S'pore aesthetic doctor injected woman with 3 times recommended dermal fillers dosage, woman suffers 19 months of facial pain

An aesthetic doctor in Singapore has been temporarily prohibited from administering dermal fillers after a patient complained that he had administered three times the recommended dosage during a treatment. The doctor disputes the allegations and has appealed.

The overdosage resulted in the patient experiencing chronic facial pain for at least 19 months, which eventually required a nerve surgery to alleviate.

The patient also lost her job as she dealt with the medical issues.

Details of the case and the temporary restrictions on the aesthetic doctor were laid out in a grounds of decision published on Oct. 7 by an Interim Orders Committee (IOC).

What happened

On Apr. 1, 2023, the patient visited the doctor, Wong Kai Jie Isaac, at his clinic, The Artisan Clinic.

This was her first visit.

Wong is listed on the clinic's website as its founder.

During the visit, Wong recommended a procedure involving the injection of dermal fillers.

The patient consented, and Wong proceeded.

The label on the packaging stated that the maximum annual dosage is 2ml, according to the grounds of decision.

The patient said Wong administered a total dosage of 7ml in one sitting.

Side effects and treatment

Following this, the patient reported to Wong that she suffered pain on the left side of her face.

Wong diagnosed a vascular occlusion, and proceeded to inject hyaluronidase into the patient's face multiple times in an attempt to reduce the effects caused by the dermal fillers.

Vascular occlusion refers to a blood vessel blockage.

Hyaluronidase is an enzyme to dissolve hyaluronic acid.

From Apr. 2, 2023, to Oct. 8, 2024, the patient made repeated visits to see Wong regarding the side effects or complications as a result of the dermal fillers injection.

These side effects include persistent left facial pain, blocked blood vessels and nerve pain.

From Apr. 2 to Jun. 21, 2023, Wong continued to inject hyaluronidase into the patient's face at multiple consultations.

On Jun. 22, 2023, Wong brought in another doctor to help check for temporomandibular joint dysfunction, a jaw condition.

After this consultation, the doctor messaged Wong and informed him that he was not sure if continued injection of hyaluronidase would be helpful.

Following this and until May 3, 2024, Wong continued with injections of hyaluronidase and steroids, among others.

19 months of pain

The patient ultimately experienced chronic facial pain lasting at least 19 months, according to the grounds of decision.

The pain resulted in high blood pressure and weight loss of over 20kg arising from changes in appetite.

The patient also lost her job as she dealt with the medical issues and suffered a negative impact on her mental health.

During the course of the medical episode, the patient sought medical attention from other doctors and underwent a nerve surgery to alleviate the pain in the left side of her face.

She filed a complaint against Wong with the Singapore Medical Council (SMC) on Nov. 4, 2024.

SMC's position

According to the grounds of decision, the SMC disclosed five other complaints against Wong that similarly allege over-dosing. Wong’s counsel said none of them involved vascular occlusion and that no disciplinary finding has been made on any of them.

The SMC recommended that an interim order be issued to make Wong's continued registration as a medical practitioner conditional for a period of 18 months, pending the conclusion of investigations.

The conditions include not offering or administering dermal fillers.

SMC posited that such an interim order is necessary to protect the public, given that Wong had failed to provide the "requisite standard of care" when administering the dermal fillers or in managing the side effects or complications.

It argued that Wong ought to have known that the maximum annual dosage was clearly stated on the packaging.

SMC pointed out that Wong's treatment of the side effects using hyaluronidase was inappropriate, given that the dermal filler used was a non-hyaluronic acid filler.

Wong's case

Arguing against such an order, Wong said that no prima facie case had been made out against him and that there was no risk to the public if he practised without conditions.

Wong pointed out that the 2ml maximum dosage label was printed by the dermal filler's manufacturer to comply with local regulatory requirements.

In fact, Wong claimed the manufacturer does not specify a maximum dosage in many countries where the dermal filler is distributed.

The manufacturer had also indicated that a maximum dosage of 12ml per session is safe.

On this, SMC noted that the change in maximum dosage only occurred in March 2026.

Hence, whether 7ml was clinically safe was a separate question to whether Wong had knowingly exceeded "clearly stated regulatory limit".

Wong also contested the SMC's point that his treatment of the side effects was inappropriate.

Wong argued that the hyaluronidase injections were to treat the blood vessel blockage rather than dissolve the injected dermal fillers.

Furthermore, Wong highlighted that he has administered a total of 19,667 dermal fillers from 2018 to 2026.

Out of these injections, he said this was the only occurrence of a blocked blood vessel.

Wong also submitted that he had met the standard of care and informed his patients of the potential risks, side effects and complications before treatment.

While SMC pointed out that Wong was not proactive in referring the patient to a specialist to treat the side effects, Wong countered that he immediately arranged another doctor for the patient for hyperbaric oxygen therapy on Apr. 1, 2023.

Conditions imposed on Wong's practice

After considering the facts and circumstances submitted by both the SMC and Wong, the IOC sided with the SMC's recommendations and conditions were imposed on Wong's practice.

The conditions will be in place for a period of 18 months or until the conclusion of the proceedings against him, whichever is sooner.

Apart from not offering or administering dermal fillers, Wong must also not treat any patient in relation to any side effects or complications arising from the administration of dermal fillers.

He shall only administer products within the dosage or indications permitted by the Health Sciences Authority or in accordance with the manufacturer's specifications.

He must also inform SMC of all the places where he practises or intends to practise.

He must also inform any organisation or person employing him for medical work about the conditions imposed on his medical registration.

Wong has submitted an appeal to the high court to revoke the interim orders.

His appeal is scheduled to be heard on Oct. 28.