Dermal Fillers: 10 Important Things You Need To Know



Everything you need to know dermal fillers Dr Siew

Dermal fillers are an integral part of anti-aging aesthetic medicine. Since Restylane fillers were first FDA approved 20 years ago, more than 28 million Restylane treatments have been performed. Today, we have many other filler brands, such as Juvederm, Belotero, and Teosyal. There are a lot of misconceptions and confusion regarding hyaluronic acid filler treatments. Here are the 10 most important things you need to know about fillers before getting your treatment done.

1) Fillers Restore Lost Volume and Lift Skin

Dermal fillers are gels made up of chemically modified hyaluronic acid molecules, so that they have varying degrees of cohesivity, hardness, and plasticity. Once injected into the skin, they restore lost volume, such as in the cheeks or temples. This gives the skin a lifting effect, so that you look more youthful. Because bone and fat loss are both replaced by fillers, years are usually taken off the face in just a single treatment, with results that are natural and aesthetically beautiful, if done well.

2) Fillers Refine Skin Texture

Hyaluronic acid absorb tons of water – up to 200x their size. Hence, when injected into the dermis, dermal fillers restore the plumpness to the skin and give deep hydration. It also refines the skin texture to minimize pores and brighten skin. The popular Skinboosters treatment is based on this principle. Wrinkles, fine lines, pores, skin tone and texture are all improved.

dermal fillers Hydration SKinboosters
Dermal fillers restore skin hydration & elasticity through the Skinboosters treatment

3) Fillers Sculpt Facial Features – But There Are Limitations

Dermal fillers are a convenient alternative to plastic surgery for facial sculpting. Common areas which can be enhanced with fillers include the nose, chin, cheekbones and forehead. For facial sculpting, I prefer a stiffer filler such as Restylane SubQ or Belotero Intense – they give a more sculpted appearance.

However, fillers are not a replacement for plastic surgery. For example, if you have a very broad nose with a bulbous tip – a surgical rhinoplasty may give you a better result. It important to discuss your desired outcome with your doctor, and whether fillers can help you get there.

Dr Siew Broad Nose Everything you need to know Fillers
While fillers can sculpt facial features, a broad and bulbous nose like mine will respond better to surgery

4) You Will NOT Look Worse If You Do Not Continue Filler Injections

A common misconception is that once you start filler injections, you can never stop, because if you do, you will sag and look worse than before. Once injected, dermal fillers stimulate your body’s collagen as well – hence even after just one treatment, you will look better than when you started, even after the fillers disappear in a year or so. What’s more, after repeated sessions, the results last longer and longer.

5) MORE is not Always Better

The biggest problem with dermal filler treatments today, in my opinion, is overfilling.

This has given rise to the pillow face phenomenon – men and women who look too puffy from having too much fillers injected. The problem is twofold – it happens when patients ask for more and more, or when doctors try to sell their patients more and more.

Dermal Filler J curve Dr Siew
For everyone, there is an optimum amount of filler injection which will give the best result.

Fillers can be addictive. However, the outcome from filler procedures follow an inverted J curve – you look better when the right amount is put in, but there will come a point where you start to look worse, when a critical point is reached.

Rememebr that a filler procedure is different from a buffet dinner. Just because you are getting more filler product does not mean you will look better. What is important is a natural, beautiful result.

6) Several Different Dermal Fillers May Be Needed In a Treatment; Your Doctor May Suggest A Different Filler From What You Had in Mind.

Performing a filler treatment is like painting a picture – with your face as the canvas. Just as how you cannot paint a picture with just one colour, it is impossible to achieve an optimum result with just one type of filler.

Because the skin and anatomy in every part of the face is not the same, filler products with different physical characteristics (e.g. softness, cohesivity, moldability), are required to “blend” them in. For example, I use up to 3 different dermal fillers to treat the delicate undereye area alone.

Dr Siew Filler Palette
An example of the fillers I work with. I use no less than 17 different fillers for varying purposes, and different areas of the face. Every doctor will have his/her own favourite fillers he/she works with.

