22 February 2021
How do you tell if someone has had cosmetic enhancement with dermal fillers? The truth is, unless you have before and after pictures to compare; it can be hard for an untrained eye to tell with subtle enhancement done by expert doctors. Dermal fillers are one of the most popular aesthetic treatments in Singapore; and they are a versatile way of sculpting the face to enhance facial proportions and correct signs of aging like laugh lines. However, the more isn’t necessarily the merrier with dermal fillers; in fact too much dermal fillers can make you look dysmorphic.
In this blogpost, I’ll be sharing general and specific tips on how you can avoid looking like you had too much work done. But let’s start with the fun part- a look at some of the giveaways that someone’s had too much fillers injected into their faces.
Update January 2021: Facial swelling in a few patients who received the Moderna COVID-19 vaccine has been reported. You can read more about this report and why it happened in this blogpost COVID-19 Vaccine & Facial Swelling After Dermal Fillers.
For a short while (thankfully), pillow face was the de rigeur look to emerge from Hollywood- round, overinflated faces accompanied by sunset eyes.
As we age, changes to the soft tissues and bone resorption cause the cheeks to look flatter and more hollow. Cheek fillers are often used to correct these signs of aging by restoring cheek plumpness and lift the face (the Liquid Facelift). You can read more about cheek fillers and see how it’s done in my clinic in this blogpost Getting Cheeky: A Guide to Cheek Fillers.
A little goes a long way with cheek fillers. The truth is with cheek fillers, you don’t need that much volume of dermal fillers, even if you are looking to create apple cheeks. Overdone cheek fillers can cause a pillow face- an overly puffed up face that looks distorted.
Not to be confused with chipmunk cheeks (the name is self explanatory), pillow cheeks describe the look when excessive cheek fillers obliterate the natural lid-cheek junction. This causes a continuous swollen face from the lower eyelids to the mid face, like a pillow. The eyes also look smaller and squashed together. The shape of the eyes look like that of a setting sun over the horizon, hence the description, sunset eyes.
How can pillow face and sunset eyes from cheek fillers be avoided?
Look for a doctor with the aesthetic sensibilities to know when to stop-after all, the difference between just right and overdone, is really just one syringe of dermal filler away. It will also help if you speak to your doctor to understand her style and concept of beauty and it differs from doctor to doctor. My preference is to keep to natural looking facial proportions in line with your ethnic group- less is definitely more. Apple cheeks may not be preferred in some cultures and ethnicities.
Secondly, you can consider alternatives or combinations with cheek fillers, so that the total volume of cheek fillers you require are lesser. Using a smaller volume of cheek fillers avoids the overfilled syndrome ala pillow face and sunset eyes. Treatments like Profhilo to rejuvenate and lift the skin and face threadlifts can also restore cheek contours.
Profhilo is an anti-aging treatment for the skin. It contains a high concentration of hyaluronic acid with a unique biochemical structure. This allows Profhilo to hydrate and bioremodel the skin to gently lift the skin and improve skin firmness and texture. Profhilo is not a dermal filler. You can read about the details of Profhilo and see how I do it in this blogpost is Profhilo the Injectable Skincare of the Future?
Face threadlifts are another way to lift the skin and soft tissues of the face. This helps to restore the natural facial contours that have sagged due to aging. In a face threadlift, very fine dissolvable threads lift and skin. The threads used in face threadlifts also stimulate the face to build collagen so that the lifting results are more sustained. You can read more about face threadlift in this blogpost, Silhouette Soft Face Threadlift.
The pursuit of a higher and slimmer nose bridge are among the common reasons patients request for nose fillers. Nose fillers in the bridge can elevate the nose bridge for a slimmer and more elegant look. For patients with a broad and low nose bridge, nose fillers are a convenient in-clinic treatment for nose enhancement.
One of the lesser known side effects of nose fillers is the appearance of the Avatar nose. The broadening of the nose bridge occurs due to the nose fillers spreading sideways. The appearance is akin to the blue Na’vi in the movie, Avatar, hence the name Avatar nose has been coined to describe this side effect of nose fillers.
How can Avatar Nose from nose fillers be avoided?
There are safer alternatives to nose fillers in Singapore. Some of the complications of nose filler include blindness and tissue necrosis due to occlusion of the blood vessels. Alternatives like the Hiko nose thread lift can elevate and slim down the nose bridge and tip while avoiding these complications of nose fillers.
The Hiko nose thread lift is a non-surgical nose augmentation that is popular in Singapore, South Korea and the Philippines. The Hiko nose thread lift originated in South Korea and involves the precise placement of threads to lift up the nose bridge. The nose threadlift works by a twofold mechanism- first the threads mechanically lift up the nose bridge for a higher and slimmer nose. Secondly, the nose threads build collagen along the path of threads as they dissolve. As the threads do not spread sideways or penetrate blood vessels, the complications of nose fillers like the Avatar nose and blindness are bypassed.
