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"As a typical man, I am very lazy when it comes to grooming, but I strongly believe it is important to look fresh. Hence, I take time off my busy schedule to have my maintenance treatments done - yearly Ultherapy and fillers, quarterly lasers, for example. When we look fresh, we feel better and more confident. - DR SIEW TUCK WAH

"Like most women, I feel that it is not always easy to look and feel your best. It is a conscious, moment-by-moment decision to make the right choices for health and well-being, whether from physical, emotional or spiritual aspect." - DR SYLVIA RAMIREZ

"First, accept and love yourself, and then as a well-loved person, love others." - DR SHIAU EE LENG

"I believe that we all have the potential to live without limits, and be the best version of ourselves. For me, it's very simple really. I try to live in the present, not in the past nor the future. I believe that it's what you do in the present that can change your future and redeem your past." - DR KENNETH LEE

Putting Your Best Face Forward

Four doctors tells us more about the latest in medical aesthetics
Dec 21, 2018 5:50 AM

Dr Kenneth Lee: Matching corduroy jacket and trousers, long-sleeved striped shirt, all by SANDRO. Loafers, by TOD'S.

Dr Shiau Ee Leng: Perlee Signature bracelet in pink gold, Perlee diamonds bracelet in pink gold and diamonds and Magic Alhambra 2-motif earrings in pink gold, grey mother-of-pearl and diamonds, by VAN CLEEF & ARPELS.

Dr Sylvia Ramirez: Perlee Couleurs bracelet in pink gold, carnelian and diamonds, by VAN CLEEF & ARPELS.

Dr Siew Tuck Wah: Pullover, by SANDRO. Linen trousers, by COS. Lace-up shoes, by TOD'S. Omega Seamaster Diver 300M Co-Axial Master Chronometer 42MM in steel on rubber strap, by OMEGA.

Market voices on:

PEOPLE WHO SEEK MEDICAL PROCEDURES to improve their physical appearance “not only want to be in good health, they also want to enjoy life to the fullest, be fit and minimise the effects of normal aging”, says the American Academy of Aesthetic Medicine. In addition, these patients are requesting quick, non-invasive procedures with minor downtime and very little risk.

In other words, attitudes towards medical aesthetic treatments – as they are called here – are favourable and appear to have become increasingly popular over the years.

“In multiple reports, including the most recent report from the American Society for Aesthetic Plastic Surgery, non-surgical facial aesthetic procedures have increased exponentially,” says Dr Sylvia Ramirez, medical and scientific director of Cutis Medical Laser Clinics in Singapore. “In fact, they reported a 44 per cent increase in demand for non-surgical procedures in the past five years.”

She adds that this trend is set to increase in 2019 and beyond because of increased awareness regarding the safety and effectiveness of noninvasive procedures; greater demands on both men and women for self improvement; and the stronger emphasis on overall health and well-being where being “fit” also includes “looking as good as you feel”.

“Part of being successful in our careers and in the business environment not only includes looking vigorous and fit, but also fresh, youthful and less stressed,” she explains.


According to Dr Kenneth Lee, co-founder of SW1 Clinic, non-invasive treatments are set to rise due to a paradigm shift in people’s mindset from merely treating existing problems to preventative therapy. “Skin tightening therapies using improved platforms such as Ultherapy will continue to dominate the anti-aging market,” he says.

“We have seen the average age of a patient seeking skin tightening treatments dropping from someone in their late 40s to someone in their 30s, showing that both men and women are more proactive in taking care of their looks, and very willing to invest in the future of their skin.”

Apart from taking preventive measures, Dr Ramirez says patients want to look as natural as possible.

“A recent analysis that we’ve done in our clinic database suggests that patients are looking for ‘rejuvenation’ and not ‘correction’ of a specific concern,” she reveals. “In addition, a recent global survey suggests that women in their 50s prefer to look ‘great for their age’ and not younger.”

Further, since facial aging is a result of changes in various layers of the facial tissues, which together, reposition the skin downwards, she predicts that the trend is towards combination treatments that yield the most “balanced” results. “Because every layer of the skin and its underlying supportive structures goes through changes over time, each aspect needs to be addressed with a combination of treatments,” she says.

