Mothers and daughters have always done girly things together. Sharing makeup; mani-pedi sessions; body scrubs at the spa. Now add cosmetic surgery into the mix as families talk about breast implants and eyebag removal as easily as discussing which college to apply to.
With the influence of Korean pop culture, Instagram, selfie apps and the general perception that good-looking people get better jobs, cosmetic surgery is on the rise. So too has demand for non-invasive procedures by general practitioners. But while the latter industry continues to boom, the cosmetic surgery sector has sagged, hampered by price competition, advertising rules and aggressive marketing by foreign medical centres. It's even prompted outspoken surgeon Woffles Wu to suggest that Singapore's cosmetic surgery sector is in dire need of a makeover itself. But is it?
Who does it and where
Property manager Lina Lee (not her real name), had surgery to correct her droopy eyelids in a well-known Seoul medical centre at the recommendation of her sister-in-law, whose daughter was going to have her eyes done as well.
"I wouldn't have done it if my sister-in-law hadn't come back with positive results and less pain than expected," says Ms Lee, 61. She did the surgery three years ago because her eyelids were affecting her vision. She also had her eyebags removed, "since I was already going through the procedure". She adds that she healed very fast, thanks to "this Korean surgery technique".
She didn't consider doing the operation in Singapore because "it's expensive and (the surgeons here) are not as skilled as the ones in Seoul. You can imagine how popular eyelid surgery is in Korea - so many people are doing it daily because the clinic is full. Practice makes perfect. I've seen a few friends who did it in Singapore and it took years for them to look natural again."
For former breast reduction patient, SL Woo (not her real name), her decision to reduce her breast size from 36D to 34B was not cosmetic but for health reasons as they gave her a backache.
The 40-something homemaker had the operation four years ago at Bangkok's Bumrungrad International Hospital, for about a third of the price in Singapore. (The hospital's website lists it at US$6,699). "I did my research and a friend recommended a doctor. Then the consultation was done over email, and I met my surgeon on the day of the surgery itself."
The whole experience was wonderful, she declares, and the hospital room was spacious and just like a hotel. Her husband and children accompanied her to Bangkok and she could even coach her kids for their exams during her post-surgery recuperation. "I would do it again, because I want to have A cup sizes," she declares, although her doctor and husband haven't encouraged her.
The bane of Singapore surgeons
Patients like these are the main reason that business has softened for Singapore's cosmetic surgeons. As long as prices remain attractive outside of the republic, there will be a stream of people doing it overseas.
Dr Wu says there are multiple reasons for the slowdown even though there's been much greater public acceptance of surgery and hence, demand. One is the depressed world economy and also Singapore's; the property price hikes over seven years ago; Singapore's strong currency and the higher rates it pays for medical equipment and consumables. This makes local patients look outward and caused a drop in foreign patients coming to Singapore, exacerbated by the lack of medical travel promotion by Singapore Tourism Board, notes Dr Wu.
The biggest bugbear is the guidelines against doctors advertising here, with the greatest impact coming from the ban on the use of "before and after" pictures.
"This is one of the effective educational features and it's allowed practically everywhere else. So it's just not a level playing field for Singapore aesthetic doctors, as a lot of advertisement angles are deemed as unethical," points out Dr Wu. "The clinics overseas are so aggressive but they don't fall under Singapore's jurisdiction, so they advertise heavily in our Internet space as well," he adds.
Singapore's cosmetic surgery - and also medical industry in general - is running on its former reputation established in the past, he believes. What gets his goat is also that some Singaporeans who go overseas for face or body jobs but return with a botched outcome have gone to see doctors in Singapore for corrective measures but "bargain" for lower prices.
Then there are foreign doctors coming to Singapore and even doing consultations at hotels which is illegal, but they rarely get called out for it.
His concern is not unwarranted. "The number of patients from Singapore coming for cosmetic surgery in our Seoul hospital has tripled since 2011," says BK Kim, the founder of BK Plastic Surgery Hospital. He adds that cosmetic surgery is much more popular among Singaporeans now but they prefer to do it overseas, in Korea and Thailand. "We have better business in our hospital because of patients from China and Singapore," he adds.
He can't say the same about his Singapore branch, The BK Clinic at Novena, which has offered mainly aesthetic services since 2014. "We have not seen a significant increase in patients."
He notes that patients go for aesthetic procedures at the Singapore clinic, but prefer Korea for the actual surgery. "Besides being cheaper, they want the full facilities and surgery by Korean plastic surgeons for better results."
Invasive versus non-invasive
The notion that one can achieve surgical-quality results without going under the knife has seen the non-invasive aesthetics industry boom over the last five years, with over 100 such clinics in Singapore, a 50 per cent jump.
Even so, the line between glorified beauticians and general practitioners qualified to perform medical-grade treatments is blurring, says David Loh of David Loh Surgery. The honorary secretary of the Society of Aesthetic Medicine (Singapore) notes that medical regulations have made it very difficult for new doctors to do more invasive procedures. "In order to broaden their scope of services, they instead expand into even less skill-based and non-invasive procedures that are not unlike those offered in spas," says the GP. Even beauticians are opening clinics, he adds.
