What filler correction is
Filler correction starts by asking what is already there. The filler is what is being assessed, not your face. Adding more is one option among several, and for filler that already feels heavy it is rarely the first one. Taking some away, treating what cannot be dissolved, waiting, or doing nothing are all legitimate outcomes.
Hyaluronic acid filler can stay in tissue for longer than many people expect. [3] It often arrives one reasonable appointment at a time, and a face can carry layers from several years. Published guidance on hyaluronic acid filler links problems to the patient, the product and the procedure together, and a consensus group wrote that most relate to sterility, placement, volume and injection technique. [7] [8] So the first job is to find out what is there and where it sits.
Dr Sin Yong assesses and treats this himself on Orchard Road. You do not need a complication to have your filler looked at.
What it deals with
A face that looks rounder, flatter or heavier than it should. This may be the pattern called pillow face. See pillow face treatment.
Fullness where filler was not meant to be, such as the lip border, under the eyes or along the jaw. Ultrasound shows where it now sits.
A firm area you can feel or see, weeks, months or years later. What it is decides what can be done. See Ellansé and Sculptra lumps.
Product, or the collagen it prompted, has built up along the cheek or jaw and adds weight to tissue that is already descending. See jowls treatment.
You may not know what was injected, or when. Ultrasound often helps to show what is there.
It does not have to be a complication. A result you are unhappy with is a fair reason to ask.
What each filler needs
What can be done depends on what the filler is made of. Hyaluronidase acts on hyaluronic acid. [1] [2] It does not dissolve other filler materials. For these, published management has mainly involved medicines injected into the nodule and surgery, [9] [10] with energy-based devices in a minority of reported cases, [5] slow natural breakdown for polylactic acid, and sodium thiosulfate described for slow CaHA breakdown. [11] This is where Dr Sin Yong uses the Sculpting mode, and that use rests on his clinical experience.
| Material | Examples | Dissolved by hyaluronidase? | What Dr Sin Yong does |
|---|---|---|---|
| Hyaluronic acid | Most soft gel fillers | Yes | Usually dissolved, in a targeted way, after mapping. |
| Polycaprolactone (PCL) | Ellansé | No | Sculpting mode, after mapping. |
| Poly-L-lactic acid (PLLA) | Sculptra | No | Sculpting mode, after mapping. |
| Poly-D,L-lactic acid (PDLLA) | Juvelook, Lenisna | Only the hyaluronic acid part | Sculpting mode, after mapping. |
| Calcium hydroxylapatite (CaHA) | Radiesse | No | Sculpting mode, after mapping. |
| Layered filler | Hyaluronic acid over a collagen stimulator | Hyaluronic acid part only | Hyaluronic acid first, then reassess, then the Sculpting mode on what remains. |
| Grafted fat | Your own fat | No | Superficial excess may suit the Sculpting mode. Large, deep excess is referred. |
| Silicone or PMMA | Permanent fillers | No | Mapped first. The Sculpting mode may be used, and surgical removal is discussed where it fits. |
What the ultrasound map shows
Ultrasound shows where filler sits, how large it is and which layer it is in. It can also help to identify the type of filler, and polycaprolactone has a recognisable appearance on a scan. [12] [13] A consensus panel advises identifying earlier filler before anything is injected, and calls ultrasound necessary for managing complications. [4] This matters because an injection record can be missing or out of date. Dr Sin Yong performs the scan himself and looks at each area before deciding anything.
A scan has limits. It may not settle what a lump is, and if the picture is uncertain he says so. It also does not replace looking at your face at rest and in expression, and feeling for depth, firmness and edges.
Dissolve, treat, wait or refer
The scan and the examination lead to one or more of five decisions, in a planned order.
Hyaluronic acid is usually dissolved with hyaluronidase, aimed at the excess and not the whole area. It is done in stages with a review between them, to avoid over-correcting the face in one sitting. See filler dissolving.
Where the excess is PCL, PLLA, PDLLA or CaHA, he directs laser energy at each mapped deposit, layer by layer, in the same visit and without an incision. See Time Freeze Laser LCLR®.
A lump that is red, hot, tender or growing quickly is treated as an inflammatory or infected problem first. It is never lasered while active.
Recent filler, swelling or a bruise may need time before anything is decided. Waiting is a plan, and so is doing nothing.
Permanent filler such as silicone or PMMA, or deep material that remains after other steps, may need a surgical opinion. Cutting filler out leaves a scar and has its own risks.
“Hyaluronic acid can be dissolved in minutes. A collagen stimulator cannot — it has to be remodelled.”
The visit, in order
Why more filler is rarely the first step
When a face feels heavy, it can be tempting to balance one area by filling another. That adds to the total amount of product in the face. Dr Sin Yong looks at what is already there before anything new is added.
Where and how filler is placed matters. A review attributes facial overfilled syndrome to excessive filler and to injection technique, and says anatomy plays a significant role. Its authors conclude that it mostly affects people of East Asian descent, and the abstract gives no prevalence data. [14] Filler may still have a small place later, once the excess has been dealt with and the face can be read properly.
If your filler was done overseas
Bring what you have: the product name, the date, the areas and the number of sessions. If you have no records, the assessment still goes ahead, and ultrasound helps to show what is there. Some products used abroad are not registered in Singapore, and a few are permanent, so finding out what is there comes first.
Correction is often staged, so plan your trip around the assessment and a review. See the guide for overseas patients.
What filler correction cannot do
Tissue may have stretched and ageing has carried on. The aim is the excess, not a return to a past photograph.
Some material usually remains. A collagen response, once formed, is your own tissue.
Hyaluronidase has no effect on PCL, PLLA, PDLLA, CaHA, fat or silicone.
Dissolving does not tighten skin. Lax skin is a separate question, and it may need lifting or a surgical opinion.
A suspected vascular occlusion is an emergency that needs urgent care, with hyaluronidase used where the filler is hyaluronic acid. Time Freeze has no role here.
Risks to understand
Swelling, redness and bruising can occur. Allergic reactions are uncommon but can be serious, so allergy is screened for. The enzyme can also act on your own hyaluronic acid, which may leave an area looking hollower.
Tenderness where filler was targeted, and less often small crusts or temporary darkening. Rarely a burn, blister, lightening, scarring or more fat loss than intended. Eye injury is possible if eyes are unprotected. Treatment waits in pregnancy, on freshly tanned, sunburnt, infected or inflamed skin, and after a recent course of oral acne medication.
A lump that is left alone may stay. Any lump that grows, turns red or becomes painful needs a doctor the same day, or A&E if none can see you.
Surgical removal leaves a scar and can cause dents or nerve injury. A surgeon will explain this.
What affects the fee
Fees are not published here. They depend on the areas involved, the extent of ultrasound mapping, how much is dissolved or treated, and how many stages the plan has. A written quote follows the assessment. See how fees are quoted.