Dr Siew Tuck Wah, medical director of Radium Medical Aesthetics, agrees: “Combination anti-aging treatments will be the main trend next year. This involves the use of several treatment modalities, such as botulinum toxins, fillers and Ultherapy to holistically treat an aging face with the most natural results. Bio-stimulating fillers such as Radiesse which tighten and rejuvenate when injected under the skin have been very popular and will continue to be in 2019.”

In fact, he says that although Radiesse has been approved by the U.S. Food and Drug Administration (US FDA) for more than 10 years, doctors are now discovering more new uses for the versatile filler. “Radiesse not only restores volume loss associated with aging, but also improves skin texture and lift sagging skin by inducing our skin to produce collagen and elastin.”

Meanwhile, the “evergreens” would still be pigmentation control like pigment lasers and anti-aging treatments like Ultherapy, says Dr Shiau Ee Leng, medical director of CSK Group of Aesthetic Clinics.


When it comes to aging, skin laxity is the number one reason why we look older with age, says Dr Lee. “In fact, having a few wrinkles may not always make you look older, but having saggy skin and jowls is a surefire way of giving your age away.”

As we age, we lose collagen in our skin and deeper parts of facial tissues over time, says Dr Ramirez. “For instance, it has been shown that we make 1 per cent less collagen per year starting in our 20s, and by our 40s, we lose more collagen than we build, resulting in progressive changes in the skin.

Once a woman hits menopause, a whole range of more visible and sudden changes may occur, such as up to 30 per cent collagen loss and thinning of the dermis and epidermis, drying of the skin, hyperpigmentation and hair growth changes. This collagen loss contributes to laxity and sagging skin showing as loss of definition of the jawline, formation of lines around the nose and mouth, making us look tired and older.”

Indeed, Dr Shiau says skin tightening is important after reaching the age of 25, when aging begins. But since people don’t immediately jump to surgical facelifts at the first signs of sagging, while others just want to prevent such signs for as long as possible, non-invasive skin tightening is often the option of choice.

“There are many options like quick-fix injectables such as botulinum toxin and fillers to correct the wrinkles,” she says. “Then there are maintenance therapies like Ultherapy which uses ultrasound energy, and other radiofrequency and infrared devices and lasers.”

In general, collagen building procedures are of benefit to most patients, explains Dr Ramirez. “Ultherapy reaches the dermis and the underlying fibrous tissue (known as SMAS or superficial muscular aponeurotic system). The SMAS is an important structure that holds the skin in place, and is the target of some types of partial surgical facelifts.

With Ultherapy, collagen building occurs in the deeper layer of the skin as well as in this SMAS layer. This happens without needles, cutting or disturbing the surface of the skin, there is minimal to no downtime needed, and the procedure is well-tolerated by patients.

Ultherapy is a US-FDA cleared treatment whereby the safety and efficacy have been established through many clinical trials. As Ultherapy allows direct visualization of the tissue that is being treated, doctors can see what layer of the skin is being treated and can precisely target the particular tissue to be tightened.

Of course, this does not mean there are no other skin tightening modalities available, says Dr Lee, noting that there are radiofrequency or ultrasound devices that target at a more superficial depth. As a result however, a few sessions may be needed for the effects to accumulate, and there is a need for more judicious maintenance sessions
after, he says.

Dr Ramirez adds that there are many “copies” of Ultherapy, and these are not necessarily backed by clinical studies and may not be effective or safe.


Consider what it is about your own face or skin you want to improve, says Dr Lee. “Don’t change the way you look because of someone else.”

Also, check on the experience and safety track record of the clinic and doctor you’re eyeing.

“It’s always safer to get recommendations from friends and relatives who have personally attended a particular clinic or seen a doctor,” says Dr Shiau. “Before making a decision, get information from reliable sources like independent research institutions or public or government-funded organisations with no financial implications when they provide information.”

Patients must also look into safety, that is, whether the treatment has a proven track record for safety and efficacy, says Dr Siew.
“There are new treatments in the market all the time, often with irresponsible claims. Have a conversation with your doctor and have him or her tell you all the pros and cons of the treatment, and the possible side effects. Don’t believe everything the Internet says.”

Dr Ramirez says that for lasers and other medical devices, always ask about the origin and quality of the equipment. This can be judged by the existence (or lack) of robust clinical trial data that have been reviewed by expert doctors, as well as US FDA clearances.