Many of my patients would know my treatment ethos is firmly rooted in delicate and subtle changes. Instead of using aesthetic medicine to change someone’s face entirely, I’d much rather use it to fine tune what they already have and keep the end result natural. Many won’t understand this thought process — that’s fine with me.

Recently, I was asked at an international seminar I was lecturing in, by a foreign doctor, “Who appreciates subtle changes? Don’t patients pay you to get a newer, reformed version of themselves?” Well, this is a highly contentious subject as it’s easy to assume that only obvious changes make your money’s worth. Unfortunately, the reverse is true. Allow me to explain how subtle changes are healthier, more natural looking and artistically pleasing instead.

Who knows our faces the best?

It’s actually firstly ourselves — we know our faces the best, since we look at it in the mirror every single day; followed by a skilled aesthetic doctor who has seen many types of faces. For the patient, minimal but impactful changes can make a world of difference. Take when the faintest wrinkle or sunken area disappears — the keyword here is “disappear”. Most people who do aesthetic treatments like injectables go with the intention of improving or removing imperfections, not creating something that wasn’t there before, like a bulge or hump.

A notorious example is the “witch chin” phenomenon caused by excessive chin fillers. Chin fillers, when done correctly, should make the face look slimmer and HIDE a bulky jawline, not cause the chin to protrude out like a witch’s. There have already been many such cases around, including celebrities like Hong Kong actress Fanny Sieh. While Sieh got her horrific defect from chin implants —which was de rigueur at the time— her facial structure today is an excellent example of what will happen if you overdo chin fillers and don’t know when to stop.

So how do we get a natural and subtle result? The answer is straightforward: using less product. Less product means less injections, less pain, less side effects and less amount of money spent. Sounds simple enough, but many fail to see it and insist on the more the better. Of course, I don’t blame them, as many patients can be blindsided by their perceived flaws. But it is the job of the doctor to be aware of the dangerous consequences of excessive products and to educate the patient. 

Besides, you don’t actually need more to achieve satisfying and flattering results. When it comes to injectables, a small amount is enough to stimulate collagen regeneration. Too much can lead to: 

Foreign body reactions

Several reports show that when overdone, fillers and collagen stimulators can cause foreign body reactions including palpitations and swelling even a month after your procedure [1]. 

Muscle atrophy

Muscle atrophy is known to be a common side effect of botox. Yes, it can happen — but only if you inject it in mindless large amounts and do it way too often. Muscle atrophy is not only cosmetically distressing but impacts future injections as well [2]. This is why I always tell patients that botox effects can last forever – and many people reach the state of permanent side effects when overdone with too much greed. The reverse is true; when you use appropriate amounts, the lasting benefit can be permanent. 

Scarring

Threadlifts are extremely low risk with virtually almost no risk of scarring. Yet, there have been cases of patients who experience visible scarring and bumps from botched facial threads due to excessive threads and lack of skill from the doctor [3]. 

The same ‘less is more’ concept applies to lasers — a weak stimulus stimulates and regenerates, but a strong stimulus inhibits and destroys. 

When doctors and patients can’t recognise subtle changes, that’s a real sin — because even observant bystanders can recognise them, and badly done work even on tiny details can be picked up. Take for example the recent Fann Wong saga, where a local aesthetic doctor analysed the 50-year-old actress’ face at Star Awards 2021 and was able to tell that she overdid her cheek fillers.

When perfectly done subtle details reflect the doctor’s skills

I should add that using less products requires greater expertise especially when placing the injections in delicate and meaningful areas. Let’s take the eyes for example — precise eye-hand coordinations and firm control is imperative for under-eye or upper lid fillers, where the skin is very thin. In order to achieve a beautiful masterpiece, the doctor must be able to pick up subtleties and master the art of injecting. 

It’s so much easier to bomb someone with loads and loads of treatments and injections to achieve visible results. This “carpet bombing” style of treatment is less elegant, brainless and simply requires you to just throw “bombs” onto the whole area to achieve the desired effect. Take for example tattoo removal — a doctor who carpet bombs would just blast the tattoo with the Q-Switched Nano or Pico Laser at high power ONLY. This can cause horrible blisters while only removing minute amounts of the tattoo. The correct way to do it is to start with a deeper laser known as FracTat, followed by the Pico Laser, which has already proved to lessen downtime WHILE removing even MORE tattoo ink in a single session [4]. My colleague, Dr Lena Fan, has also written about FracTat in her article “The Ultimate Guide to Tattoo Removal in Singapore”.

To further elaborate, a real life analogy is like playing the piano or any musical instrument. It is easy to “bang” the piano keys, but it takes skill to play softly and capture every delicate touch crisply. So before doing any treatment that could drastically change your appearance, make sure your doctor nails the subtle details first. 

Conclusion

Am I saying all this because it’s difficult to get obvious results, or is this just a post meant to rebut baseless statements, like when a certain doctor claimed that melasma cannot be treated completely? By the way, melasma can be cured — I will address this in a separate post; Or am I trying to protect my case when I say acne scars can be removed and not just reduced? (Side note: I’m aware of the flak I’m receiving from other clinics because of that post, I will do a video regarding this issue). 

Here’s the thing: the difficulty is not in getting obvious results that stick out like a sore thumb; it is obtaining visible results that you personally feel confident about without others being able to tell you had work done. It might feel tempting to brag about the procedure you’ve just done and have it written all over your face, but aesthetic treatments should not be treated like material commodities such as branded bags to make you stand out! 

References

1. Alcântara, C., Noronha, M. S., Cunha, J. F., Flores, I. L., & Mesquita, R. A. (2018). Granulomatous reaction to hyaluronic acid filler material in oral and perioral region: A case report and review of literature. Journal of cosmetic dermatology, 17(4), 578–583. https://doi.org/10.1111/jocd.12374
2. Salari, M., Sharma, S., & Jog, M. S. (2018). Botulinum Toxin Induced Atrophy: An Uncharted Territory. Toxins, 10(8), 313. https://doi.org/10.3390/toxins10080313
3. Garvey, P. B., Ricciardelli, E. J., & Gampper, T. (2009). Outcomes in threadlift for facial rejuvenation. Annals of plastic surgery, 62(5), 482–485. https://doi.org/10.1097/SAP.0b013e31818c18ed
4. Bäumler, W., & Weiß, K. T. (2019). Laser assisted tattoo removal – state of the art and new developments. Photochemical & photobiological sciences : Official journal of the European Photochemistry Association and the European Society for Photobiology, 18(2), 349–358. https://doi.org/10.1039/c8pp00416a