DrFL Fillers – Overview

History
One of the earliest applications of dermal fillers was in the treatment of cancer patients who appeared hollow and gaunt, to help restore self image and confidence. These fillers tended to be permanent, and appeared somewhat artificial. As fillers became more extensively used for aesthetic applications, autologous fat came into fashion, as it was believed that using the body’s own fat as fillers was the most natural. However, as fat is “soft” and has no innate lifting capabilities, a large volume of fat is usually required to lift and rejuvenate the face, which may make the patient appear puffed-up, bloated, or like she has “done something to her face”.

Today
Advancements in hyaluronic acid (HA) based dermal fillers have revolutionalised minimally-invasive facial lifting and sculpting. With strong instrinsic lifting capabilities, the ability to keep its shape under stretch or compression, and the ability to integrate with the body’s tissues and stimulate natural new collagen formation, these HA fillers go beyond simply replacing lost volume, to effectively and naturally lift and contour the face with relatively small injection volumes, helping the patient look younger, rejuvenated, and in fact appear slimmer, despite having volume added to the face.

Under the face are multiple fat pads that are continuous with each other. To put simply, some of these fat pads help to lift and support the face, while other fat pads “weigh” the face down. As we age, we lose fat and collagen in the areas that provide support, while the effects of gravity worsens the dependent areas further, giving rise to the appearance of hollow temples and cheeks, sunken tear troughs, deep nasolabial folds and sagging jowls.

Combining a modern understanding of injection anatomy with advanced HA fillers with strong lifting capabilities, we are now able to selectively rejuvenate fat pads that in turn provide support to the dependent areas of the face, delivering for our patients a naturally lifted, youthful and vibrant appearance, that is safe, effective, and consistent over the years.

There is no perfect filler, but there are bad ones

Nowadays, a whole lot of science, research, and safety testing goes into every syringe of filler. On the contrary, a budget or unlicensed filler has little of those, commonly leading to unsatisfactory results or results that do not last, even potential complications. Amongst premium and reputable fillers, each product has its own unique properties, making it ideal for certain areas of the face, but unsuitable for others. For example, a product that is ideal for revolumising and lifting hollow and sunken cheeks, will feel hard and lumpy if injected in the lips.

At DrFL clinic, we use only premium fillers that are well studied, rigorously tested, licensed and approved. We carry a full range of fillers from soft to strong, stretchable to rigid, to ensure that the most ideal filler will always be used for your treatment.

Targets
Hollow, sunken temples

Expectations
Temples appear fuller. Smooth, natural curvature restored. Eyebrows on the side closer to the temples are lifted.

Impact
Hollow temples make a patient appear old and gaunt. Rejuvenating the temples returns the patient a youthful appearance, while the added effect of a lateral brow lift makes the patient’s eyes appear more “open”, and resultantly more energetic.

Combination
In more mature patients or patients who have less bony support in the temple area, fillers can be combined with the collagen stimulator Ellanse, for even better results, that will also last longer.

Targets
Sunken tear troughs, dark eye rings, fine undereye wrinkles, eyebags*, tired looking eyes

Expectations
Tear troughs (or under eye hollows) are significantly to completely smoothened out. Dark eye rings appear much less prominent. Fine undereye wrinkles are less visible. Mild to moderate eyebags appear less prominent and less droopy. However, severe eyebags* will not be improved by this procedure, for which surgical intervention may be required.

Impact
Sunken tear troughs and dark eye rings are notoriously unsatisfying to treat using only skincare products or lasers, as the primary cause for it is loss of soft tissue support as the body loses collagen in the area over the years. Tear trough rejuvenation using injectables directly restores this support, helping the patient’s eyes appear less tired, and the patient appear sharper and more energetic.

Combination
At DrFL clinic, we combine fillers to provide deep structural support that is natural and lasting, with collagen stimulating threads closer to the surface to more completely smoothen out the tear trough. This combination provides even more refined results, and much lower risks of lumpiness and discoloration, compared to conventional filler-only methods.

Targets
Flat, deflated cheeks, deep nasolabial folds, heavy jowls, prominent Marionette lines, saggy and droopy appearance.

Expectations
Cheeks appear fuller and lifted. Apex of cheek is restored to a higher position and in accordance to the cheek bones, conferring a youthful appearance. Selective re-inflation of specific fat pads that provide structural support to the rest of the face helps lift the nasolabial folds, jowls and Marionette lines, while also providing support to the tear troughs. This lift naturally and effectively improves the appearance of the aforementioned areas, which may then be further improved by direct injections, if still required.

Impact
Lifted and rejuvenated cheeks appear youthful and healthy, while restoration of the high point of the cheeks reflects light in a way that highlights the cheekbones in the front view, while restoring the natural Ogee curve in the oblique view, once again conferring a youthful and sculpted appearance.
Possibly the most important area for facial rejuvenation with fillers, the Mid Face Lift goes beyond simply rejuvenating the cheeks, to providing structural support for dependent and saggy areas of the face. As fillers stimulate natural collagen production in the areas it is injected, the face remains lifted even after the fillers have gone, due to the lift provided by the increased natural collagen in areas of the face that provide support.
Combination

In more mature patients or patients with a greater element of fat or loose skin, the Mid Face Lift can be further enhanced through combination with thread lift procedures that can provide superior mechanical support, and/or non-invasive energy based devices such as Ultherapy or Venus Legacy, to further lift the face and tighten skin. Combination therapy often means less of each product is required, which translates to lower costs and potential risks, results that appear even more natural, and results that last longer, due to synergistic effects on collagen stimulation.

