Hubert Burda Media


Tempted by a facelift but don't want to go under the knife? CATHARINE NICOL investigates the best nonsurgical alternatives


DESPITE THE WORST efforts of Meg Ryan, Nicole Kidman and the late, great Joan Rivers, scandals like the PIP breast implants of 2010 and toecurling trends like Kim Kardashian's “vampire facial” and Sharon Osbourne's “designer vagina”, chasing that elusive beauty – which may have been denied by Mother Nature, life's ups and downs, or trauma – has never been more popular.

“In plastic surgery we apply medical knowledge and science to change the way our clients look and feel about themselves,” says Singaporean plastic surgeon Woffles Wu, speaking at the SpaChina Summit 2014. And he emphasises that a good aesthetic eye is “the secret to success. It is a marriage of medicine, art and psyche.”

You could say there are two kinds of beauty in the world: inner and outer. While the former is the kind of beauty we are all encouraged to focus on, it is the latter that brings in billions of dollars annually to an industry that can barely keep up with demand.

And yet the comparative popularity of plastic surgery is being severely nipped and tucked by nonsurgical treatments. Looking at the global figures presented annually by the International Society of Aesthetic Plastic Surgery, almost 12 million nonsurgical procedures were carried out in 2013.

“Relatively speaking, the market for aesthetics is increasing three to four times faster than surgical,” says Wally Chen Teck Meng, medical director at Sense of Touch Medi-Spa in Hong Kong. “What we can do now with non-surgical, minimally invasive treatments is quite amazing. Most people are much happier doing procedures that require little or no downtime. Surgery is a big plunge with at least two to three weeks' downtime. How many of us can afford to lie at home in bandages?”

While Korea is the Asian pioneer when it comes to beauty procedures, with women almost in danger of looking like clones of each other, Chen sees mainland Chinese women following closely in their footsteps. For them, pain and payment are non-issues as long as they look visibly improved.

“In general, Asian patients start treatments early, whenever we can earn enough money to afford it,” says Stephanie Lam Chuk-kwan, resident specialist plastic surgeon at Central Health Medical Practice. “I see Chinese patients as young as their early twenties wanting nasal augmentation or to improve a receded chin. Caucasian patients start to come to the clinic when they hit their mid-thirties, usually after having children, or when they start to see signs of ageing.” She adds that women from northern and Southeast Asia often seek decreased pigmentation, v-shaped faces and round, apple cheeks while Westerners look for wrinkle reductions, skin tightening and high cheekbones.

“My patients often ask me what is new, what is cutting-edge,” says Lam, “but they're paying a premium to come and see me so I need complete confidence in the procedures I offer. My reputation and career are on the line. Only with expertise and a collective experience of many people using a procedure would I be able to recommend it to patients with confidence.” With that in mind, here's a list of the most popular treatments around today.


Lam considers Botox as mainstream as make-up. Not only tailor-made for paralysing wrinkles, Botox lifts brows, augments the chin, smoothes the neck and slims the jaw line, as well as preventing excessive underarm sweating and slim-lining the calf muscle. Full effects take a few days to fully show and there is little immediate downtime.


Fillers use injections of hyaluronic acid, collagen or synthetic collagen, fat or platelet-rich plasma (aka the vampire lift) to reverse the loss of volume caused by ageing. Results include filling out hollows and scars, smoothing the smile line by filling the cheek, helping to contour the jaw and increasing nasal height. New generation fillers last longer than before, up to 18 months rather than six to nine. Expect little downtime, although some redness, bruising or swelling may appear.


Platelet-rich plasma (PRP) skin rejuvenation uses your own blood, spun in a centrifuge to separate red and white blood cells from the plasma that is now enriched in platelets. The platelets help the tissues of the body heal and grow, softening wrinkles, smoothing skin, minimising sun damage and improving toning. PRP injections supposedly help to stimulate your own collagen and are often given in conjunction with fillers; they're relatively painless and have minimal effects of redness, swelling or bruising.


Based on radio-frequency technology, Thermage is FDA-approved, non-invasive and, although not pain-free, requires minimum downtime. Results from the “bulk heating” device include a remodelling of the collagen and the tightening of ageing skin and the tissues underneath. It is ideal for the arms, inner thighs, stomach and buttocks, and for lifting the face and upper eyelids. There may be some redness but there is no real downtime and results can be seen in as little as a day.


Using HIFU (high intensity focused ultrasound), Ultherapy goes deeper than Thermage and is ideal for more mature skin. The device boosts the production of collagen and tightens tissues using a low-energy heat, with some swelling or redness for a few hours and a gradual improvement seen over two to three months. There is some pain involved, with doctors suggesting sedation or the prior taking of painkillers. Ulthera is currently FDA-approved for the face and décolletage but not for other areas of the body.


PDO micro-threads have been used for years for internal surgical sutures and in their new form are inserted under the skin and pulled to lift, micro-hooks anchoring them in place. A significant tightening can be seen immediately. Improvements continue within the first two to three weeks as swelling and bruising decrease and the threads stimulate collagen production. Using a flexible cannula needle minimises the number of threads required, bruising and bleeding. Korea is starting to swap in PLLA threads (previously used in implant surgeries) for PDO threads as they last for two to three years before they dissolve, rather than nine months. Patients require a local anaesthetic and there's a downtime of about three to five days.


An injectable made of PLLA acid that helps the skin replace collagen and correct wrinkles and folds – especially the nasolabial, marionette and chin lines – Sculptra is designed to be applied a number of times over a few months, and can last for more than two years. The new liquid face lift treatment combines threads and Sculptra.

Other treatments to look out for include Photogen System, IPL for pigmentation, microdermabrasion, chemical peels like Cosmelan or Mesoeclat and stem cell technology (as yet unapproved for aesthetics).

Many patients may feel overwhelmed by such a vast choice. Lam explains: “Patients always want noninvasive procedures with no downtime and no risk that will make them as beautiful as possible and as slim as their body will allow. It would be great if there was one magic injection/potion/machine that could take them there but the truth is that in reality that dream is still far away.”