Botched filler jobs on celebrities and influencers have sparked fear, but the truth is, fillers can be amazing when done right. This article explores what goes wrong—and how to get fillers done beautifully.
WORDS DR SIEW TUCK WAH
 FEATURED EXPERTDR SIEW TUCK WAH Medical Director Radium Medical Aesthetics |
Dermal fillers, or soft-tissue fillers, are a popular minimally invasive treatment which sees the doctor injecting a substance—most commonly hyaluronic acid—under the skin to plump up the targeted area.
This treatment has become very popular in recent years, as it is very effective and safe when performed by a qualified and experienced person.
HOW FILLERS CHANGE THE WAY WE APPROACH AGEING
Instead of having to undergo a facelift surgery, we can now take years off our faces in just about an hour using minimally invasive injections.
Fillers can be used to treat many areas on the face, including the forehead, cheeks, temples, lips, and jawline (see the image above). It can also be used to enhance facial features such the nose and chin.
The Search for the Perfect Apple Cheeks
You may have heard of ‘apple cheeks’, an endearing term used to describe rounded cheeks in women that resemble apples, particularly when smiling.
Such an appearance is very sought after, especially in Asian cultures, as apple cheeks embody youthfulness.
Ageing Isn’t Kind to Apple Cheeks
Apple cheeks are formed mainly by the deep fat compartments found beneath the muscles of the face that are responsible for facial expressions.
As we age, it is not only the skin which becomes less elastic. The ageing of the cheek area involves all facial structures: fat, muscles and even bones.
Hence, we lose volume in the cheeks as we age, and our previously rosy apple cheeks look less full.
The skin and superficial fat pads of our face will sag due to gravity, giving the appearance of folds and wrinkles.
Finally, with the resorption of bone in the cheek area, less support is available for the other complex structures that form the cheeks. This worsens the sagging even further.
Fillers Can Restore Those Apple Cheeks
Some of the most common areas for filler injection administration are the cheeks and the undereye.
Upon injection in these areas, fillers will create volume in the cheeks to restore the apple cheeks that have been affected by ageing time.
The doctor can also use fillers to lift the skin around the cheeks.
There Is a Downside…
The rampant and indiscriminate use of fillers have given rise to the huge problem in medical aesthetics that we see today: the overfilled syndrome.
THE OVERFILLED SYNDROME
You don’t have to look very far to understand what the overfilled syndrome is all about.
Everywhere you look, you can see famous faces that appear unnaturally puffed up. The term ‘pillow face’ is often used to describe such unnatural and puffy looking cheeks, which are more often than not due to filler injections.
It is so widespread that you see it in many celebrities and even politicians both male and female all over the world. Just open up your Instagram!
The Cause of This Is Two-Fold
One, doctors are putting in too much filler.
Two, doctors are re-injecting filler too often.
Overfilled faces often do not happen overnight. They happen when patients undergo repeated filler injections.
The Biological Changes Caused by Overfilling
When we inject more and more fillers into the same area in the cheeks, the cheeks become heavier and start to sag downwards due to gravity.
As the cheeks sag, folds and wrinkles began to appear. This prompts the person to seek more filler injections, which in turn causes a vicious cycle of increasing sagging and overfilling.
When you look at certain celebrities’ pictures, you will notice that their cheeks become increasingly plumped up over the years as they age. This is a tell-tale sign that reinjections of fillers were done before the original ones were metabolized.
Why Many People Don’t Seem to Notice That Overfilling Is Happening Until It’s Too Late
Reason 1: Visual Adaptation
Believe it or not, our concept of what beautiful is will change based on what we are exposed to.
Because we are exposed to more and more exaggerated facial features on platforms such as Instagram, we begin to accept these features as being normal and even beautiful.
What we used to think of as being unnatural—thick fish lips, exaggerated cheekbones—slowly become normalized in our subconsciousness as we see them repeatedly around us on TV, social media, etc. This phenomenon is known as visual adaptation.
Reason 2: Perception Drift
Perception drift is a phenomenon first described by US dermatologist and cosmetic surgeon Dr Sabrina Fabi.
As we undergo repeated cosmetic procedures over time, we forget how we used to look like.
Because of this, what we want to achieve with cosmetic procedures begin to shift as well.
