NINE AESTHETICS TREATMENTS, DEMYSTIFIED

The doctors break down the nine most common procedures - from fat grafting to fat freezing - and tell us their purpose and cons.

1.THREAD LIFT

Dissolvable threads inserted under the skin create a scaffold around which new collagen and tissue can grow, giving your face a lift.

WHAT’S IMPROVED: Thread lifts have come a long way. “The premise remains the same today – offering skin-lifting effects – but the procedure is now relatively non-invasive with little downtime, compared to face-lift surgery. The threads, previously smooth, now have various barbs and hooks, and are dissolvable,” says Dr Ivan Puah, founder of Amaris B. Clinic.

BEST FOR: Jowls and marionette lines.

WHAT A SKILLED DOCTOR CAN DO: “It’s a skill-based treatment, so a more experienced doctor can deliver a better and safer outcome,” says Dr Puah.

PROS: “It shows more immediate results than radiofrequency or ultrasound procedures, which take time to show,” says Dr SK Tan, founder and medical director of IDS Clinic.

CONS: Bruising may last for a couple of weeks. You may also feel discomfort and “tightness”. “Occasionally, thread ‘extrusion’ may occur – when the inserted thread comes out and has to be removed,” says Dr Tan.

WHAT CAN GO WRONG: Bleeding and a formation of a blood clot, which resolve over time,” says Dr Tan. Dr Puah adds that there are risks of infection and a dimpled appearance on the skin.

HOW OFTEN TO DO IT: In a year or sooner, as the threads dissolve.

2.RADIOFREQUENCY

Radiofrequency (RF) waves heat skin’s underlying layers, to induce collagen and elastin production, and skin repair. “It reduces the appearance of fine lines and loose skin,” says Dr Karen Soh, founder of Prive Clinic. It can also help increase skin thickness for better resilience and moisture retention.

WHAT’S IMPROVED: Newer devices offer increased penetration depth and safety, minimising discomfort while maximising results. Some machines combine RF with other therapy methods like pulsed electromagnetic field therapy for better effects. RF treatments include: Thermage (the most popular; just one treatment is needed), Profound (microneedling + RF), Exilis (ultrasound + RF), and Thermi RF (temperature-controlled RF).

BEST FOR: Sagging jowls, cheeks, brows and under-eye area, as well as fine lines and dynamic wrinkles. Results take a few weeks to show.

WHAT A SKILLED DOCTOR CAN DO: Know which areas are sensitive and prone to complication, and how to avoid them. Carry out a detailed assessment to identify the most-needed area of focus for the best results.

PROS: Said to be better than ultrasound treatments, but doctors are divided. “I feel that the response is individual, while price and pain factor are also important determinants,” says Dr Tan.

CONS: Discomfort, mild tenderness and swelling. You may also need repeat sessions if results are not forthcoming.

WHAT CAN GO WRONG: Nerve irritation, where you experience muscular “twitching” for a short period, says Dr Tan. “Occasionally, there is nerve damage resulting in muscular weakness of the area, but this is usually temporary. Another reported complication is ‘hollowness’, especially of the cheeks, as a result of RF ‘melting’ fats in other areas.”

HOW OFTEN TO DO IT: Yearly for Thermage. At six-month intervals for Profound, for the first two sessions, then yearly, says Dr Soh. Weekly for Exilis. Four to six treatments a week apart for Thermi RF.

NOT SUITABLE FOR: Pregnant or breastfeeding women; if you have a pacemaker or defibrillator, have metal implants in the treated area, or suffer from major health problems such as severe heart disease, connective tissue diseases and cancer.

3. FACE LASERS

There are two kinds. “Ablative lasers remove the outer layer of old, damaged or pigmented skin and stimulate collagen production to tighten skin. Non-ablative lasers work under the skin’s surface to stimulate collagen growth and improve skin tone,” says Dr Lam Bee Lan, founder of Ageless Medical.

WHAT’S IMPROVED: “Doctors can now better combine lasers for better results,” says Dr Siew Tuck Wah, medical director of Radium Medical Aesthetics.

Dr Lam says fractionated technologies combine ablative and non-ablative lasers, offering shorter recovery but very good results.

