SINGAPORE — The popularity of dermal fillers is on the rise due to social media trends and greater awareness of the range of cosmetic procedures available, but doctors have warned that patients should be aware of the “inherent risks” of such treatments. 

Dr Rachel Ho, medical director of La Clinic, attributed the increased take-up of medical aesthetic procedures here to greater access to information about non-surgical procedures that are available. 

“People are now more proactive in addressing signs of ageing and volume loss, and they are realising that fillers are very safe,” she said.

There is also the influence of Western and Korean standards of beauty, with celebrities and social media influencers openly discussing and recommending procedures they have done.

This makes cosmetic procedures “more acceptable and sought after by the general public”, said Dr Edwin Lim, medical director of Edwin Lim Medical Aesthetic Clinic.

However, as with any cosmetic procedure, things can go wrong. 

In Singapore, a recent case of a woman who went blind after a dermal filler treatment in July has raised concerns about the safety of dermal filler treatments.

The case, the first local report of blindness resulting from dermal fillers, is currently being investigated by the Health Sciences Authority (HSA). 

TODAY spoke to doctors specialising in medical aesthetic treatments to find out more about what dermal fillers are and what risks they carry for customers who seek aesthetic treatments. 

WHAT ARE DERMAL FILLERS?

Dermal fillers are made of various substances that are injected into a target area to plump up the skin and soft tissues, addressing aesthetic concerns such as sunken cheeks or a recessed chin. 

Dr Bernard Tan, medical director and founder of Bay Aesthetics Clinic, said that fillers are “strategically injected” to restore a loss of facial volume that happens as people age and to enhance facial features. 

He added that dermal fillers are one of the “most commonly requested non-surgical cosmetic procedures”.

There are many types of fillers on the market, each with slightly different properties, said Dr Janna Joethy, who is a plastic surgeon at Nassim Plastic Surgery.

In his practice, he uses different fillers based on factors such as density and the area being treated. 

Some popular types of fillers include:

Hyaluronic acid fillersCollagen stimulators Fat grafting — where fat is taken from one area and transferred to another area of the same person

Another common aesthetic procedure sought here are botulinum toxin injections, commonly referred to as Botox. 

While dermal fillers and Botox injections are both popular injectable cosmetic treatments, Dr Lim said they are “quite different and serve distinct purposes”. 

Botox works by blocking nerve signals in the muscles where it’s injected, temporarily paralysing the targeted muscles to change the appearance of wrinkles caused by muscle contractions. 

This includes addressing forehead lines, frown lines and laugh lines on the outer corners of the eyes, also referred to as crow’s feet. Effects after treatment can last for around three to six months. 

According to Dr Daniel Chang, faculty and physician trainer with the American Academy of Aesthetic Medicine, these injections are priced at around S$15 to S$20 per unit, and sessions typically cost around S$200 to S$300 per area based on the number of units needed. Cost of treatment also varies depending on the brand of injection used. 

In comparison, fillers can be divided into temporary and semi-permanent categories. 

For temporary ones, which are mainly composed of hyaluronic acid, Dr Chang said prices can range between S$800 and S$1,000 per syringe, with effects lasting from six to 15 months.

For longer lasting results, semi-permanent fillers can cost from S$1,300 to S$1,800 per syringe, depending on the number of syringes used. Results tend to last for 15 to 24 months, he said. 

“It’s not uncommon for people to use Botox and dermal fillers in combination to address multiple signs of ageing. For example, Botox can be used to relax forehead lines, while dermal fillers can add volume to sunken cheeks,” Dr Chang added.

HOW SAFE ARE FILLERS IN SINGAPORE?

In Singapore, dermal fillers are classified under Class D Medical Devices by the HSA, which is the highest risk class. 

This means that fillers are highly regulated and are subject to product registration and dealer’s licence requirements. Dealers must also report adverse events. 

Under the Singapore Medical Council’s Guidelines on Aesthetic Practices for Doctors, filler injections to the face, neck and hands can only be performed in clinics. 

The guidelines also state that filler injections can only be administered by dermatologists, plastic surgeons, ophthalmologists trained in oculoplastic surgery, as well as ear, nose and throat surgeons with facial plastic training.

In addition to using medical products approved by the HSA, Dr Chang said that obtaining “informed consent” is crucial to ensuring safety. 

“Informed consent refers to the process through which a healthcare provider informs a patient about the risks, benefits and alternatives of a medical treatment or procedure, and the patient voluntarily agrees to undergo the treatment or procedure based on this information,” he added.

In consultations before treatments, doctors typically inform patients of the following risks from fillers:

Minor adverse events include:

Bruising at the injection siteRedness and swelling which usually subsides within a few daysLumps and bumps

While major adverse events include:

Intravascular injection, where the filler is injected into a blood vessel. This can lead to skin necrosis or blindnessAllergic reactionAbscess formation

Dr Tan said that minor adverse events such as bruising do not occur frequently, while major adverse events are rare.

Instances of people going blind after a dermal filler treatment are very rare, said Dr David Loh, the president of the Society of Aesthetic Medicine.

This occurs when filler material is accidentally injected into blood vessels, where it then makes its way to the blood vessels of the eye.

“It is not related to any specific filler material and can happen even in the best of hands,” said Dr Loh, who owns a clinic at Novena Medical Centre.

“There are ways to prevent such complications, and that is through a thorough understanding of the anatomy of the blood vessels of the face, as well as a safe injection technique.”

Dr Loh is also the author of a paper titled Prevention and Management of Vision Loss Relating to Filler Injections, which was published in the Singapore Medical Journal in 2016.

MODERATING THE RISK WHEN GETTING FILLERS 

While all filler treatments have some “inherent risk”, doctors told TODAY that dermal fillers are “generally safe” when administered by trained professionals. 

The degree of risk of injury when getting fillers can depend on a few key factors, including the site of injection, the type of filler used and the training the person performing the procedure had undergone. 

Certain areas in the centre of the face, such as the nose and area between the eyebrows, have blood vessels closely linked to the eye’s vascular supply.

This makes accidental filler injection in these areas particularly dangerous, leading to possible complications such as vision impairment.

Some doctors also emphasised the importance of only seeking services conducted by licensed medical professionals, who have to follow strict regulations that govern the administration of dermal fillers. 

Dr Vincent Tan, the founder of Vincere Aesthetics Clinic, cautioned against opting for treatments conducted in unregulated environments such as residential apartments.

“Without formal medical education and training, these providers may lack a crucial understanding of human anatomy, necessary to administer these treatments safely,” he said.

“They might not be equipped to handle adverse events properly if they occur.”