It can be very confusing (even for doctors) to understand the many brands of hyaluronic acid fillers available in the market today. In addition, each brand will have several subtypes in the family. In my opinion, amongst the reputable filler brands such as Restylane, Juvederm, Teosyal, Belotero, there is not one brand which is clearly better than the other. Every brand has some products with strengths and weaknesses – and it is up to the doctor, to discover his own favourite fillers for different purposes – much like how an artist chooses his colour palette.

Because of this, your doctor may suggest a dermal filler which is different from what you originally wanted, because he thinks it will give you a better result. Do not be afraid to ask your doctor which filler he uses, and why he prefers one over the other, for you.

7) Dermal Fillers Can Last a Long Time

Hyaluronic acid fillers are made up of molecules of hyaluronic acid. They are gradually degraded by our body’s natural hyaluronidase over time. Chemical modification via polymerisation and cross-linking allow the fillers to assume different hardness, plasticity, and longevity.

Hyaluronic Acid Dermal Filler Structure Dr Siew
A very simplified chemical structure of Hyaluronic acid fillers. Cross linking allows fillers to last up to 18 months

With improving technology, fillers are lasting longer and longer. In general, thinner fillers such as Restylane Skinboosters last shorter – 3-6months. Harder fillers such as Juvederm Voluma last up to 18 months. Newer 2nd generation fillers, such as Neauvia also last 18 months or more. The longevity of fillers depend on many factors, such as the product, lifestyle, area of the face, and even injection technique. With repeat treatments, the fillers also last longer and longer. I have had patients whose fillers are still in place after several years!

8) Every Doctor’s Style is Different

It is important to understand your doctor’s style, and decide if you are comfortable with it. Ask for before-after pictures, so that you can learn more about what he or she thinks is a beautiful aesthetic result.

For example, I feel very strongly about creating a natural result. After treatment, my patients will look fresher and better, but will still have some lines and imperfections. My priority is not let anyone know that work has been done.

I know that my style is not for everyone – I had patients who prefer a more exaggerated result, and have moved on to see other doctors instead.

madonna before after pillow face Dr Siew
Your doctor’s style is something you should be comfortable with. I emphasize keeping the results natural, with preservation of some lines and imperfections. Filling up all lines produces the “pillow face”, rampant in so many celebrities. Madonna now has less wrinkles and hollows under the eyes, but you can see how her cheeks look significantly more puffy now than 26 years ago.

9) Your Doctor’s Expertise is as Important as the Filler Product

A hyaluronic acid filler is really just a gel in a syringe. In the right hands, this gel can create miracles. In the wrong hands – they can result in disasters. There are reports of beauty salons performing filler injections by untrained therapists, claiming to use “Restylane” and “Juvederm”, at discounted prices.

Remember that reputable filler brands only can be acquired by licensed doctors; and even if unregistered salons manage to get their hands on them, it is extremely dangerous to have the procedure performed by someone who is not trained.

The filler product is only part of the equation. Your doctor is far more important in ensuring a good result from your procedure.

10) Severe Complications, Though Rare, Can Happen

Dermal filler injections are remarkable. However, adverse events can occur. Mild and common side effects include temporary swelling, and bruising. More serious, uncommon side effects include infection and delayed immune reactions.

filler blindness Singapore
Blindness from nose filler injections have happened in Singapore. Picture source: Lianhe Wanbao 联合晚报

Severe complications include skin necrosis (dying of the skin) and even blindness – these are caused by inadvertent occlusion of the arteries by the filler gel. These are extremely rare, but can be catastrophic when they occur. It is important to have a conversation with your doctor before your treatment, so that you understand the risks involved for the procedure.


  1. Dr siew are you able to help? I did a Chin filler today but not sure if it’s certified and it seems like my eye is red and eye sight getting blur. Can I get help and assistance from you? Thanks

    Call me if can

  2. Wow, it’s interesting to know that there are different kinds of fillers to be used for such a procedure. I’m thinking about getting dermal fillers for myself after I started having more and more wrinkles and feeling like my cheeks are starting to sag. I hope I can find a doctor that can walk me through the differences between each kind and how they contribute into making me look younger.