Although Looksorn (surname withheld) realises that ageing is inevitable, he is committed to doing whatever it takes to preserve his youthful looks for as long as possible. He went to see a dermatologist for the first time back when he had just entered secondary school and was plagued by acne. Ever since then he has made great efforts to keep his skin looking fresh and healthy, consulting beauticians and investing in high-quality imported cosmetic products, mostly collagen-based.
He told Life he once paid 50,000 baht for an intensive facial treatment to rejuvenate his skin.
"I simply want to look young. Who doesn't? I think, being attractive is a boon for people," was the candid response from Looksorn, 36, an openly gay man. "Good-looking students are more popular with their peer group and teachers. Attractive applicants have a better chance of getting the job. Concern about one's appearance is quite normal these days."
Getting increasingly self-conscious about his looks as he progressed through his 20s, Looksorn began to check out techniques designed to reverse the changes associated with ageing, researching products and procedures on various websites. As a present to himself for his 30th birthday, he signed up for a course of Botox injections to get rid of crow's feet that had become very noticeable, especially when he smiled.
"I took a good hard look at myself in the mirror. The lines had become deeper. I wanted my face back the way it was before," he reasoned.
Three years ago, he started a facial treatment involving dermal filler to correct volume loss and make minor adjustments to his nose and profile. The injections were given by an experienced dermatologist.
"I exercise regularly and eat the right foods but I don't think either of these practices have helped keep me looking youthful. But I regained a lot of self-confidence after the [dermal filler] treatment. It's great to have the old me back," he said.
Due to the high cost of plastic surgery and the long recovery time, Looksorn said he prefers non-surgical procedures.
"Plastic surgery can often look fake," he said. "Anyway I don't have the large sum of money I'd need to pay for surgery of that kind. I do realise that I'll have to go back for more [dermal filler] injections and that the treatment may prove costly over time."
Looksorn was excited to hear from a friend about a backroom beautician _ a so-called moh krapao ("bag doctor") _ who offered inexpensive dermal filler treatments to clients who visited her house. Although not a qualified dermatologist, this person had given injections to Looksorn's friend and the latter had suffered no ill-effects. So Looksorn decided to give it a go, too.
"You know, jabs of this sort are sometimes administered by nurses or other healthcare staff even though the treatment is carried out at the clinic of a trained surgeon," reasoned Looksorn, who works in the marketing department at a leading local company. "So I just threw the dice and took my chances."
The savings were also considerable. The moh krapao was only charging about 2,000 baht per treatment, whereas certified dermatologists levy a fee of between 8,000 and 10,000 baht for carrying out a similar procedure. So Looksorn paid a visit to the illegal clinic and counts himself lucky not to have suffered any serious side-effects.
''I'm satisfied with the results,'' he said. ''I've just had the normal complications [redness, bruising, etc]. If I could afford to pay for a legit doctor, I would of course go for the best and safest treatment every single time.''
Other clients of backroom beautician haven't been so fortunate, however.
A recent case that made headlines was that of a product presenter in her early 30s who collapsed and fell into a coma, from which she is unlikely to recover, after having filler material injected into her buttocks. The young man who carried out the procedure subsequently turned himself in to police.
Although he has assumed the title of moh (doctor), he had no medical qualifications whatsoever, but had once worked as an assistant at a registered skin clinic where he had learned how to give injections.
Botched cosmetic jobs like this are on the increase, said Dr Krisada Duang-urai, president of the Dermatological Society of Thailand, pointing to the rising number of people seeking treatment to repair damage caused to their faces.
''Many patients worry about bruises and redness. Some have now got asymmetrical facial features or have experienced the migration of filler material from the original site. There have been a few reports of people being permanently blinded,'' Dr Krisada added.
When our skin ages, explained Dr Jinda Rojanamatin, acting director of the Institute of Dermatology, the dermis gradually loses collagen, the protein that provides major support to our skin and which is responsible for its texture, shape and elasticity. Collagen loss leads to dry skin and wrinkling.