Valerie Kurniawan, head of marketing and communications for a global tech conglomerate, has been on both sides of the aesthetic coin. The 50-year-old underwent an abdominoplasty more than a decade ago to tighten her stomach skin after she gave birth to twins. She hasn't done any surgical work since, but has tried almost every non-invasive aesthetics treatment out there for both face and body. "Anti-cellulite machines are over-rated, I tell you. It would be unwise to spend blindly without thorough research."
She now does facials twice a month. "Maintenance is always better than treatment although this depends on your budget because it doesn't come cheap," she says.
With aesthetic treatments being expensive yet temporary, and cosmetic surgery having less of a social stigma as more opt for 'minor' adjustments rather than full-on face lifts or re-shaping, the decision to do one or the other needs to be carefully considered, say doctors.
While it's hard to generalise, plastic surgeon Colin Tham says that "younger patients are more adventurous, willing to undergo more procedures to change their facial appearance or body shapes or even Occidental proportions".
On the other hand, the director of Aesthetics at Asia HealthPartners says that most patients above 40 are more conservative, "opting for natural, ethnically appropriate results."
Procedures to correct upper eyelid hooding, remove eye bags are among some of the most requested procedures, say surgeons in Singapore. Next on patients' wish list are the lifting of sagging jowls and removal of double chin, correction of sagging breasts and fatty areas of the body.
Men are also into it in a big way. Vincent Yeow of Dream Aesthetics and Plastic Surgery Clinic says that they have seen a steady growth in the number of young men in their 20s and 30s coming in for rhinoplasty as well as liposuction.
"Young patients' concerns tend to be more on enhancing their aesthetic appeal instead of fixing medical conditions which typically only affect them later on due to the effects of ageing. As for the older men who are typically at least in their 40s, they generally request for correction of droopy eyes. Often, these patients also add eye bag removal procedures to their treatment plan."
The good thing about Singaporean patients is that they are a pragmatic lot and tend to ponder longer over surgical procedures than their Korean counterparts, says Ng Siew Weng of Sweng Plastic Aesthetic and Reconstructive Surgery.
His view as a plastic surgeon is that while there are many more non-invasive techniques over the last few years, they are not as effective as surgery.
Dr Loh of David Loh Surgery agrees. "Invasive surgical procedures are obviously effective otherwise they won't exist. Recovery time should be part of the consideration, and results depend on the surgeon. While non-invasive, non-surgical procedures purport to do what invasive ones do, they are much weaker alternatives and the results are milder. My caution to patients is not to be influenced by all that they read online. Have a trusted doctor to speak with. And speak with friends who have done it firsthand. If they are doing non-surgical procedures, at least make sure no harm will come their way and the worst that can happen is 'no results'."
And yes, the cosmetic surgery scene is much more competitive today. But asAsia HealthPartners Dr Tham puts it, "It's not a bad thing - it makes us strive to be better and rise above the rest."
WHAT'S SAFE AND WHAT'S NOT
If you're planning to have cosmetic surgery, or even Botox or fillers, here are some things to consider
Surgeons say that eyelid surgery, nose jobs and fat transfer - with more predictable results - are fairly safe procedures which can give the patient a quantum improvement in appearance.
Asians are good candidates for minimally-invasive facelifts, says Dream Aesthetics' Por Yong Chen. This is because Asians tends to suffer from sagging muscles rather than wrinkled skin, and these days, there are thread and mesh lifts that do a good job in pulling up facial muscles and injections to stimulate collagen in the targeted deficient areas of the face.
But artificial breast fillers are a no-no because they frequently migrate, become infected and cause lumps, adds Dr Por.
Asia HealthPartners' Dr Colin Tham agrees, as breast fillers have come under a lot of scrutiny. He adds that even the manufacturer of the safest filler, Macrolane, has released an advisory that it shouldn't be used in breasts as it potentially interferes with the detection of breast cancer.
He also advises against cosmetic procedures that interfere with function, like surgical calf muscle reduction, as well as any surgical procedure which is not performed by a specialist surgeon with appropriate subspecialty training.
Dream's Dr Yeow says permanent filler injections should be cautioned against because it's difficult to reverse its effects should the patient be dissatisfied with the outcome.
Sweng's Dr Ng points out that injection of fillers into the nose can result in blockage of blood vessels which can lead to skin necrosis (portion of the nasal skin dying) or blindness." I would caution against the use of permanent fillers which last for a few years. These can cause scarring and granuloma (small area of inflammation in tissue) formation which can be very difficult to treat."
Dr Wu says that he now often travels abroad to give lectures on safe techniques on how to give fillers and fat injections. "The indiscriminate use of fillers have caused about 200 cases of blindness in the world because they've clogged up optic arteries. And this procedure is being done mostly by general practitioners. There has also been 40 to
50 deaths in the world due to fat injections. I see this developing into a big medical calamity in four to five years' time," he concludes.
This article was originally published by The Business Times on January 28, 2017. For more articles like this, visit www.businesstimes.com.sg.
READ MORE: Beauty obsession of the week: A new hydrating overnight facial peel that will transform your skin.4 key things every Singaporean should strive to have by the age of 35.