Why a face looks sunken
With age, collagen and elastin fall, deep facial fat pads are lost and bone resorbs. Some people naturally have less facial fat. Smoking, heavy sun exposure, poor diet and significant weight loss can add to the change. In Asian patients, the cheeks, under-eye area and temples are commonly affected. Temples hollow as bone remodels, fat thins and the temporalis muscle can lose bulk.
The signs include hollow temples and eyes, deep tear troughs, flatter cheeks and deeper lines. Laxity is a separate cause that often sits alongside these. Dr Sin Yong starts by separating true volume loss from tissue that has descended, because filler suits one and lifting suits the other.
Sunken face treatment Singapore: matching the need to the method
| What you notice | Method that may fit | Limit |
|---|---|---|
| Hollow temples | Temple filler with hyaluronic acid, placed deep or under the skin | Supports the brow tail but does not lift a descended brow |
| Flat or hollow cheeks | Cheek filler, with hyaluronic acid or a biostimulator chosen at assessment | Does not tighten loose skin |
| Deep structural loss in the midface | Radiesse or Ellansé placed deep | Cannot be dissolved |
| Diffuse volume loss | Sculptra | Not for lips or fine lines |
| Tear trough hollows | Hyaluronic acid filler | Filler does not iron out lines |
| Descended tissue with some hollowing | VF Lift or Time Freeze Laser first | Filler then covers only the remaining deficit |
| Skin firmness | RF microneedling | Aimed at firmness, not volume |
Choosing a product
Products behave differently. Hyaluronic acid can be dissolved with hyaluronidase. It is used for tear troughs, superficial placements and a discrete temple hollow. Radiesse is calcium hydroxylapatite and Ellansé is polycaprolactone. Both are biostimulators used for deep structural volume, and neither can be dissolved. Sculptra is poly-L-lactic acid, listed for diffuse loss. The product, plane and amount are chosen for each area. Volume is added conservatively and reviewed step by step, which helps to avoid a pillow face look. Earlier filler of unknown type in the same area needs assessment before any more is placed.
How placement works
Filler is layered on bone for structure and in the subcutaneous fat for contour. A cannula is used for broader volume and a needle for precise points.
A needle goes onto bone beneath the temporalis, typically for a deeper concavity under reasonably thick skin.
A blunt cannula places a thin sheet of softer gel, typically for a shallow hollow or thinner skin.
The temple is assessed before the cheek, since an empty temple can make the cheekbone look wider.
Cheek symmetry is checked with photos after treatment, with a review at two weeks.
Why lifting may come before filler
Adding filler to tissue that has descended can add heaviness, especially in the lower face. Where both volume loss and laxity are present, lifting is usually done first, so that less filler is needed. The VF Lift uses monopolar radiofrequency with no injectables, threads or incisions. It can be planned for hollowing with laxity, and a very thin face is treated with restraint. HIFU and Ultherapy are not used on lean faces, because they can make hollowing look worse. RVR ProLift repositions tissue with no threads or energy, but it does not replace lost bone or deep fat.
How a filler visit goes
Who this suits
It suits people with true volume loss in the cheeks, midface or temples, and those with reduced cheekbone projection after age or weight change. A concave temple at rest, with reasonably thick temporal skin, is a typical case for temple filler. You need realistic aims for softer, more natural support, and you need to accept that a consultation may decide against filler. Mild to moderate midface descent can also be suitable for cheek filler.
Who should wait or avoid it
This includes planning a pregnancy.
Active problems in the area come first, including a cold sore.
A known allergy to a filler component or lidocaine needs another plan.
Bleeding disorders or blood thinners are reviewed first.
These are reviewed individually.
Filler of unknown type in the same area, or non-absorbable filler, must be disclosed.
Temporal headache or jaw pain needs assessment first.
What treatment cannot do
Filler adds volume. It does not lift.
Added volume on lax tissue can make the lower face look heavier.
Marked sagging with heavy skin excess is referred to a plastic surgery specialist.
Hyaluronidase has no effect on Radiesse, Ellansé or Sculptra.
Sculptra is not for lips or fine lines.
Risks and side effects
Swelling, tenderness, redness and bruising are common and usually settle. After temple filler, a dull headache, tightness and chewing discomfort can also occur. Less common problems are lumps, asymmetry, migration, an overfilled look and delayed nodules. Vascular occlusion is rare but serious. Pale, dusky or mottled skin, or severe or worsening pain, needs same-day assessment. Any change in vision is an emergency, so go to the nearest hospital emergency department. See the warning signs page. Hyaluronidase is kept on hand for hyaluronic acid cases.
Recovery and fees
For the first 24 hours, avoid pressing the area, heat, alcohol and hard exercise. A cool compress can help. In the first week, keep the area clean, and avoid facial treatments and dental work unless your doctor agrees. Use sun protection, and avoid strong sun and saunas early on. Fees depend on the product, the amount, the number of areas and planes, and whether lifting is needed first. A written quote is given at consultation, and that visit also decides whether filler is advised at all. The final contour is judged once swelling has gone.