When it comes to the conversation of beauty, in recent years the focus has shifted from the transformative use of makeup to embracing and enhancing your beauty through the use of effective skincare, prompting many to adopt a minimalist approach to beauty. And while the no-makeup movement has been empowering for many, it can be daunting for those who do not have the privilege of naturally good skin. 

But what happens when the results you desire cannot be achieved with skincare alone, but going under the knife feels daunting? Well, a good middle ground is a combination of non-invasive and minimally invasive aesthetic treatments that combine the usage of machines and injectables. 

One such combination treatment is the Sculptra X Thermage Facelift. Recommended by aesthetic doctors for patients who are interested in rejuvenating their skin, what makes this duo so effective is that both treatments help to stimulate collagen production, but in different ways. 

When administered together, the treatments help to treat the main issues most patients face when it comes to ageing: loss of volume and sagging skin. As both treatments can be administered in the same session, it’s also a great option for patients who want results, but can’t afford the time for regular aesthetic treatments. 

Dr Shiau Ee Leng, Chief Medical Director of ClearSK Aesthetic Clinics

We speak to aesthetic doctor Dr Shiau Ee Leng, Chief Medical Director of ClearSK Aesthetic Clinics to get the lowdown on this combination treatment, the subtle and natural effects it produces, and why it’s so effective when it comes to anti-ageing.

Firstly, what exactly is Thermage?

Thermage is a non-invasive radiofrequency (RF) therapy that delivers heating energy to the deeper layers of the skin while concurrently cooling the surface of the skin. It uses an improved energy algorithm that delivers radio frequency in a series of micro-pulses to the skin. This helps to tighten the underlying layers of your skin while concurrently giving it a boost in natural collagen production. In addition, a built-in vibration accompanies each pulse, so that it minimises device contact and heating effect on the skin, resulting in better patient comfort during the procedure. 

As a result, it can be done infrequently, about once a year or one and a half years. Think of this treatment like you’re “ironing” your skin to make it firmer and lifted.

What’s the difference between Thermage and other energy-based treatments such as HIFU?

Both Thermage and HIFU systems both use energy to invoke and restore collagen production in the dermal layer of the skin. However, the type of energy used is different: Thermage uses radio frequency (RF) energy while HIFU uses ultrasound (US) energy. Thermage has an RF penetration of up to 2/3mm depth, whereas HIFU has a US penetration of up to 3/4.5mm depth. There is a misconception among the public that the deeper the penetration, the better.

But if a person has very thin skin, they might end up feeling excessive pain and minimal results when they do HIFU. This is because the ultrasound waves are hitting the bone and not even stimulating the collagen of the skin because of how deep the penetration is. If you’re hitting the bone, the treatment won’t work as effectively as your bone doesn’t grow any collagen.

If a patient has thinner skin, they would actually be happier with the results of Thermage whereas a patient with a fuller and plumper face would be more suitable for HIFU. So it’s important that the doctor assess your skin properly and give recommendations on whether you are more suitable for either treatment.

What is the best age to start Thermage?

Your 30s are the best age to start Thermage. We usually recommend it to people from 25 to their late 30s as most patients at this age don’t really have muscular sagging yet. An additional side benefit of Thermage is that it can also reduce acne outbreaks because the layer of the skin it hits is exactly where the oil glands are.

For those who are unfamiliar with aesthetics, what is Sculptra?

Sculptra is an injectable dermal filler that stimulates collagen production within the skin. Approved by the Food and Drug Administration in 2000, the injectable itself contains Poly L‑Lactic Acid, a bioactive and biodegradable compound that is most often used for skin issues with a long-standing safety profile.

As we age, we start to notice our faces looking sunken or lines such as our nasolabial folds begin to deepen. This injectable will help to renew youthful firmness and restore your skin’s structure by helping you to produce your own collagen naturally.

Typically what happens when Sculptra is injected, it acts like a fertiliser for your skin. I will inject it in the area I want collagen to grow. The product is bio-solvable and gets absorbed into your body, and what you see at the end result is your own collagen that your body has produced.

What are the effects of Sculptra and how long can it last?

The effect is very subtle, which is the current trend for aesthetics. People tend to prefer a natural look and like the idea that it is your own collagen stimulated. You’ll begin to notice that your cheeks feel a lot firmer and the nasolabial folds are less sunken. Some patients have also experienced better skin textures and the appearance of their pores has been minimised. 

How long the effects start to show depends on your age group. If you’re in your 20s, you can start seeing results in as fast as 30-40 days and if you’re in your 30s, you will notice results in about 40-50 days. But of course, a healthier person who doesn’t smoke, has a good diet and sleeps well will definitely produce collagen faster and see better results.

Who is Sculptra suitable for? 

It’s very good for patients who are beginners at aesthetic treatments and are just looking to maintain their skin. The changes are very subtle, and you won’t look very different from what you originally looked like, but you will notice that you look less tired. Though if a patient has very sunken features, they will see a significant change after 3-4 months. But because the change is gradual due to your own collagen production, the effects aren’t as sudden and people won’t be able to tell. 

