This week on “On the way with Chom”, the talented host “Chompoo – Araya A. Hargate” takes us to meet Dr. Petch, MD. Chairat Sermsin, an international expert in skin and beauty, who will share his knowledge about current cosmetic procedures. If the procedure goes wrong, the face will be deformed for life. Is it true that there is a risk of blood clots that can lead to death? If you want to be beautiful but don’t want to take the risk, what should you do?
There are so many cosmetic procedures these days. You will hear news that you feel is dangerous, not up to standard, and the most common one is fillers, which are so severe that they can cause blindness. What is the actual principle of fillers? And what are the possible side effects, from mild to severe?
Dr. Petch: Filler is a filler. Currently, the filler we use is Hyaluronic acid. This type of filler is friendly to our skin. It fills in areas that are deficient or may be added in areas that we need, such as when we are getting older, temples, under the eyes, or cheek grooves are gone. This is added in areas that are missing. What areas do we need to add? For example, the lips, chin, and other areas that are added. Therefore, filler is very popular. There are some good things and some side effects. Side effects can be divided into 3 main types. The minor ones may be found in the form of swelling of the filler in the area where we injected it.
Does that mean even the ones that are legal and approved by the FDA?
Dr. Petch: Yes, it is not called a severe side effect. There may be some swelling and shrinkage, but after a while these symptoms will improve.
It can happen even if you use the real thing. Moderate symptoms are like in cases where we inject and get an infection. These symptoms may take months. Some people have 6 months, some people have 1 year before these symptoms appear.
What causes infection?
Dr. Petch: It might be contamination during the procedure, whether it is cleaning the skin because when we inject, we have to clean the skin first, right? The second thing is the aseptic technique or even when injecting, did the doctor’s hand touch it? Was the needle clean? It might bring germs into the area where we injected. The time frame for this to occur is uncertain. It might be a month to 6 months. In some cases, it might take a year before these symptoms appear. The most severe cases are related to blood vessels, whether it is compression of blood vessels or entry into blood vessels. These are severe and dangerous symptoms and are often found in the news.
As for blindness, how does this happen?
Dr. Petch: Yes, it can be found. It is called a case report. For most unexpected events, there is no research done to prove that they are accidents during the procedure. When we inject filler, our face has blood vessels, right? In the case of fragile blood vessels, or sometimes when we inject it right into a blood vessel, the filler molecules can run into the blood vessel and block various positions, especially the small blood vessels that are often found and make headlines, such as the blood vessels in the eyes. Because the blood vessels in the eyes are already small, when injected, the image goes black. The eyes cannot see at all. It will be a case report. Or in severe cases, another important blood vessel in the body is the blood vessel in the brain. After injecting for a while, it is similar to a stroke. Paralysis occurs immediately.
Is there anything more serious than this?
Dr. Petch: If we assume that it is a stroke but the blockage occurs in a dangerous position of the brain, there are many parts of the brain, right? Some parts are not unimportant, but are not important. Some parts are very important, such as controlling breathing, controlling the body’s nervous system. If it is blocked there, it will be fatal. It is very dangerous. In foreign countries, there are also case reports in the form of bad experiences with fillers, but they were done about 10 years ago. It is a case report of what happened. In about 3,000 cases, it was found that about 0.1 percent were strokes, which means the blood vessels were blocked. Another about 0.1 percent also had death. So I think it might be consistent with stroke as well, which is that it is blocked in a very important position of the brain, causing death.
What causes injected filler to flow together and form clumps?
Dr. Petch: We might have seen in the past that some people inject fillers, saying that they went to get injections in their face, and then after 1 year, 5 years, 10 years, the filler from the top piled up at the bottom. I guess that these are silicone fillers, as I mentioned earlier, the filler we use is Hyaluronic Acid Filler, which is skin-friendly and fits well with the skin. These will not flow. However, if it is silicone filler, these do not fit our skin. After injecting on top for a while, when it does not fit, our body will continue to release it, and it will fall to the edge of the face. Sometimes, it becomes inflamed, becomes bumps, or waves like this. Or it may be that some quack doctors or people who are not doctors inject it, so they do not know that this substance is not skin-friendly and is not safe to inject.
If we go to clinics, will we know that they use genuine fillers that meet standards? Is there still a chance that we will find the old silicone fillers, Hyaluronic Acid Filler?
Dr. Petch: At present, I am sure that there are still some. They are called fake drugs. But at present, pharmaceutical companies will try to do whatever they can to verify that this box is real medicine. It is different from the fake drug box. But the fake drug itself has also developed itself to imitate the real drug. There will be a QR code to scan. There may also be various gimmicks to scan as a double check that it is definitely real. Unbox in front of the QR code between the box and the syringe. This will be checked continuously so that the recipient or the patient must receive real medicine.
How can we know if it’s real? There are already fakes available for scanning.
Dr. Petch: Sometimes it is called dressing. Mostly, counterfeit medicines cannot be done exactly like this. But how do they do it? Sometimes outside the box, there is a QR code for the real thing, inside the box, there is a fake thing. Something like that. So you have to check from the beginning by choosing a clinic. A clinic that has standards and is certified by the FDA. Certified by the Public Health Department as a standard medical clinic.
There is another case that has made quite a lot of news. It is about injecting a lot of filler and causing the face to become distorted. Is there too much CC or something?
