Lip filler in Singapore natural proportions, real risks, and how to undo it

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What lip filler is, and what it can change

Most lip fillers today are cross-linked hyaluronic acid, a gel based on a sugar molecule the body already makes. Cross-linking lets the gel last months rather than days, and most lip products contain a little local anaesthetic (lidocaine) for comfort. Lip gels are softer than the firm gels used on the chin or cheekbones, so the lips still move and feel natural.

Filler can add volume to thin lips, define a softened border, lift the corners slightly, even out asymmetry, and restore fullness that has deflated with age. It cannot change lip colour, fix lines made by muscle movement on its own, or tighten loose skin above the lip. Dermal fillers are regulated in Singapore by the Health Sciences Authority (HSA), and it is reasonable to ask which product is being used and to keep a record of it.

Lip filler is a medical procedure. At SkinRev Lab we do not inject anything; lip filler is performed by Dr Sin Yong at IN Eternity Clinic after a face-to-face assessment, and it is priced at consultation by the clinic.

Proportions

Natural proportions: why less often looks better

Lips look natural when they suit the rest of the face. Doctors look at the balance between the upper and lower lip, the width of the mouth, the length of the area between nose and lip, the profile from the side, and how the lips move when you talk and smile.

One frequently cited study ranked faces of white women and found the most attractive upper-to-lower lip ratio was about 1:2, meaning the lower lip slightly fuller than the upper. It was a study of one group of faces, and ideals vary between ethnic groups and cultures, so it is a starting point for discussion rather than a rule. For many East Asian faces, a soft, hydrated lip with a defined border and modest projection tends to look most like the person.

Common signs of overfilling are an upper lip that sits further forward than the lower, a shelf or ledge of filler above the border, a rolled-out upper lip that hides the pink border, and fullness that spreads into the skin above the lip. These often build up gradually with repeated top-ups, because filler can remain in tissue after the visible fullness has faded.

Styles

Russian lips vs classic lip filler

The Russian lip technique places filler in many small vertical passes from the border towards the inner lip. The aim is height rather than forward projection: a flatter, heart-shaped look with a lifted cupid's bow, popular on social media. Classic lip filler works more with the lip's own contours, using small amounts in the border and body of the lip to add gentle fullness, projection and definition.

There is little peer-reviewed research comparing the two. The style that suits you depends on your lip shape, the length of the area above the lip, your teeth and jaw, and how your lips move. A doctor should explain why a style does or does not fit your face, rather than offering one technique to everyone.

What to expect

Consultation, the treatment, and the days after

A consultation should cover what you want to change, your medical history, cold sores, allergies, any previous filler and where it was done. The doctor looks at the lips at rest, talking and smiling, and may advise a smaller change than you expected, or no filler at all.

On the day, numbing cream is applied and the filler is placed in small amounts with a fine needle or blunt cannula. The injection itself usually takes about 30 minutes including preparation. Swelling usually peaks over the first one to two days and settles within about a week, and lips often look bigger and slightly uneven at first. Avoid pressing or massaging the lips, saunas, heavy exercise and alcohol for a day or two unless your doctor advises otherwise.

The result is judged at a review after a few weeks, once swelling has gone. In a meta-analysis of HA lip augmentation, 91% of people still had fuller lips at two months, 74% at six months and 46% at twelve months. Lips move constantly, so filler here tends to fade sooner than in the cheeks or chin.

Risks

Risks: from bruising to vascular occlusion

Most side effects are mild and settle on their own: tenderness, swelling, bruising and small bumps you can feel for a week or two. In a meta-analysis that pooled 1,496 people, tenderness and swelling were the most frequent effects, while cold sore flares and allergic swelling were uncommon. People prone to cold sores may be offered preventive medication.

Other problems are less common. Lumps and nodules can appear early or months later. A bluish tint under the lip skin is usually the Tyndall effect, where HA placed too shallow scatters light. Filler can spread above the lip border, especially after many top-ups, and delayed inflammatory swelling can occasionally appear weeks or months later. A global consensus on HA filler complications noted that most can be avoided with proper planning and technique.

The serious risk is vascular occlusion, where filler enters or presses on an artery and cuts off blood supply to the lip skin. It is rare, but it can cause skin damage if not treated quickly. Signs usually appear during or soon after injection.

• Skin on or around the lip turning pale, white, blotchy, grey or dusky is an emergency.
• Pain that is increasing rather than settling needs urgent attention.
• Any change in vision after filler anywhere on the face is an emergency.
• Spreading redness, warmth, pus or fever after a few days can mean infection.
• Contact the clinic that treated you at once, or go to an emergency department.

Anatomy and imaging

Lip arteries, and where ultrasound helps

Each lip has its own artery, the superior and inferior labial arteries, running horizontally through the lip. In an anatomical study of 193 specimens, the arteries ran mostly on the inner side of the lip muscle, under the mucosa (78.1%), sometimes within the muscle (17.5%), and rarely just under the skin (2.1%). Their course was most variable in the midline. The authors suggested that the subcutaneous plane away from the midline is a safer location for volumising material, which is one reason technique and depth matter so much.

