When you are seeking for an aesthetic treatment, a few questions may arise to you:
- How can I be sure if this treatment is safe for me?
- What qualities should I look out for in a doctor?
- What are the benefits and risks of this treatment?
Overall, these are all valid and good questions. Hence, you should have them addressed before you decide which treatment and doctor to go for.
Read on to find out about how you can effectively choose your treatment!
What are the guidelines that regulate aesthetic practice?
The guiding rule in any medical procedure rests on two key points. Firstly, you must see if the treatment will benefit you. Secondly, your safety must be a priority.
Sadly, aesthetic medicine is not classified as a speciality under the Singapore Medical Council (SMC). Overall, guidelines for good and ethical clinical practice still apply.
In essence, the treatments given must be:
- Safe without causing harm.
- Effective in getting desired results.
- Prioritise your well-being.
During consultations, you should be made aware of the expectations of each treatment in detail. Again, the side-effects and complications of the treatment are no exceptions. Moreover, we must explain them to you in detail.
Likewise, you must also give informed consent before proceeding with any treatment.
How is aesthetic treatment safety ensured in Singapore?
In general, the safety of all medical procedures rests on the foundation of clear guidelines and adequate training. As a matter of fact, the SMC’s official “Guidelines on Aesthetic Practices for Doctors (2016 Edition)” defines these guidelines for aesthetic practice . In order to perform the treatments independently, we must have adequate training and are required to attend a certified course. After the completion, we may then obtain Certificates of Competency (COC). Above all, these certificates will have to be in relation to the specific procedure that is recognised by SMC.
MOH aesthetic practice guidelines, in short
In 2008, the guidelines were issued first  which were later updated in 2016. Also, you can access "The Guidelines on Aesthetic Practices for Doctors" (2016 Edition)  via SMC's website. In other words, it provides us to perform aesthetic treatments a framework to work under. Thus, we are able to carry out the treatments under appropriate risk-adjusted regulatory oversights. For example:
- Which are low-risk and higher risk aesthetic procedures?
- Who can or cannot perform them?
- What training is required?
- Where can they be performed i.e. in the clinic or the operating room?
Also, it covers topics such as:
- The definition of aesthetic practice
- Professional responsibility
- Allowed aesthetic procedures
- Ethical compliance to the guidelines
What treatments can aesthetic doctors perform?
There are only certain treatments that we can perform. As such, such treatments have to be covered under the MOH aesthetic practice guidelines. Currently, these are the only approved procedures that we may perform :
- Chemical or pressurised gas
- Liquid peels
- Intense Pulsed Light (IPL) for skin rejuvenation
- Other light-based devices for skin tightening & skin rejuvenation
- Lasers/IPL for hair removal
- External fat reduction treatments
- Botulinum toxin injection
- Filler injection for the face, neck and hands only
- Thread lifts
- Lasers for treating vascular disorders
- Lasers for pigmentary disorders
- Fractional lasers for skin rejuvenation
- Ablative lasers to remove benign skin lesions
Are aesthetic doctors required to go through special training?
To become trained doctors, we must attend a local or overseas training course. In addition, we will have to get verification from SMC. It must state that the course certificate qualifies as a Certificate of Competency (COC) . In other words, these training courses generally cover, in detail:
- The fundamental basis of the treatment
- Indications for treatment
- Contraindications to treatment
- Pre-operative assessment
- Informed consent taking
- Operative skills
- Post-operative management
- Management of potential complications
Often, they include expert-led demonstrations of the procedures as well.
Above all, we will have to take a test at the end of the course. The test determines if we have met the learning goals and have achieved basic competence. In addition, the SMC governs the standards of these practices. As a result, these standards help to keep Singapore a reputable and safe place where you may go for procedures.
How are the treatments proven safe and effective?
The aesthetic practice world is evolving quickly with new techniques and treatments. Of course, only a well-conducted clinical trial may show the treatment's benefit and safety. A trail can then be further established when additional published clinical trials support them.
For a treatment to be in the recommended list of procedures in the SMC’s Aesthetic Practice Guidelines, there must be:
- At least three scientific papers and
- Is published in the English language
As a matter of fact, a treatment method will have to be proven to be safe and effective. Only then, it can be listed. For those that are not listed, they may be done after vital regulatory approvals as well as within the context of the clinical trial. As that said, they cannot be offered as a service.
What are the side-effects of aesthetic treatments I should know about?
Before you can give your informed consent, you must be made aware of the possible side-effects. This is just like any other medical treatment. While benefits are the aim, there will still be some side-effects.
