Over the past half a decade, I’ve seen a sharp rise in the trend of using multiple syringes of dermal fillers for full-face rejuvenation. Where once the focus was on targeting specific areas, like the laugh lines or under-eye hollows, now we’re seeing younger patients wanting to sculpt their faces, add volume, and sharpen their features. A significant amount of fillers are injected to enhance jawlines and to build nose bridges or to volumize the columella. Some doctors pump syringes after syringes into the temples in an attempt to volumize the area.
While I understand the desire for these
enhancements, I’m also cautious about the long-term effects of using so many
fillers. Yes, dermal fillers are a great way to restore volume and enhance
features, but they’re not without risks.
- Risk
of delayed reactions: Though hyaluronic acid is naturally
found in the body, the stabilizing agents used in dermal fillers can cause
delayed hypersensitivity reactions, leading to inflammation or swelling
that could require medical intervention. As a surgeon who performs plenty
of facelifts, I can tell you that these fillers never fully resorbed and I
remove plenty of residual fillers during facelifts.
Filler
granuloma identified and removed during facelift surgery.
MRI Scan shows fillers present after one
injection 5 years later.
- Lymphatic
drainage issues: Too many fillers can block lymphatic
drainage, leading to puffiness, dullness, or even skin issues like
breakouts. Think frequent filler injection to delay eye-bag surgery and
what you have over time is the inevitable lymphatic blockade.
- Migration and unnatural aging: Dermal fillers break down at different rates, which could cause them to shift or migrate over time, potentially leading to unnatural aging patterns. Many are also injected within the muscle and accumulate over time preventing animation which unlike Botox never fully resorb giving an unnatural appearance to animation of the face.
I believe the accessibility of dermal fillers
is a good thing — they provide a non-surgical option for many who want to
enhance their features. However, moderation and proper consultation are key.
It’s essential to balance enhancing beauty with maintaining the natural
structure of the face. When it is time to stop fillers, as ethical practitioners
we have to stop advocating fillers to our patients, period!
"Oh don't worry - we can always dissolve it with hyalase!"
When it comes to dissolving hyaluronic acid —
whether it’s from your body’s natural cells or from filler injections — there’s
an important factor at play: the enzyme hyaluronidase. Hyaluronidase is a class
of enzymes that plays a crucial role in breaking down hyaluronic acid within
the body.
Now, for your filler to break down naturally,
your body would need to produce a steady amount of hyaluronidase at the
injection site over an extended period. The problem? Your body doesn’t want to
do this.
You see, hyaluronidase is responsible for breaking down hyaluronic acid, but if your body regularly produces it, it can begin to break down not just the filler, but also your skin and other tissues. Essentially, if your body made hyaluronidase constantly, it could result in unwanted breakdown of healthy tissues, which is something your body is designed to avoid. So, while we can use hyaluronidase in a controlled setting to dissolve filler, it’s not something your body wants to continuously produce — and for good reason. As fillers are injected in multiple planes and get embedded in muscles, subcutaneous tissues, fat and periosteum, it is not possible to dissolve every single bit of filler with hyalase injections. Also note that certain types of fillers such as Sculptra, Radiesse and Ellanse do not respond to Hyalase. They accumulate in facial tissues over time and there comes a time when organic surgery is the only answer for the clinical scenario.
It’s a balancing act that’s critical to
understand when considering any injectable procedure.
My 20 cents.
Dr Lee Seng Khoo
