By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
The evolution of beauty or aesthetic treatments seems to have reached its pinnacle in this millennia, since there appears to be a whole new branch of medicine dedicated to “aesthetic medicine”. The regulatory medical council of Singapore worked with dermatologists and plastic surgeons last year to release a set of updated guidelines on the practice of aesthetic medicine in Singapore. It sought to stipulate what aesthetic medicine, was, and it was not, as well as regulations surrounding its practice in Singapore.
As a dermatologist, I am often asked by members of the public, my patients or even my colleagues in other specialties if I practice aesthetic medicine. The short answer is yes, but the long answer is that the question itself was wrong.
Since then, I realised how confusing it was for the layperson to navigate in this medical “specialty” and how I could not blame them for not understanding or asking the wrong question fundamentally. I seek to provide an insider perspective on how aesthetic practice should be regarded by the public.
Fundamentally, and amongst my peers, I do think that we, as as a community of medical professionals still believe (perhaps with some naivete on our part) that public opinion does hold us in an altruistic light. This is why I believe we owe it to the public to tell the truth. At the heart of it, I hope to show an honest perspective in the cut-throat industry of aesthetic treatments, advice that I have shared with friends, relatives and patients of mine and along the way enlighten readers on what to expect.
1. Doctors are trained to help people with diseases and aesthetic medicine is not regarded as a medical specialty
The public will be surprised to know that there is no internationally accepted definition of “aesthetic practice”. Aesthetic medicine is also not regarded as a specialty or subspecialty. For conditions relating to plastic surgery, the specialist recognised by the Ministry of Health would be an accredited plastic surgeon. In the same vein, accredited dermatologists specialise in treating both cosmetic and medical dermatology conditions, relating to skin, hair and nail health.
The realm of aesthetic medicine encompasses the field of research and development that dermatologists and plastic surgeons specialise in. However, due to the increase in the number of non-specialists practising aesthetic medicine, medi-spas offering aesthetic treatments and overlap with the lucrative beauty industry, it’s easy to get confused. Amongst these are also medical practitioners who have undergone rotations in dermatology or have pursued a family practice diploma in dermatology but are not accredited dermatologists.
The current Singapore guidelines issued refer to the UK Cosmetic Surgery Interspecialty Committee definitions for “cosmetic surgery” as the boundaries of “aesthetic practice”. Precisely, this would refer to procedures or surgeries that alter the appearance, colour, texture, structure, or position of bodily features, which otherwise would be considered to be within the socially acceptable range of ‘normal’ for that individual.
2. I am a dermatologist; I practise aesthetic dermatology and carry out aesthetic treatments but I am not an aesthetic doctor
The term “aesthetic doctor” is not regulated and is actually disallowed under the latest regulations. In the early years of my dermatological training, I spent a good amount of time in the medical dermatology department of a local tertiary hospital, mentored by an inspiring professor of dermatology, whose golden words I remember distinctly till today. In response to my enthusiasm to enter the dermatology specialty training programme, he reminded me, that “Wan Lin, you are training to be a dermatologist, and not a beautician. Dermatologists are not beauticians.”
To begin with, I entered dermatology because I was really fascinated by how the skin manifested all sorts of underlying internal conditions of the body in such a unique way. When my dermatology professors were able to diagnose complex diseases of the kidney, liver and even organ cancers, just by analyzing the skin, seemingly at a single glance, I was floored and was determined to become like them.
This is interesting now, that the word “aesthetics” is linked to the medical profession, and to be exact, dermatologists and plastic surgeons are considered the key opinion leaders in this field, which is increasingly practised by non-specialists such as general practitioners. This leads me to reflect upon what my mentor said to me long ago, that “dermatologists are not beauticians”, which is probably why I react with a certain degree of chagrin whenever someone suggests that I am an aesthetics doctor.
3. What is beauty ?
As a junior doctor several years ago, I rotated through the department of plastic surgery before I entered into my dermatology training. A particularly memorable doctor I met there was a respected plastic surgeon that did exclusively reconstructive surgery, meaning he would not be involved in any surgeries for cosmetic enhancement, due to his personal beliefs. In my time there, I learnt from this surgeon the most about reconstruction, which meant restoring anatomy in patients who have suffered from trauma or tissue loss from cancers/infections.
Of all the cosmetic/aesthetic surgeries I participated in throughout my rotation, the ones that left the deepest impression on me were all reconstruction cases, when I saw how true beauty was when one could restore to its original form and function, rather than just changing one’s appearance so you could recreate the same K-POP idol pin-up look. The latter, by the way, is always changing. That’s just my personal take. It led me to reflect on the true calling of a doctor, even in the field of plastic surgery.
My private practice encompasses both medical and cosmetic dermatology cases. In terms of aesthetic treatments, I own a variety of laser/aesthetic machines equipped with advanced technology and work with injectables such as fillers and botox.
For concerns relating to pigmentation, irregular skin texture, scars, these to me are not mere “aesthetic” concerns because a dermatologist can diagnose each of these as specific conditions due to an underlying problem affecting the skin. Patients are also suffering from poor self-esteem and a lot become withdrawn, depressed and anxious thinking that nothing can be done about their skin. All of these concerns can also be definitively treated.
