Work in progress

That could mean two things - nature is at work. And so are medical treatments. While the former gets on with your ageing process, the latter help delay it. In a two-part series, Aryeman Raj looks at the various options available for cosmetic age reversals.

Like guests who've overstayed their welcome, those fine lines gradually, very gradually, catch you unawares, spreading to occupy more space on your face and one day get so entrenched in their home (your face, silly) they ignore all eviction notices. You can call the cops, throw the book of rules at them, get the entire neighbourhood to threaten them but, nada, zip, nothing works. They stay put.

And that's when you begin to flashback. You try to think of the first wrinkle or what looked like one but you didn't think it would end up as one, appear on your face. At the time you didn't make a fuss.

Perhaps, you told yourself, it is a consequence of too much sun or too little moisturiser or too many late nights and too little sleep. There are so many reasons why your skin sulks, you tell yourself. It will rid itself of its sulk and get back to its smiling self soon.

Ha ha. Wrong assumption.

The sulk looks like it's worsening and ping! the light bulb moment followed by the dash to the beauty shop to look for that wonder age reversal cream. It will do the trick, you tell yourself.

Ha ha. Wrong assumption again.

After all this time, the lines have turned stubborn. They ain't leaving you so easily. To get them to go, it's going to cost you. Money, heartache, sleepless nights ...
So, how do you reverse the clock? Or, even better, how do you know when the clock strikes one - the first warning sign that a wrinkle is on its way.

At the cost of sounding cliched, prevention is better than cure. But you have known that all along. Every medical doctor will tell you that. Every beauty therapist will tell you that. But you would've been too busy enjoying the summers of youth to hear the clock strike.

Now, when the eviction notices don't work, what will? Friday speaks to various experts to determine ways on how to smile away your frown lines.

Dr Mohan Rangaswamy
Specialist Plastic Surgeon, Welcare Hospital, Dubai

What are the psychological factors that drive women to undergo face makeover surgeries?
The reasons for cosmetic makeovers vary. Among women, it is usually a long-felt desire to change something that they perceive as different, ugly, asymmetrical or out of proportion, which they are unable to correct by exercise, dress or make-up. Another category of women are those who wish to experiment or want to look "hip" or "cool".

Then there are those who try to emulate their idols. But most of the time, it is the urge to retain their youthful appearance and to undo the effects of multiple pregnancies, poor diet, lax lifestyle and personal neglect.

For women in particular, does ageing mean looking ugly?
It is interesting that in many women (and men) "ugly" is just a personal perception. To us, the doctors, the issue might be very minor, but to the patient, it is not. This puts us in a delicate position as we try to bring perspective to the problem.

Without an outright rejection of that person's viewpoint - who seems to be bothered about a seemingly minor problem - we try to understand them. Here, it must be said rather categorically that if disproportional anxiety persists after counselling, then that person is not a good candidate for surgery.

Is psychological and emotional maturity expected from a client opting for a cosmetic surgery?
Yes, definitely it makes a big difference. Recently, I had a woman client who had her nose augmented in another country. She came back to Dubai wanting to remove the bone graft. She wanted her original nose back.

The surgery that was performed on her was a correct one. All she had to do was wait for the swelling to decrease and allow the bone graft to integrate naturally and she would have had a fine-shaped nose.

In spite of counselling her, she wasn't convinced and she shopped around till she found another doctor who agreed to do what she wanted. This turn of events came about due to a combination of facts - an immature candidate who opted for surgery without being aware of the full facts of post-operative healing.

There was a gross mismatch between her (hasty and unreasonable) expectations and the immediate result (which eventually would've been fine). This case highlights the importance of psychology and emotional maturity in cosmetic surgery.

What should a person going in for cosmetic surgery keep in mind?
As with any other medical treatment, the most important thing is a clear assessment and diagnosis of the case that should be shared between the doctor and the patient. This should include an assessment of the person's mental make-up and insight into his/her expectations. This is why a proper consultation directly with the doctor is important and cannot be replaced by any brochure or menu.

I am totally against a "property agent" type of counselling where procedures are shown and the patient (read client or customer) just chooses and says "I want that.

How much does it cost?"
The next consideration is Risk Benefit Ratio. What is the extent of change anticipated and what is the risk the person is going to subject herself/himself to in order to achieve that change? A small improvement with a big risk factor is not a good proposition.

However, a big improvement that may come with a reasonably small risk factor is worthwhile. Please notice that all procedures have a risk, however small. In cosmetic surgery, we have taken care to reduce all possible risks.

Any specific tips on post-operative care?
Post-operative care by an expert is very important. It is essential to go back to your surgeon for scheduled visits and follow instructions.

People have this strange tendency wherein for a minor conventional surgery, they will follow the doctor's advice to the T, but for a cosmetic surgery that is quite often much more complex, they tend to adopt a very casual attitude to medical advice.

