Health

Beastly aspects of beauty jobs

From filler jabs to fat-reduction sessions, doctors share the risks of five popular treatments here

Filler, threadlift, botulinum toxin, fat-freezing and high-frequency ultrasound treatment (Hifu) seem to be everywhere now. Four doctors tell us what can go wrong with these procedures.

FILLER

Its role: To fill hollowed areas, such as those under the eyes, smooth wrinkles or deep lines and give features a lifted appearance.

It is one of the most popular aesthetic procedures. According to the International Society of Aesthetic Plastic Surgery, over 2.8 million filler procedures were done worldwide in 2015.

What can go wrong

The filler can migrate, whereby the hyaluronic acid (the stuff in fillers) moves from where it is supposed to be, to another part of the face, said Dr Georgia Lee, medical director at TLC Lifestyle Practice.

This can happen even if the procedure is done by a renowned professional who has done it 10,000 times.

Why? Because filler migration can just happen, it is about the luck of the draw.

"It can happen immediately, especially if it is a tricky spot (under the eye is one), with visible bulges as the telltale signs," said Dr Lee.

The filler can also be injected into the wrong place, such as a blood vessel.

What happens next is one or both of these conditions

1. Embolism, whereby "you'll experience unusual and intense pain during the 'wrong' injection'," said Dr Lee.

"Your skin will turn white or pale because arteries - including the ones to the eyes - carrying blood are blocked. This will be followed by the formation of red patches and, in a worst-case scenario, blindness."

2. Necrosis, which occurs when the "oxygen supply to the skin is cut and tissue starts to die and turn black".

"Skin breaks down and ulcers may form over the next few days. Skin can heal, however, with minimal scarring," said Dr Lee.

How they're fixed

1. Embolism: "All injections are stopped immediately, and the filler neutralised and dissolved with pure hyaluronic acid and hyaluronidase, an enzyme," said Dr Lee.

"If vision is compromised, 'eyeball CPR' (whereby pressure is applied repeatedly to the affected eye for 10 to 15 seconds, released, then again for three to five minutes) may be performed, after which an ophthalmologist will be contacted (there is a small window of 60 to 90 minutes to reverse the effect). Or the patient will be sent to a hospital immediately."

2. Necrosis: "The doctor may use hyperbaric oxygen therapy, which supplies oxygen under high pressure to the area, to inhibit tissue death," said Dr Lee.

How doctors get it right

1. They use a thinner, smaller needle with a blunt tip for high-risk areas where there are many blood vessels (such as under the eye and along laugh lines), as it is less likely to puncture them.

2. Doctors keep an eye out for any skin colour changes at the injection site, Dr Lee said.

BOTULINUM TOXIN

Developed to treat excessive sweating and muscular conditions, it is now commonly used to relax facial muscles and in the process, minimise the look of lines and wrinkles.

What can go wrong

Administering too little or too much of it can result in lopsided features or the inability to smile. Doctors recommend patience as botox can take up to two weeks to show its full effects.

If you're still unhappy after that, ask for a top-up.

Go with the real stuff

This seems obvious enough, but "I've had patients who had 'botox' procedures done overseas and ended up with an infection, which led to sepsis (a serious and life-threatening infection)," said Dr Alvin Wong, medical director at SKN Mediaesthetics.

THREADLIFT

Fine threads, similar to the ones used to hold an open wound together during medical suturing, are inserted into the skin.

These are absorbed by the body to help stimulate collagen production for firmer skin over time. This procedure is used to lift the brows, cheeks and jowls, and minimise a double chin. Its effect lasts up to three years.

Do give the doctor your medical history. He usually prescribes post-treatment medication, such as antibiotics and anti-inflammatory medication to prevent infection. Knowing your medical condition, especially if you are diabetic, helps him to take precautions.

Go with a real pro

Another case of the obvious, but a certified medical doctor will use a sterilised threadlift kit and will ensure the threads do not protrude from the entry points. "One patient had to be referred to a plastic surgeon to remove the threads and infected tissue surgically," said Dr Ram Nath, medical director at The Wellness Clinic. And inform your doctor if you're feeling unwell on the day of the treatment.

FAT-FREEZING

This is performed using a machine that "sucks" unwanted fat and cools it to around -7 deg C - the temperature that kills fat cells. The machines that do it right (such as Zeltiq's CoolSculpting) are approved by the US Food and Drug Administration after extensive studies for safety and effectiveness, said Dr Sylvia Ramirez, medical director at Cutis Medical Laser Clinics.

"They are equipped with stopgap systems that trigger an auto shutdown when temperature settings fluctuate."

What can go wrong, although not dire

If the temperature plunges to below the acceptable level, you will get burns. "They must be treated quickly to prevent permanent scarring," said Dr Wong.

In serious cases, there can also be nerve damage, which can manifest as numbness, tingling sensation and severe pain.

"You can't reverse the nerve damage," said Dr Ramirez. However, "it is generally temporary and usually resolves itself within six months," said Dr Wong.

HIFU

Relatively new here, it is used to reportedly help tighten collagen fibres and stimulate the production of new collagen for lifted skin and refined contours for the tummy, thighs and cheeks.

What can go wrong, although not dire

"The ultrasound waves may hit a nerve ending, which leads to a temporary tingling sensation or numbness, and/or may affect motor function or facial expressions," said Dr Lee.

This is common and will resolve itself over a couple of weeks, without medical treatment in most cases.

This article is adapted from Her World magazine.

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