For patients who come to me for ageing concerns such as face sagging, face-lifting…I always ask them first for a picture of themselves at a time when they felt they looked their best. The last thing I feel any doctor should do is to make a patient feel they are not good enough. As a society, we are already made to feel we aren’t. By the time a patient decides to go to a dermatologist for help, my position is really to offer hope, support and treatment.
I am a strong believer in natural beauty, the definition of which is what is unique and pleasing to the eye, and not what everyone thinks is beautiful( at the moment). My goal remains to restore one’s youth, at the same time maintaining the uniqueness and individuality of one’s facial features. Afterall, your skin, being the largest organ of your body, degenerates with time just like your liver, kidney, heart, bones and joint.
With laser technology, light is harnessed to trigger off new collagen formation, re-setting the genetically-programmed cell ageing process. With high-intensity focussed ultrasound (HIFU), this technology goes deep to the SMAS (Superficial Musculo-Aponeurotic System) layers where patients can now have a mini face-lift without going under the knife.
Every patient that comes to me for aesthetic treatments or procedures gets a thorough run-through of how the different layers of skin tissue which make up the face movements interact as one ages. Consequently, each patient’s individual ageing process and treatments will differ. Aesthetic treatments like botox, fillers and lasers are not procedures that can be ordered off the menu like your lunch bento, especially when each comes with a set of its own risks along with its benefits.
An accredited dermatologist or a plastic surgeon will analyse your facial anatomy, break down the cause of your ageing face, and correct those elements. Any other method of shopping for aesthetic treatments will at very best give a mediocre result, and at worst it can be outright dangerous.
4. Have problem skin? You don’t have an aesthetic issue, you have a medical condition of your skin that should be diagnosed and treated
Any perceived flaw on one’s skin can be attributed to a dermatological condition. Dark mark on your face after having a pimple? It’s post-infIammatory hyperpigmentation. Uneven skin tone? Take care you don’t actually have a skin pigmentation condition such as melasma. Enlarged pores and irregular skin texture? You could have suffered from acne in your teens and still have seborrhea, which is excessive production of oil from one’s sebaceous glands.
Untreated acne over a long time leads to blackheads and open “pores”, as well as acne scars that can be indented, “ice-pick” or “box-car” type. To a dermatologist, every single of these conditions can be broken down to the diagnosis, the cause and medical treatment, which may also include lights and lasers.
All dermatologists advocate gentle skin cleansing, regardless of your skin being oily or dry. It is a myth that oily skin needs to be stripped of its oil in order to be healthy. Au contraire, sodium-laureth sulfate laden foaming cleansers and astringents (read: often alcohol or salicylic-acid-based toners) dehydrate skin, cause eczema and sensitivity in the long term.
However, even though good dermatologist-formulated and tested cosmeceutical skincare delivers the nutrients for healthy skin, can improve acne and mild eczema, along with brightening and tightening skin for anti-ageing concerns, it does not actually treat medical conditions. With my brother, a pharmaceutical engineer, I formulate a brand of cosmeceutical skincare Dr. TWL Dermaceuticals which is an adjunct to the medical treatments I offer in my clinic.
Even though I am a strong believer in the effectiveness and safety profile of cosmeceutical skincare, I always emphasise to my patients that no amount of good skincare can actually treat their skin problem (if they have one) since their conditions require medicated treatment. Skin conditions have to be diagnosed accurately before correct medical or laser treatments is administered. The use of cosmeceuticals helps to anti-age, lighten scars and complexion by delivering evidence-based pharmaceutical anti-oxidant ingredients to skin and also prolong/enhance the results of aesthetic treatments.
5. Everyone wants to look young and beautiful but there’s nothing wrong with the existing you
No one really “needs” aesthetic treatments. Feeling overwhelmed by all the advertisements for fillers, botox, skinboosters, ultherapy and lasers? You probably are. It’s not wise to call up any medical aesthetics provider, check for the cheapest rate and order a botox or filler injection like you would deliveroo. These are all medical procedures which are regulated and comes with its own set of risks in the wrong hands. Do research, check your doctor’s accreditation. If you are concerned with ageing, seek the advice of an accredited dermatologist early from your mid-twenties onwards for prevention.
If you are in your thirties, forties or beyond, fret not, your dermatologist would discuss your expectations and treatments and he or she can start you on a regimen including lasers and injectables like botox and fillers. Or refer you to a plastic surgeon if required. If you have a true skin condition such as acne, rosacea or eczema that’s troubling you, your dermatologist will first treat it. Very often, my patients have no more complaints about the look of their skin once its treated and realise that it was not anything “aesthetic” – related in the first place. Thankfully, before they spent a bomb on beautician facials, medi-spas or cosmetic skincare.
© 2017 twlskin.com. All rights reserved.
Meet with Dr. Teo Wan Lin, consultant dermatologist at TWL Specialist Skin & Laser Centre, for a thorough consultation to determine the most suitable treatment for your skin.
To book an appointment with Dr. Teo, call us at +65 6355 0522, or email firstname.lastname@example.org. Alternatively, you may fill up our contact form here.