To restore a youthful look, some people opt to have filler material injected into areas where wrinkles or fine lines have appeared. Filler can also be used to add volume to the skin under acne scars or to achieve a smooth complexion.
''Patients can see real-time results. There's no downtime,'' Dr Jinda said. ''But fillers wear down after several months, depending on the materials used, so patients have to repeat the procedure again and again if they want to keep their skin looking young.''
Several types of filler are used. Each gives similar results but they differ in the way they work on the skin and in their duration. Certified dermatologists and surgeons prefer hyaluronic acid-based products while backroom operators tend to use a cheaper filler made from polyacrylamide. Sub-standard procedures and the use of unsuitable materials can cause undesired results including the migration of filler material from the original sites and under- or over-correction of wrinkles.
''Filler that is good for one region might not suitable for other areas,'' Dr Jinda said.
''Dermatologists and plastic surgeons are trained to choose the substance that will work best in a specific area.''
Potential complications can be as simple as bruising, bleeding, skin rashes, redness and localised swelling, More serious side-effects occur when a sustained allergic reaction is triggered.
''Never say never when it comes to complications,'' he advised.
If filler is accidentally injected into an artery, for instance, that artery can become blocked and the area of skin it supplies with oxygen could die.
The problem can become more severe if the filler obstructing a blood vessel travels to another location in the body and causes an embolism. This can occur in the legs or sometimes in the brain or heart. Blockages in any of the body's major organs can be fatal.
''Clots caused by dermal fillers are possible, but rare, said Dr Jinda. ''But if one does occur, the effects on the patient are always bad.''
Asst Prof Tanom Bunaprasert is chief of the facial, plastic and reconstructive surgery division at Chulalongkorn University's Department of Otolaryngology. He noted that raising the bridge of a person's nose using dermal filler, a cosmetic procedure now much in demand here, can be very dangerous. The patient can run the risk of vision impairment or total blindness if filler is accidentally injected into one of the arteries linked to the retinal artery. A blood vessel in the nose is closely connected to the retinal artery system and the brain, he explained.
''Try to think of the risks you are taking each time you receive an injection of filler material,'' Dr Tanom advised. ''The results you get don't last long, but the damage can be forever.''
Dr Jinda noted that some of his patients choose a course of filler injections in order to put off the day when they will have to go under the knife and get a facelift.
As a rule of thumb, Dr Krisada said, patients should only get such injections from an experienced dermatologist or plastic surgeon who is using high-quality filler material that has been approved by the Thai Food and Drug Administration. Most importantly, he went on, the procedure should be carried out in a hygienic location equipped with all the necessary medical equipment.
''Be a wise patient. Before receiving this kind of treatment, always ask the dermatologist or surgeon exactly what kind of filler material is being used and how it works to improve the skin,'' Dr Krisada advised.
''Every cosmetic treatment has its pros and cons,'' said Dr Jinda. ''Before undergoing any such procedure, thoroughly discuss the matter with a dermatologist or a surgeon who will be able to help you choose the best and the safest possible option.''
GETTING THE REAL DEAL
Dermal fillers can be roughly divided into three main types:
Temporary or resorbable fillers last for four to six months. They are considered very safe as the filler is gradually absorbed into the body and the few potential side-effects are of short duration.
Semi-permanent fillers give longer-lasting results _ usually about two years.
The third category, non-resorbable fillers, includes products containing silicone or paraffin-based substances. This category provides the longest-lasting effects but may also cause some long-term complications.
The only type approved by the Food and Drug Administration (FDA) for use in Thailand is the temporary/resorbable filler.
FDA-approved dermal fillers are marketed under different brand names. To view the complete list, visit one of these websites: http:// drug.fda.moph.go.th/zone_service/files/new_gen_list_July.pdf; or http://fdaolap.fda.moph.go.th/logistics/drgdrug/Dserch.asp.
For a list of dermatologists certified to practise in Thailand, go to http://www.dst.or.th/list_search.php