TYPES OF DERMAL FILLERS
Among the many brands of Hyaluronic acid fillers, JUVÉDERM®️ is our favorite. Within the JUVÉDERM®️ family are various “products” each uniquely designed for specific tasks. Volux is “strong” and is used for nose and chin projection. Voluma effectively volumizes the forehead, temples and cheeks. Volift is soft and is ideal as a Lip Filler. Volite is a skin hydration booster
Radiesse is a calcium based filler that triggers the production of collagen and fibrous tissue. Autologous fat grafting is a procedure using fat from another area as a filler on the face. Nanofat are the smallest particles of fat grafts, and they are believed to be rich in “stem cells“. Fat transfer is another term, used interchangeably with fat grafting, and refers to grafting fat to other body parts as buttock or breast enhancements.
Fillers can be used to restore volume to create balance, harmony of the facial features as well as to bring out youthful contours. Around 2009, we embarked on a new way to use fillers. Instead of just focusing on softening static lines like the nasolabial folds, we used the fillers to re-volumize the face.
THE DL LIFT
Then in 2018, Dr Phoon Yi Shan and Dr David Loh described a technique called the DL Lift. This technique predicts the differential shrinkage in the various fat compartments of the face and directs the injection to selectively re-inflate them, restoring tension in the SMAS, which translates to a mild lifting effect of the face. This technique is published in the Prime International Journal of Aesthetic and Anti-Ageing Medicine.
Aging comes with a downward migration of the face and a loss in volume over the cheeks. The DL Lift allows doctors to effectively soften lines like the naso-labial folds, nasojugal groove and the marionette lines, and also lift the jowls without making the face fatter. In fact, by lifting the face, the patient often appears slimmer.
Fillers can also project and enhance facial features when used on the lips, chin, the nose, the forehead or the malar area. There’s a lot of artistry in this aspect.
OUR CHOICE OF FILLERS
We also use autologous fat (patient’s own fat) as fillers. And then there are also fillers that are FDA approved with a long history of safety and efficacy that are not made of hyaluronic acid, like Radiesse.
Here are important considerations for our choice of fillers:
- We rule out anything “permanent”. We only use non-permanent fillers that are totally biodegradable after injection into the skin.
- We prefer to use fillers that are totally predictable. We need to know exactly how it behaves once injected.
- The filler has got to be smooth, even-textured and moldable at any depth.
- The filler has got to last around 12 months (even longer for deep volumizing fillers) after injection.
- Hyaluronic acid fillers are preferable because they can be easily dissolved with hylase, in the event of misplacement or adverse reactions.
Hylase, an enzyme that dissolves hyaluronic acid, allows fillers to be infinitely adjusted or instantly removed whenever needed.
We do NOT use semi-permanent or permanent fillers made from polyacrylamide, poly-lactic acid or silicone.
Faces will change over time. We will all continue to age and sag. Why inject something into the face that lasts a lifetime, when it is better to adjust it periodically to suit the “evolving” face.
Permanent fillers can potentially cause granulomas (skin reacting to foreign material) after a period of time in the skin. There’s no easy way to remove the granulomas. We can offer only limited help by injecting minute amounts of kenacort deep into the granulomas to prevent any further swelling. Remember: Hylase only works to dissolve hyaluronic acid fillers.
NB: Never agree to free-particle silicone injections for the face or the breasts. If you must have polyacrylamide, Sculptra or Ellanse injected, be sure the doctor can deal with the granulomas or skin reactions that occur later on. Good luck.
DR DAVID LOH
One of the Pioneers of Aesthetic Medicines in Singapore
Dr David Loh
Dr David Loh founded David Loh Surgery back in 2002 when Aesthetic Medicine as a field was still in its infancy. He obtained his basic medical and surgical degree from the National University of Singapore. He has 30 years of working experience, 18 years of which were in aesthetics. He is MOH-accredited to perform office -based Liposuction. He is perhaps best known for being a trainer for B*tox and Fillers in the region. He is the President of The Society of Aesthetic Medicine in Singapore.