Skin filler – a misnomer

When a person is offered a skin filler treatment, often the first reaction is: “Will it make me look fatter? I don’t want that!”

The term skin filler is a misnomer. The term was coined in the 1980s to describe collagen injections. The intention then was to fill up any skin wrinkle and crease.

Now, we know skin fillers are actually skin sculptors – they can be used to sculpt the face.

For example, when placed on the bone called zygoma at the side of the face, it can lift the face, resulting in a slimmer face. It can also lift the eyes, improve the appearance of eyebags, reduce the nasolabial folds along the sides of the nose that give us an aged look, and lift the lines that run from the corners of the mouth to the chin, called the marionette lines.

Skin fillers are also lifters. The face has ligaments, which hold the fat pads and muscles together. When placed on the appropriate ligaments, fillers can have a lifting effect on the face -like a pulley system.

Treating emotions – not lines!

Patients often walk into an aesthetic clinic and request: “Remove my lines, fix my nasolabial folds” etc. The days of merely fixing lines are over.

Dr Mauricio de Maio, a plastic surgeon and trainer for Juvederm fillers, devised a system to assess patients. He divided desired looks into positive attributes that a patient likes to have, and negative attributes that a patient wants to correct.

Positive attributes include looking more attractive, younger, slimmer and have a nicer face contour, and more feminine or masculine, depending on the gender. Negative attributes include looking less saggy, less tired, less angry and less sad.

The focus now is on treating the emotions of the patient. Emotions here do not refer to how patient feels but how he or she looks.

Once the negative attributes are fixed, usually the positive attributes will show through.

Fillers – more is more! Holistic treatment to improve Beauty Quotient and Aging

There are still practitioners out there who believe in “less is more”, thinking that injecting more fillers will puff up faces and give people an un-natural look.

Yes, we do see the overfilled faces in certain celebrities and public figures. But that only happens when the wrong volume or type of skin filler is placed, especially in the middle of the face.

In actual fact, more is more. When more materials are available, the beauty quotient of a face can be considerably improved and more years can be taken off the age of the face.

Foundation, Contour, Refinement – steps to Beautify and Youthify

Building a beautiful and youthful face is like constructing a house. First, one must lay the foundation. Second, construct the contour, just like how you would the architectural exterior of a building, to make it aesthetically appealing. Finally, like renovating and furnishing a room, one goes for refinement of the facial features, such as the eyes or the lips.

To lay a good foundation, skin fillers are injected into the cheek and temple areas, and sides of the face.

To attain a nice contour, fillers are injected along the jawline and chin areas. An attractive and youthful female face, for example, is usually oval-shaped. Also, Asian chins are often too short and the faces appear boxy. This can be corrected to achieve a more attractive shape.

Once the foundation is laid and contouring of the face is done, it will immediately appear less saggy and more attractive.

Refinements can then be made to the eyes, nasolabial folds, and lips.

MD Codes – the Da Vinci codes to the Face

Dr de Maio devised the MD codes, which is a system that helps injectors choose the areas to inject in order to deal with a specific problem. The system is very precise in also determining the quantity, method, layer, and depth of injection.

For example, to fix a sad looking face, one has to lay the foundation, fix the contour and then refine the areas around the eyes, mouth and lips. It is almost like a mathematical formula!

How many fillers are enough? I don’t have the budget!

Typically, an average of twelve syringes of fillers is a good number to make the face look more beautiful and youthful. But fret not if you don’t have the budget. The injections can be spaced out into three sessions over a period of time.

Now, most people would ask: “Isn’t that too much?” The simple answer is no. Think about it, 12 cc of filler is not even enough to fill a tablespoon.

Take care of the face animation, silly!

In the past, skin fillers are often injected so that the faces appear really good at rest. But when the face moves and animates, it appears stiff and un-natural.

Updated techniques take into consideration face animation during injection. Typically, before and after photographs are taken in the following expressions for comparison: at rest, smiling widely, being angry, being surprised, while kissing, and looking like a crybaby. This consideration ensures good results when the face is at rest and during animation

Prevention, prevention, prevention – it’s better than Cure!

Nowadays, in consultation, we often ask for the photograph of the patient’s mother or father. This is to get a good idea of how the patient will age in time to come.

Some people age well, but most people don’t. We treat patients early now to prevent future problems. Like the adage goes – prevention is better than cure. Age well, look good and stay healthy.

We can start treating when the patient is in her thirties for prevention purpose. In younger patients whom we treat, it is to beautify the face.

Men get it now – it’s not vanity, it’s survival!

In the past, we think only metrosexuals would undergo aesthetic treatments. Not anymore.

Today, more men are receiving filler injections. They find it more acceptable than going under the knife. Men are beginning to see having a youthful and energetic appearance as an edge at work and in the dating scene. Injections for men are slightly different from women. For example, we aim for a more square jaw, to accord a masculine look.

Plastic surgery and Filler injection – which is better?

Filler injections have minimal downtime in experienced hands, save for the occasional bruise.

Admittedly, only plastic surgery can fix very saggy skin and severe eyebags. But most locals find the downtime a big problem. Hence, there is an increasing preference for skin fillers.

Also, in some areas like the chin and jawline, fillers can provide very precise sculpting that implants can’t. Furthermore, it is very difficult to operate on the lips compared to injecting fillers to get the desired shape and size.

Fillers can also be dissolved, so that any undesired results can be erased. Surgery, of course, is permanent.

Not my lips, honey – wrong concept

Local patients usually do not like to have their lips injected, thinking it will make them look like Joker’s lips. Obviously, it is not helped by some of the grotesque pictures coming out of Hollywood. They think it is better suited to Caucasian lips.

Nowadays, we often advocate lip injections to accord shape and to support the sides of the lips, called lateral commissures, so that the face will look less sad and angry.

This article is written by Dr Steven Ang, who is a student of Dr Mauricio de Maio, respected plastic surgeon and trainer of Juvederm fillers. He practises at Dr Steven Aesthetics and Laser Clinic located at Blk 75D Redhill Road #01-86, Tel 64767333.