As Sculptra stimulates collagen, do you have to target specific areas?

Yes. It depends on what the patient is looking for. If you have some droopiness in the eyes you can target the temples. If you want the cheeks to appear firmer or more lifted, you can target certain areas of the cheek. 

If you already have a full and round face, is Sculptra necessary? 

If a patient is young, we’ll just do a booster dose to maintain what she already has. We tend to see a trend of young people moving away from botulinum toxins and fillers and starting Sculptra at a younger age as a preventative measure. Or if they do end up getting botulinum toxins and fillers, they can do it at a much older age or a smaller dosage.

Sculptra is administered gradually over two to three visits to achieve a stepwise stimulation of collagen. However if the patient’s body produces too much collagen naturally and feels their face looks too full, we can actually do a bit of RF treatment to tighten the skin to give a better-desired result. This is why I recommend multiple visits so you don’t end up with too much collagen, and we can tweak the areas to treat and adjust it based on the patient’s preference. 

If someone has very sunken features, how would you differentiate when to use Sculptra and when to use derma fillers?

Simply put, fillers are a very quick fix, whereas Sculptra has more of an anti-ageing effect.

An individualised treatment plan is recommended after consultation and facial assessment. If someone has more severe sagging or collagen loss, we can choose to administer it over a few sessions instead of one. They can choose to do it all in one session (but they can expect their faces to look a bit swollen) or
over the course of two to three sessions as part of their anti-ageing routine.

For example, if I have a 55-year-old patient with sunken features and lines, I’d advise them to do five to six sessions. Over time, their faces will firm up, their lines will be less obvious and the effects will last two to three years.

Fillers, on the other hand, are very effective for patients who want immediate results and don’t have the patience to grow collagen over an extended period of time. However, it tends to dissolve faster. If you have a high metabolism or love to exercise, Sculptra will be a better fit as the collagen produced is your own. It is also denser and able to resist a high metabolism. 

It’s also a more affordable option if your face is really very thin and sunken. If you use fillers, it’s 1cc per syringe so it’s very expensive. One bottle of Sculptra is 9cc so it’s more cost-effective.

Can you get Sculptra and other derma fillers at the same time?

Yes, but only in different areas. No doctor would recommend getting it in the same area as they will be worried that both treatments will interfere with each other’s effect. Filler is a gel, so if you inject Sculptra into an area where there already is filler, the Sculptra might end up getting stuck inside the gel. Then the product won’t work as it won’t be able to stimulate the collagen in that area. But if a patient wants to get Sculptra in the cheeks and filler in the nose then that’s fine. 

What are some issues that Sculptra can’t treat?

Sculptra gives a softer volumising effect and is good for treating volume loss, lightening folds and smoothening wrinkles. But for those who need face contouring like a higher nose bridge, higher cheekbones and a sharper chin, crossed-linked HA fillers with higher density and lifting capacity, for example, Restylane, would be more suitable.

What are some of the risks associated with Sculptra? There have been cases where patients have reported nodules forming.

Our clinic has been doing this for 13 years and is one of the longest users of Sculptra in Singapore. What we’ve realised is the bad press you’ve heard about it is for treatments done much earlier, like 10 years ago, and the protocol was very different. 

Sculptra in its original form is actually a powder, and back then the solution was only diluted to 3-5cc which is very concentrated. If it is not dissolved properly, it can cause nodule formation when injected into the skin.

About seven to eight years ago, the protocol has changed and now the solution is diluted to 8-9cc. After that, reports on nodule formations became almost non-existent. The right dilution ensured fewer side effects, so even if a small nodule does form, it might appear the size of a pimple and will not be difficult to treat should it arise.

Sculptra is made of a biodegradable protein powder so if there are any nodules we can always apply a bit of RF heat to the area to make them disappear. Sometimes we inject the area with sterile water and, with a bit of massage, the nodule will dissolve. Patients who still develop it (we’ve had one to two cases over the last five years) are welcome to come back to get it dissolved. But this only happens to people with extremely thin skin.

What is the post-treatment care routine like?

There is a massage routine that we recommend all patients follow. We call it the 5-5-5 routine — for five consecutive days, patients should massage the treatment area for five minutes, five times a day. This helps to ensure there’s no chance for the powder to clump together.

Why do Sculptra and Thermage have different results even though they both work by increasing collagen production?

Right now, there is a global trend where combo treatments are administered for faster and better results. Instead of doing one treatment and then waiting months for a secondary one, it can be done in the same sitting. When Sculptra and Thermage are administered together, it can stimulate even more natural collagen growth compared to when the treatments are being used separately.

For the Sculptra X Thermage combined treatment, price start from $1,800 per treatment area – subject to the number of sessions the patient requires. Individually, Sculptra prices start from $980-1800 per session, while for Thermage FLX, prices start from $1485 for upper face or complete eye treatment.