, I have lived with it until now. I've tried laser removal at a beauty salon, as well as using skin colour pigment to “cover” up the eyebrow tattoo, but these did not work well. What are the available types of treatments and costs for the removal of eyebrow embroidery?

I'm a 40 year-old Chinese male. I noticed age spots on my upper cheeks about 2 years ago. Since then, I've tried laser treatments and have been applying sunblock every day but have not seen any improvement. My mom has the same condition as well.

I've noticed worsening dark under eye circles as I approach my 30s. Will fillers be able to completely fix the problem? Otherwise, how much improvement can I expect? Thank you in advance!

I'm 32 years old and I am trying to determine the best filler for my needs. I have dark circles, slightly saggy skin and wrinkles under my eyes. Would Rejuran or Ellanse be best for me?

I read that Dysport Dermalift shrinks pores and lifts your face.

I'm in my 30s. I am looking for advice on treating/removing my eye bags and dark circles. I am considering AGNES treatment, but I wish to understand which would be the better procedure for my condition (i.e. eye bag removal, PRP, AGNES, NILER, filler or others).