BEST FOR: Ablative lasers: acne scars, keloids, deep wrinkles or very saggy skin. Non-ablative lasers: pigmentation and minor lesions.

WHAT A SKILLED DOCTOR CAN DO: Choose the best settings and prescribe proper pre- and post-care, says Dr Siew.

PROS: “Lasers target pigment and blood vessels, and don’t penetrate as deeply as RF and ultrasound,” says Dr Siew.

CONS: It’s expensive and you need to avoid the sun a week before and after treatment.

WHAT CAN GO WRONG: Postinflammatory hyperpigmentation, infections, reactivation of cold sores, and skin darkening. With ablative lasers, there’s a higher risk of burns on darker skin.

HOW OFTEN TO DO IT: Ablative: once in six to 12 weeks. Non-ablative: Three to six sessions, four weeks apart. Maintenance for both: four to 12 weeks.

NOT SUITABLE FOR: Dark to very dark skin, very sensitive skin, if you have infection in the area, or conditions with poor wound healing such as diabetes. Also, if you’ve been on the acne drug isotretinoin in the past three months.

4. DERMAL FILLERS

Synthetic versions of substances we have in our bodies, most commonly hyaluronic acid, are injected into the skin to plump, smooth lines, wrinkles and folds, restore volume or accentuate facial structure.

WHAT’S IMPROVED: Injectable fillers used to be collagen extracted from rooster combs, but these days, biocompatible substances are used instead. Dr Calvin Chan, medical director of Calvin Chan Aesthetic & Laser Clinic, says: “One of the most common is hyaluronic acid, which is synthesised to last longer, have better cohesion and deliver a nonlumpy effect. What’s more, the procedure can be undone by injecting hyaluronidase, an enzyme that dissolves hyaluronic acid.”

BEST FOR: Loss of facial bone and fat due to ageing.

WHAT A SKILLED DOCTOR CAN DO: Help you avoid an unnatural, overly full appearance by knowing the precise sites on the face to inject.

PROS: It’s fast (five to 30min) and is a non-surgical option to fat grafting.

CONS: It can be pricey if you need a lot of volume. Dr Chan says replacing facial structure normally requires 10 to 20 syringes, with each syringe costing $800 at his clinic. Side effects include pain, swelling and infection.

WHAT CAN GO WRONG: If the doctor accidentally injects an artery, it can affect facial nerves, sometimes permanently. In extreme cases of misinjection, patients can go blind.

HOW OFTEN TO DO IT: The FDA-approved hyaluronic acid filler Juvederm can last up to 24 months. Softer fillers with subtler effects may last six to 12 months before the particles are gradually absorbed by the body.

5. ULTRASOUND

Ultrasound waves induce collagen production and skin tightening. There are two types: highintensity focused ultrasound (HIFU), and micro-focused ultrasound such as Ultherapy (which delivers energy to a specific layer of the skin). Dr Low Chai Ling, founder and medical director of SW1 Clinic, explains: “HIFU is milder and requires several sessions for optimal results. Ultherapy tends to be stronger and you can see results in one session.”

WHAT’S IMPROVED: “Many years ago, the popular HIFU Ulthera treatment was very painful, even with sufficient anaesthesia. Now, HIFU is virtually painless,” says Dr Hoe Ying Min, resident doctor of Scinn Medical Centre. Dr Low adds that Ultherapy now has handpieces to treat hard-to-reach areas like the under-eye area.

BEST FOR: All areas of sagging, except over the eyes. Double chin, cheek fat, a sagging jawline and neck, nasolabial folds, fine lines, crow’s feet and forehead wrinkles are commonly treated areas. Results can take six to eight weeks.

WHAT A SKILLED DOCTOR CAN DO: Dr Low says the doctor’s skill and experience will determine your comfort, the lifting effect achieved, and the amount of side effects such as burns. Dr Hoe says experienced doctors should also assess if you are suitable for HIFU treatments and advise on the number of shots required.

PROS: Dr Hoe says RF machines reach a depth of 3mm into skin, whereas HIFU waves can reach 4.5mm. “At 4.5mm, the subcutaneous musculoaponeurotic system (a tissue sheet of collagen, elastin fibres and fat cells stretching from neck to forehead) is stimulated to produce collagen, which means a more lasting and apparent lifting effect. HIFU also requires fewer treatments compared to RF,” she says.