Thankfully, most of the common aesthetic treatments are either non- or minimally invasive. Hence, it is rare to see dangerous side-effects. Not to mention, these side-effects are more often linked with invasive treatments requiring instrumentations. To sum it up, here are a few examples:
- Arterial occlusion from facial filler injection that may cause permanent blindness.
- Gut perforation from liposuction that may cause bowel injuries.
Lucky for us, these risky side-effects can be avoided by having:
- Proper patient selection
- An experienced and qualified doctor to perform the treatment
- A proper healthcare setting
Will treatments become riskier as I age?
Your age does not affect the safety of a treatment. Despite this, treatment may be compromised if you have an age-related medical problem. Likewise, certain drugs may increase the risk of complications. Most of the time, non-invasive treatments such as IPL and cosmetic lasers are safe for all ages. More so than anything else, invasive treatments should be avoided if you have any of these conditions:
- Poorly controlled diabetes or chronic renal failure. You will have poor wound healing.
- You are taking blood thinners to prevent strokes or heart attacks. With this, there is an increased risk of bleeding.
Thread lifting and filler injections are examples of more invasive treatments
For instance, you should discuss with us if you have any underlying medical problems or are on medication. To decide which treatment best suits you, you should consider the risk-to-benefit ratio of the treatment.
Can pregnant women go for aesthetic procedures?
While you are pregnant, your unborn child’s safety should be at the top of your priority list. Hence, it may be prudent for you to delay non-critical procedures until you have delivered your child. Some conditions may be worsened during pregnancy due to hormonal changes, such as melasma. However, active treatment may not be needed during this time. Your skin will lighten by itself after the birth of your child.
Acne flares during pregnancy are common. They can be controlled with the use of:
- medication and
- blue-light phototherapy.
You may stick to non-invasive options if you wish to. However, you should avoid any injectables such as botulinum toxin and fillers .
How safe is Botox?
When done correctly, Botox is safe with minimal side-effects. However, you may see slight bruising or redness around the area of injection. Despite that, it will often fade away after a short period. Other possible of side-effects of Botox include :
- Mild pain
- Mild nausea
- Flu-like illness
- Double vision
- Blurred vision
- Dry mouth
In those with neuromuscular disease, they may have serious and rare side-effects. This is especially the case with Myasthenia Gravis. It includes difficulty in swallowing, speaking and breathing.
Serious side-effects will be highly uncommon when:
- Known contraindications are followed
- Treatment is done by a trained doctor
- Used correct Botox dosages
Botox is a quick procedure. In other words, you can even complete them within your lunch break and head back to work without a sweat.
How safe are filler injections?
Fillers are considered safe provided that they follow these three conditions. Firstly, the correct filler for the patient is chosen. Secondly, they are injected with the correct technique. Lastly, the right instrument is used to inject the filler.
Above all, the decision to use fillers is a highly personal one. Despite the benefits, there are some potential risks that you must be willing to face. Severe complications from dermal fillers are rare. The possible risks vary depending on the specific filler-type. The relative permanence of the filler substance also plays a role. Here are the possible side-effects :
- Acne-like skin eruptions
- Bruising, bleeding from the injection site, swelling
- Damage to the skin that results in a wound and possible scarring
- Infection at the injection site
- Palpability of the filler under the surface of the skin
- Skin rash with itching
- Skin redness
- Under- or over-correction of wrinkles
- Skin necrosis (ulceration or loss of skin from disruption of blood flow)
Therefore, it is important for you to address any question you may have directly to your aesthetic doctor. As significant complications may occur from dermal filler injections, it is important to be in the hands of a trained doctor. Your doctor should be ready to take on any complication that may arise from the procedure. Before going for a filler injection, you should take note of the following:
- You should be in the care of an experienced doctor who appreciates the risks
- Have a doctor who has good injection techniques
- Your doctor should know how to deal with any complications that may occur
How safe is thread lift?
Amongst the many skin lifting treatments available out there, thread lift is one that stands out the most. Thread lift offers an immediate skin lifting effect that may last for many months. Over the past decade, techniques and materials have been refined. Therefore, this in turn, has made thread lift a much safer procedure to undergo. Despite its safety, it still requires great skill and experience on the aesthetic doctor's part to perform well.
The trend towards using absorbable rather than permanent threads has contributed significantly. But, you should be aware that thread lift requires instrumentation which may allow risks to arise. In conclusion, the possible side-effects include:
- Dimpling of skin
- Thread extrusion
- Asymmetry of the face
- Infection and granuloma (lumpy skin) formation
Above all, short-lived swelling and bruising are often unavoidable. However, they are mild. To reduce these side-effects, here a few factors to consider. They are:
- Proper patient selection
- The doctor's skills & experience
- Meticulous attention to asepsis
- Proper aftercare
How safe are cosmetic laser treatments?