High-frequency ultrasound lets a doctor see filler under the skin and map blood vessels. A paper from a Dutch group described using it to see previous filler before treatment, to map vessels, to see what is happening when a complication occurs, and to inject the dissolving enzyme directly into a filler deposit. At IN Eternity Clinic, Dr Sin Yong uses ultrasound to map earlier filler before dissolving it.

Dissolving

Dissolving lip filler with hyaluronidase

Hyaluronic acid filler can be broken down with hyaluronidase, an enzyme injected into the filler. It is used for lumps, migration above the lip line, a bluish tint, an overfilled or uneven result, and urgently for vascular occlusion. A UK guideline on its safe use covers its indications, formulations and side effects, and notes that allergy is uncommon but that people with a strong reaction to bee or wasp stings have a higher risk, so tell the doctor about any such history.

Dissolving is safest as a mapped, selective process. Knowing exactly where the old filler sits, and how much is there, allows the enzyme to be placed where it is needed and helps avoid dissolving more than necessary. That is why Dr Sin Yong maps lip filler with ultrasound before dissolving. Lips usually look smaller and sometimes a little uneven for a few days afterwards, and it is sensible to wait until tissues have fully settled, usually at least two weeks and often longer, before deciding whether to add anything back.

Not every filler is HA. Some older or permanent fillers cannot be dissolved this way and need a different assessment, so bring any records you have of previous treatments.

Alternative

Lip blush: when colour is the real concern

Many people who ask about lip filler are really unhappy with lip colour or a faded border rather than size. Lip blush is semi-permanent cosmetic tattooing that adds soft colour, evens out tone and clarifies the border. It changes colour, not volume, and typically lasts one to three years.

Lip blush and lip filler can be combined, but not on the same day. It usually makes sense to settle volume first, wait until swelling has fully gone, and then design colour around the lips you will actually have. At SkinRev Lab, Signature Lip Blush is priced at consultation, with shade selection and design included.

Suitability

Who should wait, and questions to ask

• Wait if you are pregnant or breastfeeding, have an active cold sore or infection on or near the lips, or have had recent dental work or another procedure in the area.
• Tell the doctor about bleeding disorders, blood-thinning medicines and supplements, autoimmune conditions, allergies and any previous reaction to filler.
• Ask which product will be used, how much, and where it will be placed.
• Ask whether the doctor can recognise and treat vascular occlusion on site, including keeping hyaluronidase available.
• Ask what happens if you do not like the result, and how dissolving would be done.
• Be cautious of needle-free filler pens and non-medical injectors; filler should be placed by a doctor.

Where to go

Lip filler and dissolving in our network

Lip filler and filler dissolving are performed by Dr Sin Yong at IN Eternity Clinic, 9 Scotts Road, #12-01 Pacific Plaza, beside Orchard MRT. Where earlier filler is involved, he examines the lips with ultrasound before planning any dissolving or new treatment. Treatment is priced at consultation by the clinic, and depends on the product, amount and whether old filler needs assessment first; WhatsApp +65 8815 3008.

SkinRev Lab, at #B1-28 CityLink Mall by City Hall MRT, is a non-invasive centre and does not inject. It offers Signature Lip Blush for colour and HydraFacial Perk Lip for dry, lined lips, and can pass lip filler enquiries to IN Eternity Clinic. Results vary between people.

Sources

References & sources

1. Czumbel LM, Farkasdi S, Gede N, et al. Hyaluronic acid is an effective dermal filler for lip augmentation: a meta-analysis. Front Surg. 2021;8:681028.
2. Popenko NA, Tripathi PB, Devcic Z, et al. A quantitative approach to determining the ideal female lip aesthetic and its effect on facial attractiveness. JAMA Facial Plast Surg. 2017;19(4):261-267.
3. Cotofana S, Pretterklieber B, Lucius R, et al. Distribution pattern of the superior and inferior labial arteries: impact for safe upper and lower lip augmentation procedures. Plast Reconstr Surg. 2017;139(5):1075-1082.
4. Schelke LW, Decates TS, Velthuis PJ. Ultrasound to improve the safety of hyaluronic acid filler treatments. J Cosmet Dermatol. 2018;17(6):1019-1024.
5. Murray G, Convery C, Walker L, Davies E. Guideline for the safe use of hyaluronidase in aesthetic medicine, including modified high-dose protocol. J Clin Aesthet Dermatol. 2021;14(8):E69-E75.
6. Hirsch RJ, Narurkar V, Carruthers J. Management of injected hyaluronic acid induced Tyndall effects. Lasers Surg Med. 2006;38(3):202-204.
7. Signorini M, Liew S, Sundaram H, et al. Global Aesthetics Consensus: avoidance and management of complications from hyaluronic acid fillers, evidence- and opinion-based review and consensus recommendations. Plast Reconstr Surg. 2016;137(6):961e-971e.

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