Pillow cheeks and duck lips: Tell-tale signs of too much dermal filler

Choosing the right fillers and injecting them in the right areas is key to subtle facial enhancements, says Dr Mark Lim from The Artisan Clinic

When done right, fillers can subtly enhance your facial features by smoothening out wrinkles, plumping up lips and sculpting your face. PHOTO: GETTY IMAGES

Celebrities from singer Katy Perry and former model Cindy Crawford to local personality Jamie Yeo are opening up about their use of dermal fillers to look younger. 

Dermal fillers are medical-grade gel-like substances to help reduce the superficial signs of ageing such as laugh lines, dark eye circles and wrinkles. They are injected into different areas of the face, and at different depths, starting from the forehead and temples to the mid-cheek and jawline.

When done right, fillers can subtly enhance your facial features by smoothening out laugh lines and wrinkles under your eyes, reducing dark eye circles, plumping up lips, and sculpting your chin and cheekbones to give your visage a little lift.

Unlike Botox which relaxes muscles and targets dynamic lines, fillers replace volume loss. Hyaluronic acid (HA) fillers are the most common and they are a possible option if you are looking for a less-invasive procedure to help with a youthful glow.

In fact, Dr Mark Lim from The Artisan Clinic is now seeing more patients coming in to get fillers for a “pre-juvenation” – showing up when the signs of ageing are mild instead of delaying it till later.

His consultation includes taking a detailed medical history of the patient, including previous surgical and aesthetic history and lifestyle habits. Dr Lim then performs a physical examination, followed by a 3D photographic skin and facial feature analysis before recommending an appropriate solution for his patient’s concerns. Treatment can range from using energy-based devices to injecting dermal fillers

More patients are interested in getting fillers for a “pre-juvenation” – to prevent signs of ageing even before they show, says Dr Mark Lim from The Artisan Clinic. PHOTO: THE ARTISAN CLINIC

When too much dermal fillers can backfire

When it comes to fillers, Dr Lim says his patients often ask for a more natural look. “They want improvements that are slight and not drastic, with no tell-tale signs of cosmetic interventions.”

However, even with that in mind, overuse of dermal fillers can happen and can result in Facial Overfilled Syndrome (FOS), a commonly seen but rarely discussed side effect of dermal filler use.

Overfilling the face with injectables can result in an unnatural look. It is often characterised by exaggerated facial features such as “pillow face” – a round and swollen-looking face accompanied by sunken or “sunset” eyes – and protruding “duck lips”.

“Some patients have unrealistic expectations and believe that by injecting more, the fillers would last longer,” explains Dr Lim. “Other times, overfilling could be due to repeated injections of fillers into the same area, which could lead to Facial Overfilled Syndrome.” 

For example, HA Fillers have an average lifespan of about one year. Sometimes, when patients choose to inject the fillers again before the one year is up, it can lead to accumulation of filler material over time.

Other reasons for FOS include poor filler choice – injecting a static filler too superficially such that it shows up on expression – poor filler placement or relying on just fillers alone to treat ageing instead of choosing a combination of anti-ageing treatments. Studies have shown that certain areas of the face when injected with filler yield better lifting results than others. Therefore, precise filler injections help save patients from being overfilled.

Some patients also think all their facial lines can be erased by increasing the amount of fillers in their face. Dr Lim adds that he has had to turn away patients who request for treatments in places on the face that would result in an unnatural look such as the forehead. Horizontal forehead lines can be better addressed with subtle Botox use rather than fillers to “stretch” out the lines, explains Dr Lim.

“Aesthetic medicine is a combination of artistry and medical science. The role of the physician is to educate patients about appropriate aesthetic outcomes, and the pros and cons of choosing such a treatment option,” he adds.

That is why he says it is important to do your research and find out which doctor is for you and is aligned with your aesthetic goals. 

Dr Lim says: “Fillers are not a one-size-fits-all solution. There should be a limit to the amount of filler that can be placed in a certain location and depth of the face. This is based on expert recommendation to reduce risk of unnatural results and complications. It is imperative to combine fillers with other treatments for lifting like Potenza or Cynosure 5D for the most natural results.”

The choice of fillers is extremely important because the characteristics of the fillers can influence the final appearance. PHOTO: THE ARTISAN CLINIC

Dos and don’ts of dermal fillers

Patients often ask how long their fillers will last but Dr Lim says it is not an exact science.

Hyaluronic acid, a component of fillers, is broken down by an enzyme in the body. The brand of fillers, depth of injection and other external factors such as physical activity and exposure to higher temperatures in saunas or hot yoga all affect the longevity of hyaluronic acid fillers.

There may also be possible side effects if the treatment is done improperly. A superficial injection may cause something called the Tyndall effect which casts a bluish tinge over the skin due to light scattering over the particles in the fillers, says Dr Lim. 

The choice of fillers is extremely important because the characteristics of the fillers can influence the final appearance. For example, one would not inject a static filler, which is stiff and hard, in delicate areas such as the under eyes or lips. Since static fillers are not able to move with facial expressions, they will break apart and migrate, resulting in visible lumps or facial stiffness.

A new type of filler is the Teosyal Resilient Hyaluronic Acid (RHA) filler. Known as a dynamic filler for its ability to stretch and bounce back, it can be integrated into facial tissue in mobile areas of the face such as the cheeks, laugh lines and lips without breakage or moving. 

It also does not require a lot of modification to prolong its longevity compared to other traditional hyaluronic acid fillers, allowing the doctor to layer the fillers more superficially on your face without it appearing unnatural or having a “lumpy” appearance. 

“This allows it to assimilate into the facial tissue nicely and also lets it accommodate big facial expressions with less risk of disintegration or migration,” adds Dr Lim.

For those who have not tried fillers and are thinking of doing so, Dr Lim’s advice is to look for reputable brands of static and dynamic fillers and to meet with doctors experienced in dermal injection techniques for the best results.  

It is also important to have realistic expectations before going for the procedure, says Dr Lim. 

“Choose a doctor whose aesthetic vision resonates with yours, is reputable and has great patient reviews,” Dr Lim adds. “The clinic should have the complete setup to do treatments for pigmentation removal, skin tightening, thread lifting as well so that it is not just a clinic that does fillers.”

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