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Everything you need to know about Dermal Fillers in Singapore – With David Loh

DR DAVID LOH

dr_david_loh
Dr David Loh is the immediate past president of the Society of Aesthetic Medicine in Singapore, having published on his filler injection techniques. His publications on the management of filler complications is often cited in scientific journals.

 

Growing old gracefully has taken on a new meaning in the last few years.

In the past, it referred to growing old “without any work” done. These days, with plastic surgery so pervasive, growing old gracefully means growing old with “only minimal work” done. And B*tox and Fillers are as minimal as it gets in aesthetics. Let’s talk about dermal fillers in this blog, shall we?

facial_filler_faqs

 

Frequently Asked Question on Dermal Fillers

What areas are best treated with dermal fillers?

All areas on the face, from the forehead down to the chin can be safely and effectively treated with dermal fillers. Here are the more common areas that are treated.

  • Forehead augmentation and projection can contour the forehead;
  • Nose, lips and chin augmentation bring out the beauty in the central facial features;
  • Cheek and under-eye augmentation support the skin over the cheeks. This decreases the appearance of the under-eye hollows, the nasolabial folds and the jowls;
  • The temples and lateral cheek augmentation creates a natural lifting of the face.

At David Loh Surgery, we excel in the art of dermal filler injections having published our special injection technique (The DL Lift) as an instructional guide for doctors in PRIME, International Journal of Aesthetic and Anti-Ageing Medicine in 2018.

 

What are the prices for dermal fillers like?

The price for dermal fillers costs $800 per syringe of 1ml. Check out our price list

  • Treatments like the nose and lips often require only 1ml.
  • Treatments like forehead, cheek and chin augmentation require 2-3mls per area, but they do not need to be done all in one go on the same day.
  • Then there are treatments like The DL Lift (our treatment named after Dr David Loh) may require 4-5mls of fillers each time. The DL Lift is also sometimes called a Liquid Facelift
  • Skin hydration boosters also cost $1000 per syringe of 1ml. To hydrate the under-eye skin, the skin over the cheeks including the nasolabial folds, and around the lips, patients will need 2-3mls of skin hydration boosters.

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

Are filler injections painful?

All of the reputable brands of modern fillers contain an anaesthetic called lidocaine which takes away the discomfort of filler injections. You shouldn’t settle for less.

The only sensation you will feel is the tiny needle entering the skin, and the sensation of movement (not pain) when the cannula is moved under the skin.

Are fillers injection results immediate?

Yes, the results are immediate and “what-you-see-is-what-you-get”. Plus minus 10%-20% perhaps because of slight initial swelling. In fact most of the time, the results are natural enough and the patients are presentable enough to go out and meet friends immediately after a treatment. This actually gave rise to the term “lunchtime facelifts”.

Is there any recovery time (downtime) when getting filler injections?

The chances of getting a tiny bruise with filler injections is about 10%-30% depending on which areas are being treated. Also with multiple areas of treatment, there is also a higher chance of getting at least one bruise.

No doctor can guarantee bruise-free injections; after all needles and cannulas are involved in the process of filler injections. If a bruise occurs, it will need to run its natural course taking a 7-10 days to slowly disappear. Most of the time bruises are tiny and can be easily covered with a bit of makeup.

Besides bruising, which of course causes some swelling, there is often some swelling which unrelated to the bruises. This is a natural process in filler injections. This post injection swelling usually takes 3-7 days to subside.

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

 

How safe are filler injections?

preperation_facial_filler

Filler injections are only as safe your doctor’s knowledge of the anatomy of the face. So don’t settle for non-medically trained injectors like beauticians. In fact, best to approach doctors that do filler injections frequently than those who do not.

With proper training and experience, filler injections are generally very safe.

Our doctors are trainers for other doctors. Dr David Loh has published in medical literature on the prevention and management of filler complications. One of the papers have been awarded a Best Paper (Gold) Award by the Plastic and Reconstructive Journal (PRS Global Open) in 2019.