Dr. Petch: The number of CCs in an injection per time is neither right nor wrong. It does not mean that injecting 30 cc per time is wrong. Injecting 1 cc per time is right. It depends on the satisfaction of the customer and the doctor’s injection planning. I can plan the injection that this person can use 30 cc, but we have to evaluate with the patient because when we add filler, the results are immediate. We can evaluate and talk to the patient that the doctor has added this much. Now 25 cc. Let’s say we intended 30 cc. I added 25 cc. Is that okay? If the patient says there’s still a little left, do you want to add another 5 cc? So it will be in line with the goal that we have set. We planned like this.
What happens if a blood vessel is blocked and the tissue dies?
Dr. Petch: Our tissues need blood to supply them all the time, right? So if we assume that the filler molecules block a blood vessel, it will be dark or black in color, whether it is blocked or pressed on the blood vessel, preventing blood from flowing to that location. The result is that within a day, we will know whether it is blocked or not. We may see the appearance of blood vessels in rows first because the blood vessels themselves cannot flow back. Because the blood vessels must go from red to black to complete, right? And then they continue to circulate. Suppose we block it, the cycle is interrupted, the blood vessels there will be stagnant. This blood will come out as small blood vessels on the skin. After about 2-3 days, there may be pimples in that area, indicating that there is a blockage of blood vessels in that area. It must be fixed immediately.
Does filler really dissolve?
Dr. Petch: The filler really dissolves. About 99 percent. The remaining 1 percent, once it has dissolved, will have a part that is compatible with our flesh. That area will be friendly to our body. It will not cause any residue.
If I frequently inject filler, will my face age if I stop injecting it?
Dr. Petch: People who have had continuous filler injections, most of them like that type of face, so they have continued to have injections. But if their financial resources are reduced, they may have to stop or take a break. For the most part, people who have had continuous filler injections, their faces will be supported, so that the face does not deteriorate or age too much. That means, if we assume that it is the same face, and we inject on one side and not the other, and then after 10 years, the side that was injected stops injecting, I am confident that the side that has been injected continuously will look younger than the other side. It is a way to support the face so that it does not sag too much. The tendons are in this position. The face, the fat layer here does not have to reduce too much to make the face look younger or maintain that condition for a longer time.
Another thing that is equally hot is botulinum toxin. In addition to beauty, it actually also has other benefits in terms of treating diseases.
Dr. Petch: Botulinum toxin was discovered in the field of beauty by accident. It was actually used to treat abnormal muscle spasms on the face in patients with neurological problems. But it happened that the doctor injected it near the eyes. He checked that the side where the injection was given had better wrinkles than the other side. That led to the idea of looking at where the muscle lines were and seeing if it could enhance beauty. That’s the origin of the word “discovered by accident.”
Can it be used to treat stress and depression?
Dr. Petch: Mostly it is stress, which is muscle-related. Sometimes migraine injections can be used to reduce neck, shoulder, or temple areas. Botulinum toxin injections can also be used to reduce these. Or even office syndrome, stress reduction, pain reduction, depression, these may also improve.
Another procedure is thread lifting, doctor. What is the principle of thread lifting?
Dr. Petch: It is a threading to pull in the position of our flesh. Let’s use the word flesh. To move that position to another position. It’s like holding it, pulling it, not letting it hang down. Because the thing that we worry about the most with our face is, I don’t want my face to sag. I don’t want my face to have chubby cheeks. I want my face to look V-shaped and slim all the time. So threading is popular. This procedure shows results quickly. You can see results immediately after threading. There may be some side effects. It may be an infection, which is common, or even after threading, there may be bleeding under the skin, causing bruising.
Doctor, are there many side effects from thread lifting?
Dr. Petch: Infection, swelling, bruising, or some people may have symptoms similar to the famous case, causing the mouth to twitch when smiling. It may be that the thread lift has touched a nerve or cut the nerve, which is rare. If it is a mistake and it is pulled too much, we can operate and pull it out. But in cases where the nerve is cut, we have to wait for the nerve to recover. If we know our anatomy, our nerves will grow only about 0.1 millimeters per month. If we assume that 1 centimeter was cut, it means that we have to wait for more than 10 months to recover. Or sometimes, the nerves at the beginning and end of the nerves recover and are not connected. This person may not have a chance to return to normal. But as I said, it is rare, but it can happen.
Do lifting and laser treatments seem safer? Aside from the excruciating pain, are there any side effects that we should be aware of?
Dr. Petch: The advantage of the lifting machine is that you don’t have to inject anything into your face. This is a good choice, but it has some side effects or limitations. In some areas, we can’t use the stimulator, and in some areas, we can’t do it at all because sometimes it’s too painful. Or sometimes that area has a lot of nerves, which can cause muscle paralysis. Or sometimes the person who uses the machine will feel that there’s a kind of pain that they can’t stand. I’d rather have an injection. I can stand it. But both results, whether it’s the injection or the machine, are designed to support each other.
I want to be beautiful but I don’t want to take risks. What should I do?
Dr. Petch: We have to check. Point 1 is genuine clinic. Point 2 is genuine doctor. Point 3 is genuine medicine. Every clinic will have a square sheet attached to it. This sheet is called a check sheet from the provincial public health office. This clinic has been inspected, has passed the standard, has a date, and a stamp. Point 2 is genuine doctor. The Medical Council website can search for the doctor’s name to see if this doctor is genuine or not. But the important thing is that the first and last name must be correct and spelled correctly, then that doctor’s name will appear. Point 3 is genuine medicine. Genuine medicine can be checked in many ways, whether it’s the appearance of the box, the appearance of the foil, the QR code sticker, or there may also be a confirmation form from the company that links to the website. It will be a double check confirmation.