The human body does not differentiate in its response to either. It will react to a cosmetic surgery in the same way it does to any other surgery. The constant research in medical technology has ensured that the recovery time is quick and the patient is often back to work in 3-7 days.

Some women seem to be opting for cosmetic treatments in quick succession. Is there a risk involved?
Repeat surgeries on the same part increase risk in most cases as there will be scar tissue in the deeper operated areas.

Most clients should realise that on the surface it may look like normal skin but from within, an operated area is different from a virgin territory. Nevertheless, repeat surgeries are done commonly and successfully as long as they are carefully planned and executed. Sometimes, a repeat procedure is essential for fine-tuning the result or for correcting a minor problem.

Dr Max Mazen Sawaf
(MD) CEO, CosmeSurge Center, Dubai

In these times, there seems to be an unbearably heavy pressure on looking your best.

It's all about image these days. The adage, 'First impression is the last impression' has become ever so more relevant. If your colleagues notice your puffy eyes and pale face and make a passing comment on how tired and old you look, you begin to wonder if it would reflect on your upcoming performance appraisal.

In life's new blueprint, change is the only constant. Professionally as well as on a personal level, there is a continuous need to impress, in which there is no scope for looking tired and stressed out. Remember, if you feel so, then you look so. It is something that you cannot fake.

How is this linked to the anti-ageing process?
To look young, you need to be young on the inside also. While we talk about ageing, we refer to two ages. The real age or the biological age and the chronological age or the passport age. If you say you are 30, but you look 40 and your heart is 50, lungs are 60 (because you smoke), then your lungs are the real indicators of your true age.

So, age is not determined by the passing of years, but also by how strong your body is. Are internal and external ageing processes very apart?
There are two main factors to ageing. Your genes are one. There is nothing you can do about the various hereditary factors. The second is the external factors, which are the most important. If your genes play a role for about 20 per cent of the ageing process, then 80 per cent is determined by external factors which you can control.

What are these external factors?
Exposure to the sun, smoking (passive smoking included), alcohol, a diet with little fibre, excessive carbs and fizzy drinks - all can determine the speed of the ageing process.

So, correct eating habits can alter the ageing process?
Everyone seems to be eating out more often than ever before. Either it is due to lack of time to cook at home or not knowing how to cook at all. But then, I believe, it is cyclical. In a few decades, people will realise the adverse effects of eating fast food and will invest in their health by cooking at home and eating healthy.

Aren't women at the forefront when it comes to cosmetic and anti-ageing treatments?
Yes, women are at the forefront. To support the fact, I will quote an old adage which may sound quite chauvinistic but it is true. The beauty of a woman is her capital, and the capital of a man is his beauty.

In spite of the fact that women today work and are considered high achievers, there is still a great (deal of) emphasis on their external beauty. We forgive the external ageing signs on a successful man but not on a woman. We keep goading women to look slim and beautiful all the time. I think men are to be blamed here for women's vanity.

Getting older is inevitable; looking your age is not. Has the concept of ageing gracefully changed over the decades?
Ageing gracefully today means preventing and delaying the onset of ageing - external or internal - as much as possible. It is advisable to use treatments which help in delaying the ageing process rather than do something about it when the damage has already been done. Gradual ageing helps in looking younger for a longer time.

Cosmetic surgery is the last door to knock on in our search for perpetual physical youthfulness. But does it hold back ageing? Or does it only improve outwardly appearance?
This is a partial fact. Yes, cosmetic treatments are a solution to external ageing. They are not necessarily drastic, depending on which treatment you opt for. You can use a variety of minimally-invasive treatments today.

There are short-recovery and low-risk treatments like Botox injections and laser rejuvenations. These offer minimum risk as opposed to deep facelifts. The word 'drastic' sounds unnatural and scary. A good plastic surgeon will always aim for natural, predictable results with very low risks.

Cell replacement and rejuvenation therapies utilise embryonic animal organs transplanted onto humans. These have been found to stimulate production of new human cells. How effective are treatments which use ribonucleic acid (RNA) as an active component?
All these treatments are still experimental and being researched. They hold tremendous promise. For example, five years from now, one could (if the research is successful) take a hair follicle from the back of your neck and clone to give you a hundred-thousand-dense hair coverage as thick as a hairpiece or a wig which looks natural.

Helium-neon lasers have been used unsuccessfully (in the US) in attempts to produce non-surgical facelifts. Is it true that the effect of the cure is short-lived and wrinkles return as soon as swelling subsides?
Helium neon lasers, Thermage or the ND Yag lasers are claiming a lot more than what they can do. A lot of the improvement, visible on the skin after the treatment, is temporarily due to the swelling. There could be some noticeable improvement due to collagen build-up, but the results are minimal in relation to the cost involved.

Frankly, if you have a sagging face and jawline, you need a facelift in order to fix it. Early ageing on the face, however, can be addressed with a non-surgical technique.