The other aspect about safety with regard to dermal fillers is the filler material itself. As a filler material, hyaluronic acid fillers have been safely used on millions of patients since the 1990s. Without mentioning brands here, we are of the opinion that only biodegradable non-permanent fillers are safe. This is because they do not hang around long enough to cause granulomas or infections. And as the face changes, as it inevitably will over the years, fillers can be topped up to suit the changes associated with aging.

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

 

About David Loh Aesthetics

Dr David Loh is one of the first trainers and mentors in aesthetic medicine in Singapore. He developed and published in medical literature his filler injection techniques as instructional pieces for other doctors. He also published in medical literature his works on the prevention and management of filler complications.

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

 

What is the “overfilled syndrome”?

The “overfilled syndrome” is an unfortunate term coined by some doctors with the intention to disparage the work of other doctors. These doctors bring up isolated incidents of overfilled media celebrities to discourage patients from have filler injections. Perhaps these doctors are themselves not skilful enough nor experienced in filler injection, hence they try to divert clientele to the non-injection treatments. As a patient-consumer, you should be able to discern this kind of marketing tactics.

What you need to know is that you would need an incredible amount of filler material (maybe >20 syringes) to reach the kind of caricatured appearance of some of these celebrities. The so called “overfilled syndromes.” These celebrities can afford it but most patients would not be able to, and most conscientious doctors would hold back the patients before they even reach that kind of look.

The fact of the matter is that most patients with early signs of aging actually would benefit a great deal from filler injections into the fat compartments that have begun to shrink. This not only reverses the early signs of aging, but it can even prevent sagging.

Overfilled syndrome can easily be avoided as long as there is clear communication between doctor and patient. Clear goals and expectations are aligned prior to the procedure, and the  doctor has restraint in his or her approach, with  the  aim of creating a natural result while resolving the  concerns of facial aging such as sagging and volume loss.

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

 

The Only Way is Up

Improving Appearance is what we do everyday. Not making our patients look like someone else, but making them more confident through the art of the DL Lift and other techniques of filler injections. Bring out their best features and still being themselves. This is the essence of Enhancing Confidence.

 

 

WhatsApp +65 8878 8045 , call us +65 6733 5300, or send us an email here.

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Nanofat
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5 things to know about Nanofat Grafting

Fat grafting is a long established technique in cosmetic surgery; probably for as long as liposuction has been available. And that’s since the later part of the 1980s.

What’s new is that we can now select the smallest particles of fat cells (Nanofat), and use them to erase lines and wrinkles, as well as to improve skin quality. Some researchers have referred to them as stem-cell-like fractions called Stromal Vascular Fraction (SVF) or Mesenchymal Stem Cells (MSCs).

1. WHAT IS NANOFAT GRAFTING?

Nanofat injection is a method to reduce fine lines and wrinkles, or generally to improve skin quality in the face.

Nanofat is delivered like a filler injection except in this case the material used is autologous fat (one’s own fat cells).

Fat grafting (or fat transfers) are not exactly a new procedure. The procedure where grafted fat is used to volumize and lift the face, has been around for a long time. Of course, techniques and methods have improved over time. However, the advent of Nanofat represents a quantum leap in Fat Grafting methods. We are now able to treat even the fine lines under the eyes and around the mouth using Nanofat delivered with a very fine cannula.

Nanofats are actually the smallest particles of fat cells, which will survive best in a transplant scenario. The skin benefits are believed to be at least partially due to the stem-cells and growth factors in the Nanofat.

The ability to micronize fat cells down to very fine spheres has opened up many new possibilities, and as such the field of fat grafting has re-gained in popularity in the last few years.

2. WHAT IS NANOFAT USED FOR?

Nanofat can deliver skin quality improvements like the reduction of fine lines and wrinkles.

