There are now many options for improving facial appearance without undergoing surgery. Non-surgical methods are very popular due to many advantages such as avoidance of incisions, fast recovery and convenience.
With wide-spread advertising on the internet/social media and even unlicensed practitioners, patients can find it hard to determine which are legitimate treatments. Patients also need to understand which are most appropriate for themselves in the context of effectiveness, downtime, side effects and costs.
It is important to consult a qualified and experienced practitioner who can combine the practical and aesthetic demands of such treatment while maximising safety. Below are common procedures done in our clinic by our MOH-accredited plastic surgeons:
Botulinum toxin is able to block nerve signals that make muscles contract. The muscles thus relax, reducing unwanted wrinkles.
This effect lasts about 4 to 6 months. After that, the muscles move again and the wrinkles come back, although many times not to the extent they had before. In addition, Botox can potentially postpone the development of deep wrinkles and excess skin. This is because these aging changes are contributed by excessive muscle activity.
Common areas for wrinkle treatment include “crow’s feet” (lines at the outside corner of the eyes), frown lines and forehead lines. In the neck, Botox treatment can help efface the vertical neck bands and horizontal lines while giving a subtle lift to the jaw line. Botox can be used to lift and shape the brows, even correcting mild asymmetry between both sides. It does this by blocking the “squint” action of the muscles, opening the eyes and giving a more open and refreshed look.
Chin dimpling is caused by mentalis muscle over-activity, unintentionally resulting in a disgruntled and aged expression. Botox can be used to smooth the chin by relaxing the muscle, thus making the face look more pleasant. These are just some examples of how Botox can powerfully alter the facial expression that is conveyed: from worried or surprised to relaxed and calm.
A common misconception is that Botox treatment results in a “frozen” and unnatural face. This can be due to too large doses given or because the patient needs to get used to smiling “without scrunching up the eyes”. Another misconception is that a patient can get addicted to Botox and treatment is required every few months. This is not true as Botox does not cause chemical dependence, when the effect dissipates, one can choose whether and when to continue.
Repeated chewing on hard food or teeth grinding results in hypertrophy of the jaw (masseter) muscles and a square-looking jaw. Many patients perceive a square face as more masculine while a “V” face looks younger and more youthful. Botox can reduce the bulkiness of the masseter muscle, converting a square face to a more ‘V” shaped, slim one.
Repeated treatment over time has been shown to reduce prominence of the jaw bone itself without going through surgery. This is because bone is a dynamic structure that continuously undergoes a remodelling process in response to functional loading. Simply put, the thinned muscle pulls on the jaw less, causing the bone to be less stimulated to grow.
Botox injection into this same masseter muscle can improve symptoms of bruxism and jaw grinding in patients with functional issues.
Beyond its effect on muscle activity, microbotox has proven to be effective in improving the sheen and texture of the skin. This is when Botox is given in very small doses into the dermis, resulting in atrophy of the sebaceous glands.
This decreases sweat/ sebum production as well as acne. Enlarged pores become less obvious while the skin envelope is tightened.
Botox is FDA-approved for 11 therapeutic indications, due to its useful effect on unwanted muscle activity.
Migraine: Increasingly, Botox is used to reduce muscle tightness that can lead to migraines, over trigger points such as the frown muscles, temple area and the back of the head.
Muscle spasms: It can be used for uncontrolled muscle contractures of the face and body such as blepharospasm, hemifacial spasm, cerebral dystonia and spasticity. It is an essential component of the treatment of facial synkinesis in facial nerve disorders.
Severe sweating: Botox blocks the nerve impulses activating the sweat glands, thus decreasing sweat production in problem areas such as the armpits.
Excessive saliva production: It can also be used to reduce secretions from salivary glands when this is a problem, for example, in patients with drooling or salivary fistula.
Scars: in the acute phase, relaxation of surrounding muscles lessens the strain on the new scar. The cells within are less stimulated to overproduce collagen, thus reducing hypertrophic scar formation. This is especially important in areas subject to a lot of movement such as the face or over joints.
Even in established problematic scars (see scars section), such as hypertrophic or keloid scars, Botox can be combined with steroids with good results. Patients report less symptoms of itch/pain and improvement in scar colour and thickness.
One of the first signs of aging is the loss of youthful volume as facial fat pads shrink in size. This leads to loss of support and sagging of facial structures. For example, there is a natural decrease in fatty tissue under the lower eyelid and upper cheek area by the 3rd to 4th decade. The skin and muscles of the lower lid slowly lose elasticity and no longer remain tightly secured in place. This results in an obvious junction between the lid and cheek and the so-called “tear-trough deformity”.
Facial droop also results in deepening of the nasolabial folds (smile lines) and marionette lines (“puppet lines” extending below the lip corners). Hollowing in the temple area as well as thin lips are other symbols of aging.
Foundation strengthening: support facial soft tissues for lifting effect, prevent further sagging.
Contouring: recreate a youthful contour, address sunken hollows and facial asymmetries
Refinement: reduce wrinkles and deep smile lines, plump up lips
Skin boosting: replenish hyaluronic acid for firm supple skin and a natural glow (for example, Profhilo is now one of the most popular skin boosters our clinic offers)
Scar softening: Acne scars are tethered to the underlying tissue in an irregular manner. After subcision (using a cannula to release the scar fibres), filler injection allows the skin to rise and diminishes the appearance of the scar.
