Filler second opinion: what to bring and what an assessment involves

What is a filler second opinion?

A filler second opinion is an independent assessment of filler that is already in your face, carried out by a doctor other than the one who placed it. Its purpose is to answer three questions: what is there, whether it is a problem, and what the reasonable options are.

Asking for one is an ordinary part of medical care. It does not mean anything was done wrongly, and it is not a complaint about anyone. Faces change with time, filler settles differently in different people, and two careful doctors can hold different views about how much volume suits a face. Published reviews find that most adverse reactions to dermal filler are mild and short-lived, such as bruising and swelling, and that serious events are rare (Funt and Pavicic, 2013).

A second opinion can end in several ways:

• Reassurance: the filler is sitting where it should, and what you see is within the expected range.
• Waiting: the area is still settling, and a review at a later date is the sensible step.
• A small adjustment: part of the filler is reduced, or one area is balanced against another.
• Dissolving: hyaluronic acid filler is removed with an enzyme (hyaluronidase), often in stages.
• Referral: the concern needs a different kind of care.

At SkinRev Lab, second opinions on filler are part of filler correction, which is offered under Dr Sin Yong, medical adviser. The plan after assessment is to dissolve, reduce or leave the filler, and leaving it is a real option.

When is a filler second opinion worth having?

A filler second opinion is worth having when a concern has lasted beyond the first two weeks, when you have been advised a large or staged correction, or when you would simply like the options explained by another doctor. Most unevenness in the first two weeks is swelling, so an earlier appointment often cannot tell you much unless there are urgent signs.

Common reasons people ask for one:

• A lump or firmness that has not settled. See filler lumps and nodules.
• Filler that seems to sit outside the area treated. See filler migration.
• A face that looks fuller or heavier than you wanted after several rounds. See signs of too much filler and pillow face correction.
• A bluish tint or puffiness under the eyes. See Tyndall effect after filler and tear trough filler problems.
• Unevenness between the two sides.
• Swelling that comes and goes months after treatment.
• Uncertainty about whether to dissolve, top up or leave things alone.
• Filler placed many years ago, where you no longer know what is there.

When a second opinion is not the right step: if you have urgent signs, which are listed further down this page, go to an emergency department now. A booked assessment is for concerns that are stable.

If you are within the first two weeks and the area is simply swollen, see filler swelling: what is normal. Your treating provider is also the right first contact in that period, as they know what was placed.

What should you bring to a filler second opinion?

Bring whatever records you have of your filler treatments: the product, the amount, the dates and the areas, along with photographs and a list of your medicines and allergies. None of these is essential, and an assessment can go ahead without them, but each one makes the picture clearer.

If you can, come without heavy make-up on the area so that the skin can be examined and scanned.

What does a filler second-opinion assessment involve at SkinRev Lab?

A filler second-opinion assessment at SkinRev Lab involves a full history, an examination of the face at rest and in movement, an ultrasound scan where it is useful, and a discussion of the options, all carried out by Dr Sin Yong, medical adviser. The assessment takes about 45 to 60 minutes, and Dr Sin Yong does it himself.

1. History. The products, dates and areas; any previous dissolving; your medicines and allergies; recent illness or dental work.
2. Examination. The face is examined at rest and in movement, because some concerns only show when you smile or speak. Photographs are taken.
3. Ultrasound, where useful. High-frequency ultrasound can show where filler sits, how deep it is and roughly how much is present, and can separate filler from swelling or your own tissue. It can sometimes suggest whether the material is hyaluronic acid, although this is not certain.
4. Explanation. You are told what was found and what it means, in plain language.
5. Options. The plan is to dissolve, reduce or leave the filler. If dissolving is chosen, it is planned in stages, region by region, with a review between stages.

An assessment is an opinion, and it is reasonable to ask for time to think before deciding on any treatment.

Researchers describe ultrasound as a way of seeing earlier filler and the surrounding tissues before any decision is made (Schelke and colleagues, 2018). To see how the scan is used, read about ultrasound-guided filler dissolving or watch the ultrasound filler mapping video.

What can happen after a filler second opinion?

After a filler second opinion, the usual outcomes are no treatment, a period of watching and review, a partial reduction, a staged dissolving plan or a referral, and the choice between them is yours to make with the doctor's advice. Correction is never promised to restore a particular look, and what is realistic is explained before anything is done.

• Leave it. The filler is well placed, or the change is small and likely to soften. Doing nothing can be the right advice.
• Wait and review. Recent filler is still settling, so a date is set to look again.
• Reduce. A small amount of enzyme (hyaluronidase) is placed into one area of hyaluronic acid filler to soften a lump or restore balance, while the remainder is left.
• Dissolve in stages. Larger, older or multi-area filler is dissolved region by region. See dissolving filler in Singapore.
• A different approach for non-hyaluronic acid filler. The enzyme does not work on collagen stimulators, calcium-based fillers or other non-hyaluronic acid materials. For excess volume in some areas, SkinRev Lab may discuss Time Freeze Laser LCLR, noting that no published trial has tested it for filler.
• Refer. Some concerns are outside what an aesthetic doctor should manage, and you will be told so.