Recent studies have also shown that nanofat can improve the appearance of old scars (reference article – click here). (Updated in 2021 in The Plastic Reconstructive Journal: Adipose-derived stromal vascular fraction, or more commonly referred to as Nanofat, can improve skin quality via increased collagen production, and resist UV induced skin damage when injected into the dermis of the skin.

Used together with MilliFat and MicroFat, which provide structural support for the sagging face, we can reverse a host of the signs related to ageing. The only thing it does not treat is pigmentation. But it can even reverse skin damage due to sun (or UV) exposure.

Fat grafting is often used to enhance the effects of a threadlift or some non-surgical facelift like Ultherapy and Thermage.

3. WHAT IS THE FAT GRAFTING PROCEDURE LIKE?

The procedure involves harvesting fat from the abdomen or the inner thighs under local anaesthetic – essentially a mini-liposuction.

The fat is then cleaned, filtered and separated into different size cells – MilliFat, MicroFat or NanoFat. The larger fat cells are used to revolumize and lift the face, a kind of structural support, using a technique that Dr David Loh published. The technique has been commonly called the DL Lift.

The smallest of the fat cells are the Nanofat. They are used for the reduction of lines and wrinkles. Or for general skin quality improvements.

During the whole process from extraction, filtration to re-injection, the fat cells are completely free from environmental contamination (scientific jargon: closed system). We have a patented closed system for nanofat injections.

Post procedure, there will be some bruising and discomfort in the donor area (the area where fat was harvested in a mini-liposuction). This may take a few days to a week to recover. The overall discomfort is generally mild.

The face where the fat has been grafted will also be slighted swollen (about 20% bigger, I would say), and be slightly tender (sore to touch). Some bruising is to be expected, but again the overall recovery process is quite comfortable.

4. HOW LONG CAN THE GRAFTED FAT LAST?

A certain percentage of the transplanted fat will not take in the new environment and undergo apoptosis. Usually for the face, because of the rich blood supply, graft survival rates are quite high. You can expect somewhere in the region of 40%-60% grafted fat survival rates. So, we only need to over transplant by a little to achieve the desired outcomes.

After about one-month, whatever fat cells that remain will last forever. They will have been incorporated into the face and will last forever barring the ravages of time. In fact, they will expand and contract with extremes of weight fluctuations.

5. HOW DOES FAT GRAFTING PRICE COMPARE WITH DERMAL FILLERS?

When we do a fat grafting procedure, it is always a full face procedure. Meaning we treat the forehead, temples, cheeks and even the chin. And we harvest nanofat to treat the undereye and perioral areas too. The reason being that we want to maximize the areas treated because a mini-liposuction is involved each time. Multiple syringes of dermal fillers would be needed in order to treat similar areas. Maybe of the order of 8-12 syringes. At $1000 per syringe, you can imagine the cost even if we give discounts when multiple syringes are used. See your price list

Fat grafting (structural augmentation and nanofat grafting) costs $4,000 before GST. That’s it. And a proportion of the fat will stay for the long term.

The only “shortcoming” with fat grafting is that certain areas that need stronger structural support like the chin and the nose, harder HA fillers like Volux might still be better. In order to achieve the kind of projection needed for such areas.

Read more about Liposuction, Vaser Liposelection, Liposuction Not being a method of Weight Reduction, but instead Liposuction being more about a sense of proportion

And did you know we can correct over done fat transfers (fat grafting)?

WhatsApp us on +65 9153 1503 for more on fat grafting, nanofat grafting, and stromal vascular fractions (adipose derived stem cells). 

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Liposuction
davidlohsurgery

3 Misconceptions about Liposuction

First Misconception: Is liposuction a method of weight reduction?

The answer is no. Liposuction will not reduce weight and if any, it’s only marginal.

While it is an established fact that Liposuction can effectively sculpt areas that are out of proportion or are not in harmony with the rest of the body, a common misconception about liposuction is that it can also help the patient to lose weight.

