Dermal fillers in Singapore:
choosing the material before the product

What are the four types of dermal filler?

Dermal fillers in Singapore come in four materials, and the material decides what can be undone. Hyaluronic acid (HA) is a sugar already present in the skin; in a filler it is cross-linked into a gel that holds its shape. Calcium hydroxylapatite (CaHA, as in Radiesse) and polycaprolactone (PCL, as in Ellansé) are microspheres suspended in a carrier gel. Poly-L-lactic acid (PLLA, as in Sculptra) is a biodegradable polymer that is a biostimulator rather than a filler in the strict sense.

With hyaluronic acid the volume is the product itself, so what you see on the day is largely what is there. With CaHA and PCL the carrier gives early volume and is absorbed, and the microspheres remain for a time as a scaffold on which the body lays down its own collagen. With PLLA there is no lasting volume from the product on the day; the change comes from the collagen it prompts.

Hyaluronidase dissolves hyaluronic acid and nothing else. That single fact shapes where each material is used, how much is placed, and how cautiously a first treatment is planned.

What can a dermal filler not do?

A dermal filler cannot lift tissue, tighten loose skin or act on a muscle. It is not a skin booster, which acts within the skin on hydration and quality without projecting or contouring, and it is not botulinum toxin, which relaxes muscle. Which of the three fits depends on which tissue is responsible for what you see.

The commonest mistake is to ask a filler to do the work of a lift. Facial ageing is volume loss, laxity and declining skin quality arriving together, and a filler acts only on the first. Given to a face whose main change is descent, it produces a heavier lower face with the same sag. Filler is declined where the expectation is something it cannot do, such as lifting a jowl, tightening skin or making a nose smaller.

Because a filler restores structure, the first question is always what is missing: structure before volume, bone before soft tissue, and a plan for the whole face rather than a count of syringes. Over-filling is avoided by asking what is missing before asking what to add, and by checking what earlier treatment is already present.

“A filler adds volume. It does not lift, and it does not tighten. Asking it to do either is how faces end up over-filled.”

Dr Sin YongOn what a filler cannot do

Which material goes in which area?

Which material goes where depends on what the area has to do: project against bone, soften a hollow, or move with expression. The cheek, chin and jawline need support on bone, so a firmer hyaluronic acid or, where reversibility is not the priority, CaHA or PCL is placed deep. The cheek filler and chin filler pages set out how each area is planned.

The nose is a special case. Here the nose bridge is usually treated with CaHA or PCL for the support they give, with hyaluronic acid where a dissolvable option is preferred, and filler can straighten or raise a bridge but cannot make a nose smaller. The nose filler page covers the limits and the vascular risk.

Lips and tear troughs take soft hyaluronic acid in small amounts, because these areas move constantly, sit close to the surface and benefit from a material that can be dissolved. Diffuse volume loss across the mid-face and temples is often better suited to a collagen biostimulator such as Sculptra or Ellansé than to filler placed point by point; the Radiesse, Ellansé and Sculptra pages describe each one.

Who suits fillers, and who should wait?

Filler suits a change that is genuinely volumetric in a face whose skin and ligaments still give support: deflated cheeks or temples, a hollow tear trough, or shapes that were never age-related, such as a short chin, a low nasal bridge or thin lips. Someone new to injectables is often better starting with a reversible hyaluronic acid filler than with a material that cannot be dissolved. Where the main change is heavy, redundant skin, filler is not the first answer: laxity is assessed for lifting, and marked excess is referred to a plastic surgery specialist.

Treatment is deferred in pregnancy and breastfeeding, and where there is an active infection, a cold sore or inflamed skin near the site. A known allergy to a component or to lidocaine, a bleeding tendency or blood-thinning medicine, autoimmune conditions and a keloid tendency are discussed first. Earlier non-resorbable fillers, such as silicone, must be declared, because layering new product over them raises the risk of nodules, and previous filler of any type is scanned with ultrasound where the history is unclear.

What are the risks, and when should you call?

The serious risk of any filler is vascular occlusion, in which product enters or presses on an artery and the tissue it supplies loses its blood flow. Warning signs are skin that blanches white or turns dusky, purple or net-like, and pain out of proportion to the injection. These need same-day assessment. Any change in vision after filler is an emergency: go to the nearest hospital emergency department or call 995 rather than travelling to a clinic first.

Occlusion is rare, and the highest-risk zones are the nose, the glabella, the forehead and the tear trough. For hyaluronic acid it is treated with urgent, high-dose hyaluronidase, which is kept in the room wherever hyaluronic acid is injected. CaHA, PCL and PLLA have no dissolving option, which is why they are placed conservatively and why the nose, where Dr Sin Yong usually works with CaHA or PCL, is planned with particular care.

Other risks are bruising and swelling, lumps, product that migrates, a bluish tint where hyaluronic acid sits too close to the surface, and inflammatory nodules that can appear months or years later. Filler that looks heavy, has moved or feels lumpy is assessed under filler correction, and the signs that need urgent attention are set out under complication care.

What happens, step by step?

The first visit is an assessment, not a treatment. Dr Sin Yong takes the history, including any earlier filler and where it was given, examines the whole face at rest and in movement, and may photograph it for your medical record. Ultrasound can show where existing product sits. You then receive a written plan naming the areas, the material, the plane and the fee, and you can take it away; you are not expected to decide on the day.

On treatment day the skin is cleaned and a topical anaesthetic is applied, and most hyaluronic acid fillers also contain lidocaine. Product is placed with a needle or a blunt cannula, chosen area by area, in small amounts that are checked against the other side before more is added. Written aftercare explains what is expected and which signs to report, and the result is reviewed once swelling has settled.

Swelling, tenderness and some bruising at the entry points are expected, and lips and tear troughs swell more than bony areas. Temporary asymmetry while swelling settles at different rates is common and is not a reason to add more product.

What determines the fee?

The fee depends on the areas treated and how many, what the examination finds in each, the material chosen and the quantity the anatomy calls for, whether filler is used alone or with botulinum toxin or a biostimulator, and whether the plan is staged across more than one visit. Correcting earlier filler is costed separately from new treatment.

Singapore's rules for medical advertising prevent fees from being published, and a quote given before examination would be for a plan that does not yet exist. A written, itemised quote is given after the consultation, and how fees are quoted sets out what it contains.