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

DR DAVID LOH

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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?

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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?

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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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5 ways to spot and solve under-eye ageing

Updated to include Dusederm Collagen Fillers

Treat signs of aging using under eye dermal fillers

A couple of things happen as we age. The fat compartments under the eyes above the cheeks shrink (atrophy is the scientific term). Thus reducing support for the skin and muscles around the eyes. The bones around the eye sockets also remodel (change shape) which causes even greater loss of support for the overlying soft tissues. This sagging in the under eye area gives rise to the signs of aging. And dermal fillers are a great way to reduce the signs of under eye aging.

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Under-eye area showing signs of aging

5 signs of under-eye-aging:

  1. Hollowness or sunken under-eye area is the direct effect of the fat atrophy.
  2. The lengthening of the lid cheek junction (above red line)  which is due to the lack of support.
  3. The tear-trough deformity, which is a groove under the eyebags. This is also due to the lack of support.
  4. The Eyebags. These may be psuedo-eyebags caused by skin laxity rather than actual eyebags, which are caused by fat pad herniation.
  5. Dark eye circles. Thin skin draping over muscle gives rise to the darker color. Only very rarely are dark eye circles the result of actual pigmentation on the skin.

The Treatment For Under-eye Aging

The treatment however is relatively simple. Dermal fillers when skillfully injected into the fat compartments in the under-eye area provides support and resolves most of the above problem features. The dermal filler is carefully placed using a cannula (a needle with a rounded tip) to minimize trauma. The dermal filler spreads evenly over the areas treated. Lumpiness is rare with the cannula technique of injection. Bruising can sometime occur even with a cannula but are usually quite minimal.

As far as safety is concern, opinion differs. But cannulas a generally accepted as the gentle method in this area while blood vessels are a plenty. Here is a paper by Dr David Loh on safety in filler injections

As for the crepey skin in the under eye area, the dermal fillers can help somewhat, but usually a bit of laser to tighten up the skin, and reduce the fine lines, and that’s all it takes to brighten up the look. The fractional CO2 laser is good, but has a bit of downtime. Otherwise, Sylfirm or Thermage eyes are not too bad too.

Watch Dr Davin Lim from Australia being treated by Dr David Loh while he was in Singapore. Under eye dermal filler injections.

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3 Factors to consider when doing a Liquid Facelift.

The Liquid Facelift is a popular procedure in aesthetic clinics across Singapore. It is termed ‘liquid” because it involves using only B*tox (a liquid) and hyaluronic acid fillers (a gel) to create a lifting effect on the lower parts of the face. It is a non-surgical and involves very little recovery time. In fact, as a “facelift” achieved through injections only, it has also been popularly called a “non-surgical facelift” or “lunchtime makeover”.

Over the years, many experts have also described other variations of the Liquid Facelift, and they are all very good.

The are 3 important factors to consider when performing The Liquid Facelift.

  1. The first is where to inject. Great masters of filler injections have proposed various depths of injection. Some for reasons of safety (deeply just above the periosteum), while others have target the “retaining ligaments” to build “struts”and “supports” for the sagging. Dr David Loh proposes that fillers be placed into fat compartments to mimic the state they were in before they underwent atrophy with age.
  2. The second is when to inject. Understanding that fat pads will sequentially atrophy in the process of aging, might one not be able to pre-emptively inflate the fat pads to prevent sagging altogether? Hence the question about when to inject becomes quite important as we can prevent, rather than chase, signs of aging.
  3. And the last consideration is how to inject. This is a cannula vs needle question that many expert injectors of dermal fillers have weighed in on. And the aesthetic medicine community is actually quite divided on which technique is better. Dr David Loh’s technique uses a cannula to accurately deliver fillers into the fat pads.

With there 3 considerations in mind, Dr David Loh popularized and has been teaching a particular form of the Liquid Facelift since 2015, and the technique has been named The DL Lift by many in his industry; DL being the initials for Dr David Loh who described it.

What is the underlying philosophy of The DL Lift?

In 2018, Dr David Loh and Dr Phoon Yi Shan, the partners the David Loh Surgery, described and published The DL Lift in The Prime International Journal of Aesthetic and Anti-Ageing Medicine, a medical industry journal, detailing the technique for other doctors.

One of the fundamental reasons why we sag when we age is because of sequential and progressive fat compartment shrinkage. Yes, fats in the face are compartmentalized and they are adjacent to each other. When one compartment shrinks, the tension in the whole structure we call the SMAS is weakened, and sagging happens.

However, the fat compartments shrink sequentially, some like the under-eye fat pads shrink as early as when we are in our late twenties. Hence hollowness and tired looking eyes can be seen in commonly in the thirties. Then the temple fat compartments shrink in the thirties, and the lateral cheek fat compartments shrink in the forties. This leads to the formation of the jowls in the fifties. This is a well-documented phenomenon that has been published in medical literature.

Doctors at David Loh Surgery have shown that by selectively restoring volume in certain fat compartments that have begun to atrophy, we can restore tension in that layer under the skin that supports the face.

“More importantly, if we already know when which fat compartment will atrophy in each stage of our lives, we can preemptively add volume to that compartment, so that facial sagging can be slowed down or even prevented altogether.”

This preventive anti-sagging proposition is a novel concept, because in real life most people would not approach a doctor to reverse aging until aging has occurred.

The DL Lift technique involves using cannulas to accurately deliver fillers (or autologous fat) into the specific fat pads that have either atrophied or are predicted to atrophy. This restores the tension within the SMAS and gives a mild facelift type effect. The whole procedure takes less than an hour and the results are instant.

There is usually little recovery time, only the occasional bruises and some swelling that might take a week to subside. The procedure can be used in conjunction with other treatment like Ultherapy, Thermage and Thread Lifts.

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About David Loh Surgery

Dr David Loh founded David Loh Surgery in 2002 with the aim of helping his patients improve their appearance and self-image, and in the process enhance their confidence. The clinic only uses treatments that are scientifically proven to be safe and effective. The medical jargon for this is “evidence based”, and has remained a cornerstone of all treatments provided at David Loh Surgery.

Furthermore, these treatments usually involve little or no recovery-time. Treatments like b*tox and fillers, fat transfers and ultherapy are what Dr David Loh is better known for.

Dr David Loh and Dr Phoon Yi Shan have left their mark in the medical aesthetics industry through publications like the one above in The Prime Journal, as well as on matters relating to filler complications management. One of their papers was awarded a Best Paper (Gold) by the Plastic and Reconstructive Surgery journal in September 2019.

Dr David Loh is the President of The Society of Aesthetic Medicine in Singapore, which actively promotes safety, efficacy and standards of care among its members through regular teaching sessions, workshops and conferences.

David Loh Surgery (main clinic)
501 Orchard Road, #05-16 Wheelock Place, Singapore 238880

David Loh Surgery (branch clinic)
10 Sinaran Drive, #08-35 Novena Medical Center, Singapore 307506

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