If dissolving is chosen, expect swelling, redness or itch for a day or two and possible bruising. The possible reactions are set out in hyaluronidase side effects. A UK guideline advises waiting at least two weeks after dissolving before filler is placed again (Murray and colleagues, 2021); see filler after dissolving.

Should you go back to your original provider before seeking a second opinion?

Going back to the provider who treated you is usually a sensible first step, because they hold your records, know what was placed and where, and can often review or adjust the result. A second opinion sits alongside that relationship; it does not replace it.

Reasons to speak to your original provider first:

• They can tell you the exact product, amount and depth, which no other doctor can know for certain.
• A review is a routine part of filler treatment, and many concerns are settled at that visit.
• If something urgent develops soon after treatment, they are often the quickest to reach.

Reasons people also seek another view:

• They have moved, or were treated overseas, and cannot return easily.
• The treatment was years ago and the records are no longer to hand.
• They have been advised a large or staged correction and would like it confirmed.
• They would simply feel more settled having heard two opinions.

You do not need anyone's permission to ask for a second opinion, and you do not need to explain why. You are entitled to ask your provider for a copy of your treatment record, and most are glad to share it. With your consent, one doctor can also contact another so that the history is complete.

At SkinRev Lab the assessment looks at the filler as it is now. Its purpose is to work out what is there and what your options are, not to review anyone's work.

Which signs after filler are urgent and should not wait for a second opinion?

Skin that turns pale, dusky or mottled, severe or escalating pain, any change in vision, and spreading redness with fever are urgent signs after filler, and the right response is to go to an emergency department now. These problems are rare, but they are time-sensitive, and an assessment booked for another day is not the place for them.

• Pale, white, dusky or mottled skin, or pain that keeps rising, during or after injection: this may mean a blocked blood vessel. Go to an emergency department now; if you can also reach the provider who treated you at once, let them know.
• Any change in vision: call 995 or go to an emergency department at once.
• Spreading redness, heat and fever: this may mean infection. Go to an emergency department now.
• Swelling of the lips, tongue or throat, or difficulty breathing: this may be a severe allergic reaction. Call 995.

Signs that need a prompt, same-week review but are not emergencies:

• A lump that has become red, warm or tender weeks or months after treatment.
• Swelling that returns repeatedly in the same area.
• A firm lump that is growing.

Do not massage, squeeze or press on a lump unless your doctor advises it, and do not try to treat it at home. Any doctor can assess urgent symptoms, wherever you were treated. For the general picture of what can go wrong and how often, see filler problems.

What questions should you ask at a filler second opinion?

The most useful questions at a filler second opinion are about what was found, how certain it is, what each option involves and what happens if you do nothing. A clear answer to each is a fair expectation of any doctor you see.

• What do you think is there, and how sure are you about the type of filler?
• Is this still settling, or is it likely to stay as it is?
• Would a scan change the plan, and is it included?
• What are my options, including leaving it alone?
• If dissolving is advised, how many rounds are likely, and how far apart?
• How might the area look afterwards? An area can look flatter where filler had been hiding volume loss.
• What reactions should I watch for, and who do I contact out of hours?
• When could filler be placed again, if I want it?
• What will it cost, and can I have the plan in writing?

What to expect from the answers: a careful doctor will tell you what is uncertain as well as what is known, will not promise a particular result, and will be comfortable with you taking time to decide. Two opinions that differ are not a sign that one is wrong; they usually reflect different judgements about how much to change and how quickly.

It also helps to decide beforehand what matters most to you: a lump you can feel, how you look in photographs, or simply knowing what is there.

How much does a filler second opinion cost, and how do you arrange one?

At SkinRev Lab, a filler second opinion and any correction that follows are priced at consultation, and you can arrange an assessment by WhatsApp. SkinRev Lab does not publish prices for doctor-led treatments, because the price of correction depends on the examination and sometimes on a scan.

What affects the cost of correction:

• The number of areas involved.
• The type and amount of filler.
• Whether imaging is needed, as a scan adds time to the visit.
• The number of rounds planned; a plan with two or three rounds may cost more than a single visit.

It is reasonable to ask what the assessment itself costs before you book, whether ultrasound is included, and for the plan in writing. For a fuller explanation, see dissolve filler cost in Singapore.

Arranging an assessment:

• Message SkinRev Lab on WhatsApp at +65 8266 9585 and say that you would like a second opinion on filler.
• Mention the area, roughly when you were treated and what concerns you.
• Gather the records and photographs listed above.

SkinRev Lab is at #B1-28 CityLink Mall, 1 Raffles Link, by City Hall MRT, open daily from 11am to 8pm. Medical treatments are offered under Dr Sin Yong, medical adviser. If you have urgent signs, do not wait for an appointment; go to an emergency department now.