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Fillers on the Face

Nose

Ever wanted a nose job, higher nose bridge, sharper tip or wanted to correct an irregular shaped nose, yet were too afraid to have surgery? Many people share that sentiment. That explains the popularity of nose fillers today. A skilled injector can create a taller, sharper nose bridge, tip or fill those gaps in between an unsightly nose hump to make the nose a lot more aesthetically pleasing to the eye. All it takes is a few simple injections in the skin to get a dramatic low downtime improvement to the face. Because nose fillers are possibly one of the most difficult fillers to get right, it’s important to get an experienced injector for this job. Fillers are injected very superficially and the choice of filler is also important. Too soft a filler and it will spread out, producing a broad looking nose. Yet firmer fillers are tricky to handle and are thus technically demanding to inject in a superficial plane.

Chin

The chin is a very satisfying place for filler injection for many asian ladies and men. The reason is because Chinese especially southern Chinese tend to have rounder faces and wider cheeks. The net effect is a chubby or ‘cute’ look. This is in contrast to what many Chinese perceive to be beautiful, which is the “guazi” shaped face, (shaped like a watermelon seed). This means a narrow jawline and sharp chin. It is easy to achieve the narrow jawline in some ladies who have prominent masseter muscles, through the use of Botox for jaw slimming (find out more at this website www.botoxs.sg). To further achieve the perfect face shape, using a filler in the chin is necessary. About 1 to 1.5 cc of filler in the chin area, placed strategically and correctly, will create an elongated and sharper chin angle, making the face look much slimmer and sharper. This injection is particularly safe because the filler, when placed, can be shaped easily to the shape desired, so the patient can decide if he or she wants it sharper or rounder, even after it is injected. This is because hyaluronic acid fillers in particular are easily mouldable, like plasticene or play-doh, after it is injected under the skin.

Cheek

The cheek must be one of the most dramatic places and also least expected places for fillers to be placed. To an experienced doctor, cheek augmentation is one of the places where huge returns can be had from filler placement. This is because as one ages, there is a lot of volume lost from the cheek. The net result is that the face appears flatter, grooves start appearing in the cheek and below the eye (leading to tear trough deformity and prominent eyebags). Parts of the face supported by the cheek start sagging, such as the nasolabial folds and the jowls. Very often, all it takes is an injection to the cheek to set things straight. Compare the aged face to a young face and it is easy to recognize that the youthful cheek is full, has nice curves (called the ogee curve) and looks like apples. With 1 to 2 cc of filler placed strategically in the cheek, the entire face is rejuvenated. The eyebags are less prominent, the deep grooves around the face are less obvious and the nasolabial grooves and jowls are immediately less obvious. Some people may need to place an additional 0.5 to 1 cc of filler in each nasolabial groove if necessary, but this is usually sufficient to achieve a significant improvement to the face.

Nasolabial

The nasolabial groove is the line extending from the side of the nose to the angle of the lips. It is frequently called the laughter line. Everyone will have this line, from young to old. Why then does this make us look so much older? Frequently, it is the depth, and the angle of the line which makes the difference. In younger people, the depth of the line is shallow and there is no permanent wrinkle in the fold. Also, the angle of the line is more slanted (usually somewhere between 30-45 degrees outwards). 
As we age, the line gets deeper, and a permanent skin wrinkle forms in that groove. Also the angle of the groove becomes more vertical. All these are apparent and betrays the age of the person easily. The reason for this is two-fold. Firstly, the loss of fat volume in the cheeks as a person ages, causes sagging of the cheeks over this nasolabial fold, causing the groove to look very deep. Secondly, the loss of fat volume below this fold causes the groove to sink in, compounding the problem. Who would have thought that fats, something which we used to hate on the face when we were younger, are so important for looking young when we are older? To treat this problem, we simply do two things. Firstly, we inject some filler into the deep fat spaces in the cheeks to replace the lost volume. Secondly, we need to inject fats below the nose and nasolabial groove to elevate the skin. The treatment shows very good results and will last many months. The fillers in the nasolabial groove tend not to last as long as fillers placed in other low-mobility places like the cheek or the brow. This is because the mouth moves a lot during the day, from talking to eating. Movement from talking and eating will make filler dissolve faster. Fillers placed in the nasolabial groove also prevent excessive bending of the skin, resulting in prevention of formation of permanent wrinkles, or worsening of existing wrinkles in the nasolabial groove.

Lips

Lips are another area which make a big difference to the aging face. Lip fillers are also very popular with young ladies and men. When our face ages, the lips become thin, and wrinkles appear on the upper and lower lips due to frequent movement. These wrinkles are unsightly and thin lips are very obvious signs of aging. By injecting fillers in the lips, the lips will be plumped back to our youthful volume. Some young people however are not satisfied with their thin lips, and would like to have a more full, luscious kiss. In this situation, lip fillers are also indicated for lip augmentation. When lip fillers are injected, it may feel firm and lumps can be felt under the skin for a while. Therefore it is important to use a good brand of filler which is soft and easily molded. Otherwise it may be quite unnatural feeling after injection. The other important note about lip fillers is the choice of lidocaine mixed fillers like Restylane with Lidocaine, or Juvederm Ultra XC, both of which are pre-mixed with lidocaine. This is because lips are extremely sensitive areas, and injection of fillers which do not contain lidocaine can be excruciatingly painful. Some doctors may even use local anaesthetic injections elsewhere on the face to block the nerves which supply the lips, such as the infra-orbital nerve which is just below the eye. However, this is quickly becoming a thing of the past, as newer fillers with lidocaine are pretty comfortable and painless to inject.

Tear Trough

The tear trough is a very satisfying area to inject. The tear trough is as the name suggests, a valley running from the inside angle of the eye, across the cheek. The tear trough, when it gets deep, is quite unsightly. It is a reason for dark eye circles, eyebags and makes a person look tired and haggard. In order to correct this, very fine technique is needed. Filler is carefully injected along the bone below the tear trough, which will elevate the tear trough, causing it to flatten out. This conceals the appearance of eyebags or dark eye circles. Done properly, this is a very satisfying filler to perform and also to receive. Choice of filler is also important here, as a soft filler like Restylane and Juvederm Ultra XC are very natural and tends not to form lumps. Radiesse is not recommended as there have been reports of lumps forming after the injection of Radiesse in the tear trough area. The tear trough filler is also sometimes coupled with injection of deep fillers in the cheek like Juvederm Voluma or Hyacorp.

Marionette Lines

The Marionette lines are also termed “sad lines” because they make the person look sad. Fillers in this area are very similar to fillers in the nasolabial region and also in the lips, due to the close proximity to the lips. Sometimes, Botox is also injected in this region to ameliorate the sad lines, if it is found to be due to overaction of the depressor anguli oris muscles (the muscle which is responsible for pulling down the angles of the lips.

Wrinkles (e.g. Brow)

Sometimes, after many years of making certain facial expressions, deep wrinkles can form. These wrinkles are sometimes so deep that there are grooves in the soft tissues below the skin. When this happens, it is possible to correct them with fillers. Using fillers in these areas fill in the defects and corrects the problem almost immediately. This is extremely satisfying especially for people who have had these deep lines for many years, which although are relieved somewhat by Botox, but do not have complete resolution of the lines. In this situation, a marriage of Botox and fillers is the best solution.

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