CONS: Slight swelling and redness, though these normally subside quickly. You may also feel a light tingling in the treated area for up to a few weeks.

WHAT CAN GO WRONG: Rare complications include bruising and temporary numbness, which subside in a few days, or burns due to poor technique.

HOW OFTEN TO DO IT: One session for Ultherapy, and weekly sessions for milder HIFU over three to six weeks, followed by half-yearly maintenance.

NOT SUITABLE FOR: Those with severely sagging skin who need a surgical facelift instead. Also, patients with metal implants or severe and cystic acne at the treatment area, and open wounds.

5. Dr Calvin Chan, medical director of Calvin Chan Aesthetic & Laser Clinic 

7. Dr Low Chai Ling, founder and medical director of SW1 Clinic 

6. BOTULINUM TOXIN

A neurotoxin is injected into the skin to smooth wrinkles by relaxing specific facial muscles.

WHAT’S IMPROVED: The procedure has been around since 1992, allowing doctors to fine-tune their technique, for example, knowing where to inject to avoid giving you droopy eyes or sagging on one side of the face. Dr Phoon Yi Shan, a partner at David Loh Surgery, says the neurotoxin can also be used to treat neck spasms, teeth grinding, excessive sweating, an overactive bladder, chronic migraine and lazy eye.

BEST FOR: Dynamic wrinkles such as frown lines, forehead lines and crow’s feet, as well as gummy smiles, bunny lines (crinkling at the top of the nose when you smile), smoker’s lines and neck lines. It can also help slim the lower face.

WHAT A SKILLED DOCTOR CAN DO: Help you maintain a natural appearance – you should still be able to look animated and have facial expressions, not “frozen”. 

PROS: Done well, it offers visible but natural-looking results in three to four days, which is much faster than non-invasive energy-based treatments.

CONS: “There’s a small risk of bruising, which can last a few days,” says Dr Phoon. Also, swelling, and muscle weakness around the injected area, drooping eyelids or brows, temporary difficulty swallowing for a few months, blurred vision and muscle stiffness.

WHAT CAN GO WRONG: If not done well, it can result in asymmetry or a frozen look. Dr Phoon adds: “There are also studies that show a possible migration of neurotoxin to surrounding neurons and complications like botulism (muscle paralysis). But this is very rare and very unlikely with the small doses we use for facial muscles.”

HOW OFTEN TO DO IT: Every four to six months, as wrinkles will start to recur then.

7. FAT FREEZING

Controlled cooling is used to target and freeze fat cells under the skin. The area is cooled to minus 10 deg C to destroy fat without damaging surrounding tissues. The dead cells then naturally pass out of the body over time.

WHAT’S IMPROVED: Dr Chan says Coolsculpting (which is US FDAand Singapore HSA-approved) was the first fat-freezing machine in the market, and is still considered the gold standard. What’s new: improved applicators that cut treatment time by 25min and deliver a more comfortable experience.

BEST FOR: Areas with stubborn fats such as the belly, flanks, thighs and arms. Also tackles bra fat, back fat and double chin. However, due to the distribution and type of fat in different areas of the body, results may vary. It takes three to six months to see results.

WHAT A SKILLED DOCTOR CAN DO: Carry out a detailed assessment so that there’s a lower risk of complications, and side effects like asymmetry.

PROS: It can be done quickly, usually in an hour or so, and there’s little downtime. “The procedure is able to spot-reduce fat by targeting areas that are usually hard to improve via exercise. Within one session, it permanently destroys the fat cells, reducing fat in the treated area by up to 25 per cent,” says Dr Soh.

Dr Chan adds that as fat-freezing is a non-surgical procedure, it’s less likely to produce unevenness compared to liposuction, which can result in a dimpled effect.

CONS: Redness, swelling, bruising, sensitivity and mild pain, which usually go away in a few days. It’s also expensive if you’re treating large areas of fat or require repeat sessions. At Dr Chan’s clinic, it costs $500 each time to treat an area slightly larger than an iPhone.

WHAT CAN GO WRONG: A possible but rare problem is paradoxical adipose hyperplasia, where fats in the treated area harden in the months after the procedure. This may require liposuction to resolve. Dr Soh says other issues, usually uncommon, include late onset of pain, first and second degree freeze burns and hernia.