You can learn about how the Hiko nose threadlift is done by me and more differences between nose fillers vs the Hiko nose thread lift in this blogpost Hiko Nose Threadlift: All You Need to Know. With that post, you’ll also understand why the Hiko nose thread lift is preferred for non-surgical nose enhancement.
The lips are one area where it’s easy for fillers to go horribly wrong.
Fuller lips are sought after as plumper lips are thought to be more attractive. As we age, our lips thin and lose their natural, full shape due to collagen loss. Lip fillers can be used to plump up and refine the shape of the lips.
Overdone lip fillers can be unforgiving. There are many terms to describe overfilled lips- duck lips, sausage lips, trout pout. Although celebrities like Kylie Jenner have made overfilled lips mainstream, unnaturally swollen lips due to excessive lip fillers can look disproportionate.
Besides avoiding overdoing lip fillers, consider non-surgical alternatives like the Botox Lip Flip or use lip plumpers.
In the botox lip flip, a small dose of botulinum toxin is injected into the muscles around the mouth to flip out the edges of the lip. This gives the illusion of a fuller lip without actually adding volume to the lips. The results of Botox Lip Flips are more subtle than lip fillers.
Another non-invasive alternative to lip fillers is lip plumpers. Lip plumpers are lip serums that are applied to the lips. They contain ingredients like menthol that increase blood flow to the lips, causing them to plump up temporarily. Lip plumpers are non-invasive; however the disadvantage is that lip plumpers may cause contact dermatitis in some people. You can read more about lip plumpers in this blogpost NoTox: Non-Invasive Botox Alternatives- Which Ones Work and Which Ones Don’t?
In ideal facial proportions, the face is divided into equal thirds. For patients with a short or square shaped chin, chin fillers are one way to lengthen and shape the chin. Improving facial proportions of the lower face can give the face a slimmer look. Chin fillers are often combined with masseter botox injections (to slim down the sides of the face) for a more defined jawline and a slimmer silhouette.
Chin fillers can also be used to correct chin asymmetries and ‘butt chin’ in both males and females. When done by an experienced doctor, the results of chin fillers can be very natural and harmonious with the rest of the patient’s facial features. However, there is a risk of developing a witch’s chin if the chin filler is overdone. A pointy and protruding chin can make one look villainous instead of enhancing one’s appearance.
How can witch’s chin from chin fillers be avoided?
Besides choosing an experienced doctor for your injectables (injecting chin fillers with the wrong technique can also cause a witch’s chin), you can consider alternative treatments to shape the face.
In my practice, chin fillers are often accompanied with jaw reduction botox injections. In patients who have large jaw muscles (i.e. masseter hypertrophy) or grind their teeth (i.e. bruxism), relaxing the jaw muscles with masseter botox is a useful treatment. Botox jaw injections relax and slim down the sides of the lower face to improve facial proportions. A smaller amount of chin filler is needed after masseter botox injections so the risk of distorting the face or witch’s chin is much lower.
Forehead fillers can fill up the forehead to reduce the bony contours or increase the convexity of the forehead. Excessive forehead fillers can cause an overinflated forehead, like that of a Flowerhorn Cichlid fish (Luohan fish), hence the moniker, Flowerhorn Forehead.
Dermal fillers are a useful way to restore natural contours and sculpt the face. Having a balanced approach is the key to having good results without overdoing dermal fillers. Overfilling with dermal fillers distorts the natural appearance of the face and looks very unnatural.
Besides the specific alternatives to avoided these looks, here’s a couple of general tips to consider before getting dermal fillers:
• Choose an experienced doctor who is very familiar with facial anatomy and has an understanding of cultural preferences across different ethnic groups. For example, cheek fullness may be a sign of youth but apple cheeks are not preferred in some cultures. A slim and high nose bridge may look very unnatural if the natural ethnic anatomy is not respected.
• Choose a gentle approach to dermal fillers, especially if it is your first time getting fillers. You can always get your results topped up, so I would suggest doing less if you are uncertain. I personally prefer a less is more approach; using small amounts of dermal fillers (or combination treatments) to enhance your appearance and facial proportions, without overdoing or looking like someone different. An analogy would be doing Baby Botox to erase wrinkles without freezing the facial muscles. I share my personal results of Botox for my wrinkles in this blogpost Baby Botox and Preventive Botox in Your 20’s.
• Consider using reversible dermal fillers. There are several types of dermal fillers available in Singapore and the only types of dermal fillers that can be dissolved away with the antidote are hyaluronic acid fillers. If you dislike the results of your dermal filler injections, the effects can be reversible. If you had non-reversible fillers like Ellanse, Radiesse and Sculptra injected, the effects cannot be reversible. You can read more about the different types of dermal fillers available in Singapore in this blogpost Botox vs Fillers: Differences, Uses, Effects and Myomodulation.
I hope that you found this blogpost on dermal fillers useful! Have a good week ahead.