Targets
Low nose bridge, short nose, asymmetrical nose, dorsal hump, upturned nose tip

Expectations
Nose bridge is ideally heightened according to proportions of the face, with natural continuity with the forehead. Asymmetry and dorsal hump appear less prominent. Nose tip is angled towards ideal according to proportions of the face.

Impact
Nose appears more powerful, bringing attention towards to middle of the face, visually correcting facial proportions towards ideal, making the face appear slimmer, and more sculpted.

Combination
At DrFL clinic, we rarely offer filler nose augmentation for women, as nose thread lifts confer a high, straight, slender and sculpted nose, with no risk of spreading or broadening, and most importantly, zero risk of blindness, an extremely rare but potentially catastrophic complication associated with filler nose augmentation.
In men, a slender nose with a sculpted tip from nose thread lifts may make the face appear more feminine. While some men do desire that trendy “Korean” look, traditionally men prefer a stronger and more powerful looking nose, that makes the face appear more masculine and authoritative. As such, filler nose augmentation are generally preferred in men, who fully understand and accept the abovementioned risk of blindness. Also in men, nose thread lift can be done simultaenously with the fillers for the nose to appear even straighter, highlighted, with light reflecting in a straight line down the middle of the nose.

Targets
Hollowing under cheek bones, heavy jowls, saggy jawline

Expectations
Hollowing or shadowing under cheek bones appear less prominent, healthy natural curvature restored to the side of the face. Jowls and lifted and jawline appears more defined. Face appears slimmer and more sculpted.

Impact
Very prominent, bony looking cheek bones with a sharp hollowing below is considered beautiful in many Middle Eastern countries, and is popular in Western culture as the “model” look. However, on an Asian face, it makes the person look old, gaunt, and fierce. Restoring a healthy, natural curvature to the side of the face brings the face closer to the Asian ideal of a reverse egg-shaped or heart shaped face, which confers a youthful, sweeter, and more approachable appearance.

Combination
The preauricular lift or “jowl lift” is a frequently requested procedure at DrFL clinic, as fillers are placed in an area traditionally targeted by plastic surgeons doing surgical facelifts. Selective rejuvenation of this area provides excellent support to the lower face, lifting and contouring the jawline, while improving the appearance of jowling. In patients with very heavy jowls or very saggy lower faces, this can be combined with thread lift that specifically targets lifting of the jowls, and/or non-invasive energy based devices such as Ultherapy or Venus Legacy, for even better lifting and support, that also lasts longer.

Targets
Thin lips, involuted (turned inwards) lips, flat lips, dry or cracked lips, fine lines on lips

Expectations
Lip volume restored, proportion between upper and lower lip optimised based on facial proportions and patient preferences. Cupid’s bow, philtrum columns, lower lip pearls and/or pouts can be created or optimised based on patient preferences and suitability. Lips appear plumper and hydrated. Fine lines on lips improve or disappear.

Impact
It is a myth that only Caucasian women are suitable for lip augmentation, or that lip augmentation means huge, overdone, “plastic” looking lips. As we age, our lips lose volume, become thinner, and turn inwards, leaving an old and haggard appearance. Restoring volume and proportion to lips, turning them back out slightly, hydrating and smoothening them naturally restores the appearance of the lips to the way they looked when the patient was younger, which can significantly rejuvenate a patient’s look, making her appear more youthful, happy, and desirable.
Combination

At DrFL clinic, we understand that lip augmentation is unique as the lips are not just seen but also felt (kissed), while constant contact (eating) can degrade a filler faster , giving rise to results that do not last. Therefore, we combine different fillers with unique properties to ensure optimum and natural results both visually as well as to touch, that are also long lasting. For example, we use a filler with strong lifting capabilities, Juvederm Volift, to provide strong foundations and lasting results. We layer it over with a filler of excellent elasticity, Juvederm Volbella, for results that look and feel natural. Finally, we use a filler that specifically targets skin hydration, Juvederm Volite, for a plump and hydrated finish.

Targets
Short chin, recessive (pointing backwards on side view) chin, asymmetrical chin, cobblestone chin, short or squarish lower face

Expectations
Chin lengthened and projected forward, to as close as possible to the ideal chin based on proportions of face and patient preferences. Asymmetry of chin corrected – sometimes, this makes the face appear more symmetrical as well. Cobblestone appearance partially to completely resolves. Lower face appears less squarish, slimmer, more defined, and in better proportion with the face.

Impact
Genetically, Asians tend to have smaller and weaker bony support in the chin area, leading to the undesirable appearance of a short and recessive chin, and/or a lower face that is disproportionately short compared to the rest of the face. By providing support to this area through chin augmentation, facial proportions can be optimised in both front and profile views. In women, the lower face curves sweetly and continues naturally with the gentle oval of the chin for an ideal V-shaped face. In men, the lower face appears more angular and chiselled with a more powerful and pronounced chin, giving a more masculine and authoritative appearance. In both women and men, attention is brought towards the centre of the face, making face appear slimmer, and more defined.

Combination
Threadlift to the neck can lift and tighten skin just under the jawline , which will further define the jawline while reducing the appearance of a double chin, acting as an ideal complement to chin augmentation for sculpting and contouring the lower face.

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