Every patient and their needs are different. There is “no one size fits all” approach, rather in-depth facial analysis is needed to bring out the beauty in each face. As with most fillers, results are not permanent but are long lasting (from 9-24 months).
Some patients are also naturally deficient in the projection of areas such as the forehead, nose, jawline and chin. They may even be asymmetrical with one side being obviously more deficient than the other. Fillers can be used to alter facial proportions with immediate and natural results. This is a non-invasive alternative to facial fat grafting or facial implants.
Plastic surgeons actually operate on all areas of the face as part of cosmetic surgery. We are trained to have a more innate knowledge of facial anatomy than anyone else, which helps us avoid critical facial structures. With proper training and experience, filler injections are generally very safe.
Aesthetic lasers are very popular because they are minimally-invasive, quick treatments with little downtime. They are versatile as they can target all types of skin concerns. The basic principle behind their operation involves the interaction of laser light with the skin or body tissues.
The laser emits a focused beam of light that is of a specific wavelength or colour. This is absorbed primarily by the target tissue while sparing the surrounding healthy tissue.
After the laser treatment, the body’s natural healing process is triggered. This includes the production of new collagen, the shedding of damaged skin cells, or the resorption of pigment. Over time, these processes lead to the desired aesthetic improvements.
Numbing cream is first applied to numb the skin. The laser procedure typically takes between 15-30 minutes.
After a laser procedure, it’s essential to follow post-treatment care instructions. This may include protecting the treated area from sun exposure and using skincare products. This ensures proper healing and minimizes potential side effects such as post-inflammatory hyperpigmentation (PIH).
Different types of lasers and energy devices are designed for specific treatments, here are some that are commonly used in our clinic:
This is an ablative laser that vaporizes thin layers of skin. It is very useful for removal of superficial skin lesions such as viral warts, seborrheic keratoses, milia (oil seeds), small moles and so on.
How does CO2 fractional laser differ from doing a facial?
When used in the fractional mode, it creates microthermal zones within the skin, stimulating collagen production by the surrounding skin. Collagen is a protein crucial to skin elasticity and firmness. Compared to facials which barely touch the outside layer of the skin, this is a lasting and genuine rejuvenation of the skin from the inside out. Patients typically experience improvement in fine wrinkles and uneven skin texture. Although results can be seen with one session, maintenance treatment once every few months or every 1-2 years is usually performed as the skin will continue to age.
Are they effective for scars?
Scar tissue is composed of disorganized bundles of collagen. The fractional laser removes columns of this irregular collagen in a controlled fashion, allowing gradual remodelling and replacement with organized collagen. For “blending” acne scars and post-surgical scars, a few repeated sessions are usually recommended to achieve optimal results. This is because more intense resurfacing is required in such cases. The number of sessions also depends on the treatment type and individual response.
What are the benefits of the Edge One laser?
At our clinic, we use the latest Edge One Fractional CO2 Laser. It is an ultrapulse laser which generates a very narrow ablation zone, limiting the extent of thermal diffusion to the surrounding tissue. These very fine beams cause minimal redness as well as scabs that are very tiny and less noticeable. Downtime can be reduced with faster recovery compared to older fractional lasers.
What is Morpheus8?
Morpheus8 is a unique energy device that uses ground-breaking technology: radiofrequency (RF) micro-needling. It is able to cause regeneration and tightening in all layers of the skin and even down to the fat.
Microneedling, as the name suggests, involves the use of tiny, sterile needles to create microscopic punctures in the skin, thereby stimulating the body’s natural healing processes and collagen production. RF energy is then delivered into the deeper skin layers using the needles, tightening the skin and reducing wrinkles. This is much more effective than trying to deliver RF energy from the skin surface as the surface temperature would heat up too much instead.
This advanced machine can automatically deploy bipolar RF energy to multi-level treatment depths in a single cycle. This allows uniform treatment from superficial to deep (up to 8mm) with a significant reduction in treatment times. Nonetheless, being a controlled and precise process, there is little collateral damage resulting in minimal downtime. Another purported advantage is the lower risk of post-inflammatory hyperpigmentation as compared to lasers, which enables it to be used in darker skin types with a better safety profile.
Morpheus8 is designed to be used on any part of the body, including along the face, neck, abdomen, thighs, flanks and buttocks. Common skin concerns the Morpheus8 can be used to address include:
Pico laser is administered in one trillionth of a second (picosecond), which is a hundred times faster than conventional lasers. They are generally used for tattoo removal and treatment of skin pigmentation. Ultraformer III HIFU uses the latest ultrasound technology to achieve non-surgical face and neck tightening. These can be performed off-site if our doctor feels that the usage is indicated.
Thread insertion into the face is a method to temporarily reposition the soft tissues of the cheek, jawline, eyebrow and neck. Results are modest and may last up to 12 to 18 months as they are absorbed by the body over time and facial ageing is a continuous process. Although it is a less invasive alternative to getting a facelift, it has inherent risks such as bruising, skin dimpling, pain, infection, extrusion through the skin and so on. A thorough discussion with your surgeon and having realistic expectations is important before undergoing the procedure.