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In Singapore, facelifts are popular among cosmetic operations while treatment for skin is reliant on technology and creams. Two doctors discuss the pros and cons of the different skin enhancement procedures available.
Skin enhancement
For skin laxity: Fillers, available in commercial preparations such as hyaluronic acid, collagen and the like, can fill out furrows such as those between the brows. However, these are not permanent. Alternatively, the doctor may use the patient's natural tissues, which are processed in a way that only fat cells are injected as fillers.
Wrinkles: Botox blocks muscle action. Injections are administered in the facial muscles to relax them in a particular area – for instance, the lines of expression around the lower eyelids, also described as crow's feet.
Loss of skin texture, pigment changes and lacklustre skin, due to ageing: Procedures to address these include
– laser technology
– radiofrequency technology
– intense pulsed light (IPL).
Broadly speaking, these use either ablative (destructive) or non-ablative technology. Ablative technology is useful for vapourising skin blemishes such as moles or milia (tiny cysts). These lasers can penetrate up to 100 to 120 microns into the skin dermis.
Non-ablative technology is more useful in darker skin types, as it is less likely to cause further skin darkening from thermal (heat) injury. Non-ablative lasers penetrate up to 25 to 50 microns of the skin and, being lighter lasers, are more suited to darker skins.
Of the three, IPL is the "kindest" as it does not penetrate deep into the skin, but it rejuvenates the skin by exfoliating its outer layer.
Creams
• Exfoliants, e.g. tretinoin
• Moisturisers, e.g. emollients
• Bleaching agents, e.g. 4 per cent hydroquinone or the new combination of hydroquinone, fluocortizone and tretinoin.
To date, only a few clinical comparative studies show the effects of this new therapeutic regimen.
Latest treatments
Fractional technology Fraxel, Mosaic, ProFactional, Pixel
Produces thousands of tiny, deep columns in your skin (MicroThermal Zones) for treatment of scars and rejuvenation. Allows faster healing with minimal downtime.
Ouch factor: 3/5
MicroLaserPeel™
Superficial skin resurfacing for the treatment of scars, facial lines and fine wrinkles, and for rejuvenation.
Ouch factor: 3/5
PPx: Photopneumatic therapy
Light-based therapy with the use of a vacuum for the treatment of pigmentation, rejuvenation and hair removal. Ouch factor: 0/5
Biorevitalisers: Injectables
Injections of naturally-occurring skin substrates (surfaces on which an organism grows or is attached) which intensely hydrate, promote collagen formation and provide long-term skin protection against ageing.
Ouch factor: 4/5
Thermage STC tip
Thermage has been around for some time as one of the foremost monopolar radiofrequency devices. The Thermage STC tip is a new development which offers an exquisite combination of both superficial skin tightening and deep tissue lifting in a single, no-downtime treatment.
Ouch factor: 3/5
Article contributed by Dr Colin Song, Singapore General Hospital and Dr Colin Tham, KK Women's and Children's Hospital
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