MANILA, Philippines?In the past 20 years, the 300 percent increase in the number of patients having aesthetic surgery procedures has spurred medical centers to establish an entire department devoted to improving people?s appearances.

Patients range from adolescents who want a nose job before college to octogenarians who want a rejuvenating lift. The number of male patients has also increased a hundredfold the past decade.

Recognizing this growing need, Makati Medical Center?s Aesthetic Center has been upgrading its equipment and procedures.

Dr. Manuel Fernandez Jr., acting head of Makati Med who pioneered in liposuction in 1980, points out the most advanced procedure.

Vaser (Vibration Amplification Sound Energy) is an ultra-sound-assisted liposuction machine that liquifies fat before removal, facilitating liposuction procedure and lessening the pain and tissue injury.

A small probe discharging high-frequency sound energy dissolves the fat. Once melted, fat may then be seamlessly drawn out with liposuction tubes.

Compared to older liposuction machines, they pose less risks of injury of the surrounding tissues.

In Vaser, the ultrasound is more tissue-selective, making it more precise. Patients experience very little bleeding.

?It is gentler and less traumatic. You are able to siphon more adequately than the conventional liposuction machine,? he says.

As in most liposuction procedures, the swelling and the healing varies with each patient.

?No matter what you do. It will take three to four months for the swelling to disappear,? says Fernandez. The patient can return to work the next day, wearing a binder. The difference is that one doesn?t feel pummeled.

He likens the conventional liposuction machine to a vacuum that sucks in the dirt from the floor into the container.

?With the liposuction machine, you suck out the fat and put it in a bottle,? Fernandez says. ?With the Vaser, you break down the fat with the help of the ultrasound probe. The energy delivered to the target area melts the fat. In the second stage, you suction. The probe just moves to and fro. It is faster because it?s liquid, not solid fat, that is being suctioned.?

Although lumpiness after surgery depends on the doctor?s skill, Fernandez says the Vaser makes it easier for a smoother sculpt and can be used in delicate areas of the body.

?The other advantage is that males can have the six-pack abs even without going to the gym,? says Fernandez.

The average industry rate for a liposuction procedure is P30,000 per area. Add to that the use of the liposuction machine, operating fee, anesthesiologist and for some patients staying overnight, the room fee.

Although the Vaser machine costs more, Fernandez claims the patient gets value for money.

Endotine lift

Society?s premium on youth has brought about a variety of rejuvenation procedures, surgical or non-invasive.

?If you want a hundred percent rejuvenation, consider three areas of aging: laxity of the skin, volume loss and textural changes, such as wrinkles and pigmentation,? Fernandez says.

?For laxity, we do the lifts; for volume loss, fat transplant; for textural changes, lasers and chemical peel, where you burn the skin to create new skin or use lasers like IPL (Intense Pulsed Light). Liposuction doesn?t consider any age. It is targeted at skin laxity or volume excess.?

Fernandez introduced the Endotine lift six years ago. The Endotine lift moves soft tissues back to their original position. This is achieved by raising the soft tissues from the bone, reinstating it upward, and holding it in place until it reattaches to the bone.

The result is that well-rested look, not the appearance of being pulled.

Fernandez says conventional suture tends to be awkward.

?Endotine devices are biodegradable as they disappear from the system in six months. They have claws or hooks that will grasp onto the tissue. When this melts and disappears, the tissue is attached to where you want it to be. The lift lasts for eight years,? he says.

The downtime is the same as a facelift. A patient can resume activities the next day. However, due to the swelling, most prefer to go out in public 10 to 14 days after it has subsided.

He says the hospital has veered away from the thread lift. ?The term ?minimally invasive? means minimal improvement.?

Stem cells

For gaunt cheeks, Fernandez injects stem cells derived from the patient?s fat.

?The stem cell is a magic cell,? Fernandez says. ?The best ones come from fetuses with special stem cells that can become any cell?brain, bone, muscles or any organ of the body. As soon as the fetus enlarges, the brain cells develop, the stem cell is responsible for that.

?In adults, doctors get stem cells from the bone marrow. After manipulating it in the lab, they will inject it back to the patient, especially those with leukemia to fight the leukemia cells and regenerate blood cells. It?s now used as treatment for cancer cells. They?ve tried to use it for the heart.?

?Now we are using stem cells for skin rejuvenation but we are getting stem cells from fat,? Fernandez added. ?We get fat from the patient, for example, the abdomen, and do something to it. I reinject it to the face to add volume on cheeks. It?s recommended for the aging face to restore the cherubic look.?

Lasers

On non-invasive procedures, Fernandez clarifies, ?the laser is not long-lasting. It can never equal a surgical correction. But it can be an aid to rejuvenation.?

The laser department is the biggest department at Makati Med?s Aesthetic Center. Patients who don?t want surgery or the downtime undergo these non-invasive procedures. Patients who show signs of skin laxity but aren?t qualified yet for the knife, can get some tightening with the laser procedures.

There are limits to lasers. Droopy eyelids and heavy eyebags will not disappear after several sessions. This is when regenerative surgery is recommended.

Fernandez also suggests a combination. A facelift won?t improve the skin?s surface. An Infrared Pulsed Light treatment is suggested after a facelift to improve the skin tone.

Laser effects not lasting

Fernandez says he is not contesting the efficacy of lasers in melting fat or firming up sagging skin.

?My question is to what degree can lasers tighten the skin; ultrasound will not shrink the skin.

My only question is longevity of results. Lasers are supposed to penetrate the skin and burn the underlayers so it will shrink without parching the skin. It?s like burning anything, whether skin, tissue, meat or steak. It?s the same principle.?

Laser machines are attractive because they?re non-invasive. ?Patients lose their fears. The question is the longevity of results. After eight months or a year, the problem is back.?

He notes that it?s the machine owners who claim the effectiveness.

?I want to interview patients after one or two years. I?m not putting them down or saying lasers don?t work. Let?s be honest with the patient. If you say the results last for 12 months and they accept it, then fine. These lasers are being pushed by non-surgeons for commercial reasons. It?s a marketing gimmick.?

He points out the main difference between undergoing a non-invasive laser procedure at Makati Med and at a commercial center. Foremost, the doctors are rigorously screened by the hospital and are certified by a governing body. They themselves administer the procedures.

?In these centers, the doctors are not board-certified,? Fernandez says. ?Second it?s safer to do it in a hospital; even if it is non-invasive, anything can happen. In some establishments the technicians do the laser settings. It?s computerized and a no-brainer once you?ve made the settings.?

What is the cost of looking good?

Fernandez asks, ?How much is an iPod or a camera??

A nose lift is P25,000 with additional P7,000 for the hospital fee.

?People have realized that they can look better and it?s affordable.?