It’s also important to note that there are many unsafe machines that copy established ones like Coolsculpting, Zimmer and Cooltech. These are not proven for safety and effectiveness, and may result in frost bite or burns.

HOW OFTEN TO DO IT: Areas with more fats may need multiple treatments at twomonth intervals. Dr Soh says results are usually permanent and best when it is combined with good diet and exercise. If you put on weight, the remaining fat cells may expand and bring you back to a pre-treatment state.

8. BODY LASERS

Similar to lasers used on the face.

WHAT’S IMPROVED:  A new noninvasive laser treatment called Sculpsure uses laser to “melt” away fats.

BEST FOR: Pigmentation, hair removal, stretch marks, fat reduction and body sculpting, veins and vascular lesions and tattoo removal.

WHAT A SKILLED DOCTOR CAN DO: “Know the best laser to target the concern, the energy level and sessions needed, and how to reduce side effects,” says Dr Lam.

PROS: Dr Siew says: “Lasers are better for more superficial skin problems such as pigmentation.” For spider and reticular veins, Dr Lam says the Excel V Laser offers more targeted treatment and requires fewer sessions than IPL (intense pulsed light). As for stretch marks, laser can remove damaged tissue and bring about new skin, but ultrasound works well too, by tightening skin and inducing collagen synthesis.

CONS: As with lasers for the face.

HOW OFTEN TO DO IT: Depends on the lasers and the areas treated.

NOT SUITABLE FOR: Pregnant or breastfeeding women, those with open wounds on the treatment area or unrepaired abdominal hernia, and medical conditions including: skin photosensitivity, use of photo-sensitising medications; a history of immunosuppression or immune deficiency disorders; use of anti-inflammatory or anticoagulant medication; keloid formation or scar/fibrotic tissue in the area; squamous cell carcinoma (a form of skin cancer) or melanoma; neuropathic or nerve disorders caused by conditions such as diabetes, traumatic injuries, thyroid problems and shingles.

9. FAT GRAFTING

Also known as fat transfer, fat is first harvested from body areas using liposuction. The fat grafts (also called microfat grafts) are purified and concentrated, then injected into the face using a fine cannula. It’s done under local anaesthesia or light sedation.

WHAT’S IMPROVED: “The preparation of fat grafts has been improved to maximise results, and adipose-derived stem cells can be added to the grafts to enhance retention,” says Dr Chia Hui Ling, consultant plastic surgeon at SW1 Clinic.

BEST FOR TREATING: Microfat plumps skin and creates a sharper, more lifted profile (like high-looking cheeks and nose bridge). Nanofat is best for treating fine lines and dark circles.

WHAT A SKILLED DOCTOR CAN DO: Know facial anatomy well to avoid the danger zones, plus have a good sense of aesthetics and know where to inject for a better lifting effect and profile.

PROS: Dr Puah says the results last longer compared to dermal fillers and is more cost-effective when treating multiple areas. Since you’re using your own fat, you can “debulk” areas like the lower abdomen or inner thighs at the same time. Dr Chia adds that fat grafts contain your own stem cells, which will refresh the overlying skin, unlike facial implants which are permanent but are more invasive and less natural.

CONS: Around 30 per cent of fat grafts get reabsorbed into the body, so some people may need a “top up” later on, which means a second surgical procedure.

WHAT CAN GO WRONG: Risk of lumpiness, infection, poor results and, in rare cases, skin breakdown and blindness.

HOW OFTEN TO DO IT: The fat grafts stabilise after three to six months; after that, results are mostly permanent. But note that fat grafts atrophy with age, and their size will also shrink or expand with weight fluctuations.

NOT SUITABLE FOR: Patients with high risk of uncontrolled bleeding, are in very poor health with low immunity, have infection at areas to be injected, have had multiple surgeries or don’t have enough fat for harvesting. Dr Phoon says she would reject patients who’ve had previous implants done at the targeted areas as this may bring about infection.

9. Dr Siew Tuck Wah, medical director of Radium Medical Aesthetics 

10. Dr Chia Hui Ling, consultant plastic surgeon at SW1 Clinic