According to Dr David Loh, “The only way to lose weight is with determination and with help from a dietitian, a gym-trainer and occasionally, if the obesity is severe, a bariatric surgeon.” A bariatric surgeon specialises in surgery to treat pathological obesity.

“Liposuction is best used to sculpt areas that are out of proportion with the rest of the body.” Dr David Loh stresses.

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Liposuction is a procedure where fat deposits directly under the skin are extracted through a small incision in the skin. Fats wrapped around organs, which are called visceral fats, are not dealt with during liposuction.

The arms, chest, breasts, waist, thighs, calves, ankles and the area under the chin can be sculpted. These areas can be difficult to tone with just just exercise and diet, and liposuction offers a helpful option.

Dr Loh stressed that patient selection and education are important for the long-term success of the procedure.

 

Second Misconception: Can we do a full body liposuction?

“We cannot do ‘whole body liposuction’ for the obese. It will not succeed. Nope, liposuction is not for weight reduction.” he said.

Patients need to understand that they must continue to exercise and diet in order to maintain good long-term results. Areas that have been treated will not accumulate fat again. If the patient puts on weight after liposuction, other areas will take over the task of storing fat. This can cause a distortion of the overall figure. Visceral fat can also  accumulate faster around the organs during periods of drastic weight gain. This is unhealthy.

So, it is of utmost importance that patients understand that must not to allow any weight gain after liposuction. “If you maintain your weight within a plus-minus 1-2 kg band, you will be fine.”

Third Misconception: Vaser is the best form of Liposuction.

Liposuctionliposuction_and_fat_transfer can be done with the help of assisting devices. Dr David Loh uses Vaser Liposelection. But regardless of which assisted form of liposuction, it is essentially the experience and the skill of the liposuction surgeon which will determine results and the outcome of the surgery, not the tools. Dr David Loh also performs High Definition Vaser (Vaser HD).

Dr Loh also performs autologous fat-transfer to the face and breasts. This is where a person’s own fat is transplanted to the face for greater support of the skin or to the breasts for a slight enhancement. For the face, Nanofats can be grafted to do the work of fillers.

If cellulite is is caused by some degree of lipoedema, then Liposuction can be one of a range of tools to correct it.

Liposuction is performed in a Day Surgery OT and Dr David Loh works with anaesthetists to provide greater comfort and safety to his patients.

Here’s a piece written by Dr David Loh explaining what is Liposuction.

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correcting fat transfers
davidlohsurgery

Smartlipo to the Rescue. Correcting Over-done Fat Transfers

DID YOU KNOW THAT OVERDONE FAT-TRANSFERS CAN BE CORRECTED?

While Fat Transfer (aka Fat Grafting or Lipofilling) on the face is a relatively easy task for doctors with the setup for office-based liposuction, getting it just right is not always a given. There are many variables like the quality of the fat after liposuction; the quality of the skin on the face which will determine the blood supply available to support the fat;  the age of the patient; whether a smoker or not …and so forth.

I have been doing fat transfers since 2007 and I have had more than a few requests in the past to treat the overfilled foreheads, chins, and overfilled cheeks. Some were my patients, but mostly were done overseas – mainly in the country that is now very popular for cosmetic surgery. Not that their doctors are bad, I guess it must be too inconvenient to fly there to do corrections, hence they land up for corrections with me. The pros and cons of medical tourism for invasive procedures is of course a topic for another blog altogether in itself.

Our Smartlipo system is just ideal for this purpose. The technology started me on the road to liposuction in 2006, and now although I have moved on to more efficient and effective systems to do liposuction, I still fall back on Smartlipo to do small and delicate areas. Smartlipo gives me accuracy and precision to treat small areas like overfilled foreheads, cheeks and chins.

The fibre-optic system delivers pulses of laser to melt away excess fat. In doing so, I can partially or fully remove the overfilled areas. It’s almost like the “Eraser” for Fat Fillers.

Dr David Loh

Read more about fat grafting (fat transfers) to the face

 

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