Dermal Fillers in Singapore: A 2020 Review

Dermal filler treatments are commonplace in Singapore

Everybody wants to look younger: the more ‘natural’, the better. However, as any aesthetic doctor would attest: there’s no ‘aging gracefully’, unless you count wrinkles and smile lines and puppet lines as “graceful”. Most mature ladies in Singapore who look fresh and youthful have had probably some form of dermal fillers in the form of Botulinium Toxin, Fillers and/or Non-Surgical Facelift treatments done before ( just think of any friend you have who looks much younger than her age – there should be plenty). This is especially obvious in Hollywood (although the end-results of certain celebrities leave much to be desired – that’s enough fodder for another detailed blog discussion).

Signs of aging

Prominent signs of aging include fat loss in cheeks, forehead, temples, nasolabial folds, mid-face – giving a “deflated” look.

Dermal fillers and face fillers are one of the top 2 aesthetic procedures performed worldwide, only because a prominent and common sign of aging is loss of volume. Replacing the lost volume with dermal fillers regains partially the look of youth. We shall go through the kinds of fillers available currently, so that you will be able to make an informed choice as to the type of dermal fillers used together with your trusted aesthetic doctor / surgeon.

Dermal Fillers – Hyaluronic Acid

Hyaluronic Acid is a molecule present in our skin and joints naturally. You may have heard of Synvisc, Orthovisc and other brands. Those are hyaluronic acid injected into joints ( mainly knees) for joint lubrication and pain relief.

HA for the face: Its most important effect is to absorb and hold onto water molecules, an amount that is 100 times its size, therefore hydrating the tissue it’s present in. Many years ago, researchers discovered methods to enhance the properties of hyaluronic acid, by adding cross-links to the molecules – the hyaluronic acid then takes a longer time to break down, thus enhancing the duration it lasts in the human face and skin. That’s why the watery material can then thicken in consistency take on a gel form and provide a substantial volume-filling effect in the face.

Depending on the number and type of cross-linking, it can last anywhere from 3 months to 18 months. It causes considerable swelling 1-2 days after injection (due to the water-absorbing effect of the filler) and the edema lasts for 3-5 days. This point is important for patients to take note of. Your doctor should under-treat the area if he/she is using HA fillers. An advantage of this kind of fillers is that hyaluronidase (Hyalase) can be used to dissolve the hyaluronic acid in case of any adverse event after treatment, or if patient requests to remove it. (However, my hyaluronidase are used only for patients who had been over-filled or filled wrongly by other physicians – I almost never use it for my own patients). This is the number one filler being used worldwide due to its safety and efficacy (great for doctors starting out).

A drawback (besides the post-treatment swelling) is that hyaluronic acid fillers do not stimulate your skin to produce much collagen. There are studies to show some collagen being stimulated after repeated treatments, but that can hardly compare to the collagen produced by the collagen-stimulating fillers.

Common brands: Belotero, Restylane, Teosyal, Juvederm (significant edema for Juvederm and thus it’s my least favourite brand)

Dermal Fillers Calcium Hydroxyapatite (Radiesse)

Calcium Hydroxyapatite is a filler (made in the USA) consisting of calcium, hydrogen and phosphate. Those constituents are present in the bone and bloodstream of humans. This unique collagen-stimulating filler has dual effects; it gives instant volume and definition, before producing collagen over the course of the next 3-6 months. It gives a much stronger lift and definition as compared to hyaluronic acid fillers, due to its high elasticity and cohesivity. This lift and definition make it highly suitable for non-surgical nosejob, chinjob and mid-face face-lifting.

It is highly versatile for different parts of the face like the temples, hands, nasolabial folds and neck. Radiesse CAN BE DILUTED with lignocaine and normal saline according to the area treated. Basically, it can be used to augment and define ( as for the nose and chin), lift (for the cheeks and smile lines), restore volume ( temples, cheeks, zygoma, jawline, neck).