We end up wanting more and more, and our facial features change as a result, without us realizing it.
This phenomenon also applies to doctors. Their patients come asking for more, and the doctors, unable to recall the patients’ original appearances, oblige, thus creating puffed-up faces unintentionally.
Reason 3: Fillers last longer than most people think!
Traditionally, it was believed that fillers last 6 months to 1 year.
This information is derived from what we know from past studies on fillers that were submitted to the US Food and Drug Administration or FDA for approval of the use of these fillers.
Fillers tend to last much longer than the 6 to 12 months cited in many scientific papers!
The longevity of these fillers depends on the site of administration on the face. It can also vary between individuals even when the fillers were injected in the same location.
From my own personal experience, fillers often can last for at 2 to 4 years, and even up to 10 years. Accounts from other medical professionals also corroborate with my experience—for example, certain hyaluronic acid dermal fillers can last for years in our face!
Yet, many people go for reinjections of fillers every year. This frequent reinjection, combined with errors in judgement caused by perception drift, is a main reason as to why overfilling has become more and more common.
WHY FILLERS CAN COMPLICATE A SIMPLE SMILE
Soft tissue filler injections are mostly done when the patient’s face is at rest.
The problem here is that, when the doctor puts in enough filler to make the cheeks look full while the patient’s face is at this resting position, too much is already put in.
Because of this, the fillers get pushed upwards and outwards each time the patient smiles. This will only make the puffiness look more obvious and, frequently, worse!
Hence, while performing filler injections on their patients, the doctor needs to take great care to make sure that the patient looks natural both at rest and while expressing facial expressions.
TIPS & ADVICE FOR MY FELLOW AESTHETIC DOCTORSKeep Meticulous Detail of the Patient’s Appearance
Less Is More!
Combination Treatments Are Key
Work Progressively and Slowly
|
IF YOU LOOK PUFFY AFTER GETTING FILLERS, IT’S NOT THE END OF THE WORLD!
Fortunately, most fillers are made of hyaluronic acid, which gets metabolized by the body after some time. They can also be dissolved immediately with an enzyme called hyaluronidase.
Actress Courteney Cox famously had her fillers dissolved in 2017, as she felt she did not look like herself anymore.
Don’t Do Any More Fillers Until the Previous Ones Have Been Fully Metabolized
- You can also consider dissolving the current fillers in your face and start over, this time making sure that you and your doctor go slow.
Bring ‘Before’ and ‘After’ Photos for the Doctor to Have a Close Look
- This will help reduce perception drift on both your and your doctor’s part.
| This article is part of a series that take a scientifically proven look at aesthetics and beauty. |
References:
- Mendelson, B., & Wong, C. H. (2020). Changes in the facial skeleton with aging: Implications and clinical applications in facial rejuvenation. Aesthetic plastic surgery, 44(4), 1151–1158. https://doi.org/10.1007/s00266-020-01823-x
- Lipko-Godlewska, S., Bolanča, Ž., Kalinová, L., Kermen, I., Onisak, B., Papp, I., Rebrov, M., & Valančienė, G. (2021). Whole-face approach with hyaluronic acid fillers. Clinical, cosmetic and investigational dermatology, 14, 169–178. https://doi.org/10.2147/CCID.S292501
- Mendelson, B. C., Muzaffar, A. R., & Adams, W. P., Jr (2002). Surgical anatomy of the midcheek and malar mounds. Plastic and reconstructive surgery, 110(3), 885–911. https://doi.org/10.1097/00006534-200209010-00026
- Webster, M. A., & MacLeod, D. I. (2011). Visual adaptation and face perception. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 366(1571), 1702–1725. https://doi.org/10.1098/rstb.2010.0360
- Sola, C. A., & Fabi, S. G. (2019). Perception drift. Dermatologic surgery : Official publication for American Society for Dermatologic Surgery [et al.], 45(12), 1747–1748. https://doi.org/10.1097/DSS.0000000000001823
- Cotofana, S., Gotkin, R. H., Frank, K., Lachman, N., & Schenck, T. L. (2020). Anatomy behind the facial overfilled syndrome: The transverse facial septum. Dermatologic surgery : Official publication for American Society for Dermatologic Surgery [et al.], 46(8), e16–e22. https://doi.org/10.1097/DSS.0000000000002236