So what is the right time to opt for an anti- ageing treatment?
People are now experimenting with age control treatments before they even start noticing fine lines on their face. It is always better to preserve and maintain your skin from an early age rather than wait for the damage to be done. Once the fine lines and wrinkles increase and lead to saggy skin, one has to use a lot more invasive techniques (like surgical facelifts).

Is ageing in women linked to menopause?
Yes. The oestrogen level, which is high in women before they reach menopause, drops significantly later. It leads to a drier and more sensitive skin, which in turns leads to fine lines and wrinkles.

It is irrespective of the skin type. Women with oily skin also face the same future. Hormonal Replacement Therapy (HRT) is a good anti-ageing measure, provided you don't have a high risk of cancer.

If there were to be a formula to control ageing, what would be the blueprint for its success?
Diet, sleep, stress reduction, exercise and hormonal replacement help delay the ageing process. The right prescription to prevent ageing is to slow down and live a moderate lifestyle.

Consumerism and keep-up-with-the-Joneses lifestyle are taking its toll on us. We are becoming more materialistic. We pay for all this by ageing earlier (than we should). The big link here is being more spiritual and less materialistic and living healthier.

Dr Fatima Habib
Specialist Dermatologist, CosmeSurge, Dubai

Laser technology is now being widely used for cosmetic treatments, especially to treat patients with a variety of skin problems, including the damage caused by sun exposure, removal of body hair and to treat psoriasis and acne.

Dr Habib confirms that the use of lasers as a cosmetic surgery treatment has become very popular in the UAE. Here she discusses the various treatments that are available:

Photofacials

What is a Photofacial treatment?
Photofacial is a procedure in which you treat any photo-damage to the skin. This could be pigmentation or any damage caused due to excessive sun exposure. Our skin suffers from different climatic and lifestyle conditions.

For example, windy cold weather, pollution, air-conditioning, stress and bad eating habits could cause premature ageing of the skin. At Cosmesurge, we have two types of lasers to treat photo-damage.

ND YAG laser which is used on all skin types with no complications. The procedure usually takes 45 minutes. It successfully treats skin conditions like open pores, fine lines and wrinkles, reduces redness, rosacea, textural smoothness, post acne scarring, etc.

What happens during the treatment?
After a thorough consult, the patient is prepared for the treatment.

The skin is cleansed and the patient is made to wear protective eye goggles. In a wand-like action, the laser is passed over the skin repeatedly with no contact to the skin for 45 minutes, concentrating on problem areas. The patient feels a warm sensation with no pain. In fact, it is quite relaxing.

How soon can one notice the results?
On an average, most patients do see an immediate reaction as there is a slight swelling. This is primarily from the build-up of oedema, which is temporary. Eighty per cent of patients see visible results after the first session. However, permanent results are noticed after a series of sessions.

What areas can be treated?
The main areas treated are the face, neck, chest and hands.

How many treatments are needed for an effective cure?
The number of treatments depends on the severity of the condition. In most cases a minimum of six sessions are advised.

How many follow-up treatments are required in cases where a client wants to reduce the appearance of fine lines and wrinkles?
Fine wrinkles will start to look softer after six sessions or so. They will not disappear completely.

Besides ND YAG lasers, which other laser treatments are in use?
Alexandrite lasers would be used for photo rejuvenation. This treatment helps fill up freckles, pigments and moles can be removed. It also helps improve the texture of the skin.

How effective is the laser technique for removing moles and beauty spots from the face?
Using an Alexandrite laser seems to create a burning sensation which is not very comfortable. We do numb the pain, but clients may experience a certain hot sensation.

When this laser is used for removing or softening brown spots on the skin, they will become black scabs. These will dry and peel off within five days. You may need 4-8 sessions to get optimum results. There is a small amount of skin peeling.

Most laser treatments have to be repeated for a minimum of six sessions. Isn't skin-tightening a temporary phenomenon in the initial session?
The skin shows a temporary tightening in the first session. The effect of the first session makes pores smaller, evens the skin colour, making it more homogenous, and improves the texture of the skin.

Follow-up sessions are required every 2-3 weeks, and a maintenance session after every six weeks. It is like going to the gym. Once you get a well-toned body, you need to keep exercising to maintain that shape. You cannot afford to stop. Similarly, maintenance is required with cosmetic treatments.

Laser is considered to be quite an expensive treatment because of the technology that goes into it. You cannot use it as a one-off cure for anti-ageing. It is important to maintain the rejuvenation of the collagen regularly.

What are the options to this treatment?
If patients are looking for a different approach to treating photo damage, then there are other treatments available including Amelan, Cosmelan, Greenpeels. etc. During the consultation, the most beneficial programme will be recommended; and in some cases, a combination of the above may be used for optimal results.

How would you slot laser treatment?
This is a medium-intensive treatment.