Cosmetic laser treatments can be very effective and safe when done by us. However, the lasers do pose some risks to you from going through this treatment.
Like with any other aesthetic procedure, you should be aware of certain complications. They could be a temporary or permanent side-effect of the treatment. Therefore, the possible side-effects are :
- Prolonged redness of the skin (post-inflammatory erythema)
- Discomfort and/or pain
- Skin reddening or flushing more easily
- Changes in skin pigmentation (hyperpigmentation and hypopigmentation)
- Burns, blistering or other injuries from the laser’s heat
- and bacterial infections
Before embarking on cosmetic laser treatment, you should be well informed about its procedure. However, you should always first seek advice from us. During a consultation, make sure you ask the following:
- If your condition could benefit from treatment
- How the laser works
- What are the risks
You should not just focus on the benefits it will give you. In order to reduce the side-effects listed above, Proper post-laser skincare and sun avoidance are important.
The price of each treatment
|Areas Targetted:||Cost:||Recommended Intervals|
|Botox||Crow Feet||$180 - $300|
Every 3 - 6 months
|Forehead||$100 - $200|
|Frown Lines||$160 - $300|
|Square Jaw||$300 - $800|
|MicroBotox Lift||$360 - $600|
Depends on the type of fillers used
1st ml $650 - $850
2nd ml $600 - $700
3rd ml $500 - $550
Every 6 -18 months
Monthly for 3 months
Maintenance every 3 - 6 months
|Tear trough (1ml)|
SkinBooster HA $650 - $800 per 2ml
Volite $850 per ml
Radiesse $950 per 1.5ml
Depends on the number of threads
$1,200 - $3,600
Depends on the type, number of threads used and severity of laxity
Every 6 - 24 months
|Cosmetic Lasers||Pigment||$150 - $380|
1 - 3 months
|Acen Scars||$350 - $600|
|Pores||$250 - $380|
|Skin Tones||$250 - $380|
How do I know if my aesthetic doctor is safe?
To start, your first step of finding a safety-orientated doctor is usually to have your friends recommend some to you. Then, we will be the one to guide you through your aesthetic journey. As such, it is good to have a thorough discussion with us during the consultation. Similarly, this is to ensure that you are confident in us.
Here are some relevant questions that you can ask us:
- How many years has he/she been practising aesthetic medicine for?
- Does he/she have the relevant COCs to perform the specific aesthetic procedure?
- How many similar treatments has he/she performed?
- When did they obtain their COCs?
- What are the results of his/her's patients?
- Does your doctor go through all the key risks and adverse outcomes with you frankly?
- Do alternative treatments offered to you influence you unduly?
For instance, you may make a judgment if we understand your needs and focus on safety. Trust and confidence matter when it comes to aesthetic treatments.
Being able to trust your doctor is important
In your quest to look better, it is crucial to first identify your specific aesthetic concerns. In the first place, you should know what treatments are available to you to address your concerns. After that, you should understand the benefits, as well as the potential risks of the treatments you are considering.
SMC has put in place regulations that ensure the practising doctor has basic competency . It has classified allowable aesthetic procedures based on scientific evidence which are currently available. Despite this, you should still ensure you develop a trusting relationship with your preferred aesthetic doctor.
In other words, the best doctor for you is one which:
- Ensures that you fully understand the benefits and potential risks of treatment,
- Has your best interest at heart
- And also, seeks to achieve realistic treatments outcomes
In short, we will always have to adhere to the highest safety standards possible.
Dr Chin Yee Choong is a medical director at Dermclear Aesthetic & Laser Clinic. His area of practice is in the area of beauty aesthetics fields of dermatology and aesthetic medicine. In addition, he has had more than 12 years of experience in thread lifts and fillers. Besides that, he regularly travels to keep himself well-informed of the newest treatments available.
Would you like to ask any related health questions?
Read more from Dr Chin Yee Choong in his Q&A here.
4. Morgan JC. Botulinum toxin A during pregnancy: a survey of treating physicians. Journal of Neurology, Neurosurgery & Psychiatry. 2006;77(1):117-119. doi:10.1136/jnnp.2005.063792
5. Botox injections - Mayo Clinic. Mayoclinic.org. Published 2019. Accessed November 12, 2019.
6. Aesthetics Journal. Aesthetics. https://aestheticsjournal.com/feature/treating-permanent-dermal-filler-complications. Published 2016. Accessed November 12, 2019.
7. Laser resurfacing - Mayo Clinic. Mayoclinic.org. Published 2018. Accessed November 12, 2019.