There is no enzyme that can dissolve this (once injected, it will stay in the skin for 9-18 months before disappearing), so this filler is only advised to be used by ADVANCED INJECTOR DOCTORS. It is metabolized by the skin into calcium and phosphate ions and is absorbed by the body over the course of 9-18 months (depending on the individual patient). I highly recommend this dermal filler to my patients as compared to hyaluronic acid, because I love to give my patients bang for their buck (why refuse the extra collagen production if it can come along with the filler?).

I have also helped to spread the knowledge and technique of using this dermal filler by doing training for Merz Aesthetics company for Vietnamese dermatologists and plastic surgeons on 2 separate occasions.

Dermal Fillers – Poly-L-Lactic Acid (Sculptra)

Poly-L-Lactic Acid, also known as Sculptra, is a molecule that hydrolyses to carbon dioxide and water. It is not a filler per se, as it does not give instant volume filling. It is actually a collagen stimulator which results in the skin producing its own collagen. Usually 3-4 sessions of this treatment are needed before a long-lasting result of 2 years arises.

It is very popular due to the ‘subtle’ improvement it gives the patient, allowing a ‘natural’ youthful look without looking too ‘done’. There is a big group of patients who believe in this philosophy. The downside is that the collagen produced sometimes can be unpredictable and varies from person to person ( some patients may be very happy with the results and some may be disappointed), and it needs 3-4 sessions spaced 1 month apart to have the full effect. This filler is not for the patient who wants instant obvious volume restoration and lifting but if you want a more natural method, this might be your version of the “best dermal filler” in Singapore.

Dermal Fillers – Polycaprolactone (Ellanse)

Polycaprolactone is a molecule that also hydrolyses to carbon dioxide and water molecules by the skin and then used or expelled by the body. It has a powerful cross-linking technology and due to this special technology, has a range of products that last 1, 2, 3 or 4 years in the skin. They are Ellanse S (1 year), M (2 years), L (3 years), E (4 years). This is currently the only safe absorbable filler that can last up to 3 and 4 years in the skin.

It is the longest-lasting absorbable dermal filler available in Singapore now, and is suitable for patients who want a long-lasting filler due to various reasons e.g lower overall cost (the cost of 1cc of Ellanse divided by the number of years gives a much lower cost/year rate), less injection sessions(1 needed instead of 3-4 sessions). This collagen-stimulating filler also has dual effects; it gives instant volume and definition, before producing collagen over the course of the next 3-6 months As compared to hyaluronic acid fillers, Ellanse has a very high elasticity and viscocity profile, and thus is able to restore volume to the cheeks, hands and temples, lift the face and skin, contour the nose, chin and jawlines.

It is very versatile and can be used in all parts of the face, neck and hands. The only part that can’t be treated with Ellanse is the lips. Even the tear trough (a zone that is easily mis-treated by many doctors) can be treated by me with Ellanse due to my experience with tear troughs and Ellanse. Many patients regard this as the best filler in Singapore having experienced its effects.

Just like Radiesse, it also does not have an enzyme that can dissolve it and is highly recommended to be used by ADVANCED INJECTOR DOCTORS only. Once it is injected into the skin, it will stay there for the said number of years, therefore it is HIGHLY IMPORTANT for you to choose a doctor highly experienced with the use of collagen-stimulating fillers like Radiesse and Ellanse (as any poor aesthetic results will also last the same duration of time).

I am the first Singaporean aesthetic trainer for Ellanse accredited in Taipei in 2016, and also the first doctor representative from Singapore for the first Ellanse Asia Advisory Board Meeting 2016. I have conducted local trainings in Singapore and trained more than 15 local doctors on the usage of Ellanse.

Conclusion

Fillers are separated into 2 groups: ‘instant’ fillers and ‘collagen-stimulators’. Instant fillers include Hyaluronic Acid ( Belotero, Restylane, Teosyal, Juvederm) and Collagen-Stimulators include Calcium Hydroxyapatite (Radiesse), Poly-L-Lactic Acid (Sculptra), Polycaprolactone (Ellanse).

Each product suits a certain doctor and patient profile and must be chosen wisely. I would like to emphasize that choosing the right doctor for your needs is THE MOST IMPORTANT (as he would be able to recommend you the right filler for your skin type and condition and is able to produce good results with them – all the better if he offers the whole range of products).