Plastic surgery for the body

Plastic surgery is not limited to the face. Two of the most popular procedures carried out on the body are liposuction, a procedure which removes fat from certain locations on the body, and augmentation mammoplasty, the surgical insertion of either saline or silicone implants to increase the size of the breasts.

Liposuction is a procedure in which deposits of fat are removed to recontour an area of the body. Through a tiny incision, a cannula (internal suction probe) is inserted and used to suck out the fatty layer that lies under the skin. The cannula is pushed and pulled through the layer to make tunnels like those in Swiss cheese; fat cells are broken up and then suctioned out. While not a substitute for dieting and exercise, liposuction can remove areas of fat that won’t respond to traditional weight-loss methods. According to plastic surgeon Dr Amorn Poomee, women request liposuction most commonly on their hips, thighs and abdomen, while men ask for the procedure to be done on their abdomen, love handles, and breasts. ("Men hate having breasts!" says Dr Amorn.)

During the past few years, liposuction has benefited from the development of several new techniques, the most popular of which is the tumescent technique. This technique uses saline containing a local anesthetic, which is injected into the fatty tissue. The injected area is therefore anesthetised, so no general anaesthetic is required. The liquid causes the compartments of fat to become swollen or "tumesced", and these larger compartments allow the cannula to move more smoothly under the skin. This technique allows for the use of much smaller cannulae – an important benefit, because when the tunnels mentioned above eventually collapse, ridges remain; and the bigger the cannula, the bigger and more noticeable the ridges. "It take a longer time to do the operation, but the results are much better than five years ago," says Dr Amorn.

Although they are rare, complications can occur. Risks increase when several areas are treated in one session and a large volume of fat is being removed, as the operation time is lengthened. Fat or blood clots can develop and block the lungs, leading to death; excesss fluid loss can lead to shock; and infection can occur. Surgeons will usually reduce the risk of complications by dividing surgery on multiple sites into several sessions.

Augmentation mammoplasty, a surgical procedure to enhance the size and shape of a woman’s breasts, is another popular procedure. The surgery is performed on women who believe their breasts are too small; to increase the size of the smaller breasts that follow pregnancy; to balance a difference in breast size; or to reconstruct a breast following surgical removal.

The two-hour procedure beings with an incision being made under the breast, around the areola, or in the armpit. The surgeon then lifts the breast tissue and skin to create space behind the breast tissue or under the pectoral muscle – placing them under the latter is believed by some to reduce the likelihood of the breasts hardening later on. The implants are then inserted. The surgery can be done using a general anaesthetic, or a local in conjunction with sedatives. Patients can head home immediately, or stay in hospital for one to two days if they prefer. Swelling can take up to five weeks to disappear.

Complications can occur. The most common problem is called capsular contracture. This occurs if the area around the implant tightens, and leads to the breast hardening. It can usually be rectified by further surgery. Excessive bleeding may occur; if it is severe, another operation may be required. Infection can also develop around an implant – most frequently within a week of surgery – requiring its removal (it can be reinserted later on). There may also be a change in nipple sensitivity, and occasionally implants break or leak. With saline implants, the salt water will be absorbed by the body with no side effects. With silicone, however, there may be further complications, with reports of silicone leading to "connective-tissue" disorders. However, no definitive link has been found. In the US, silicone implants are banned except on a case-by-case basis, but in Thailand, both types are available.

Lend an ear and stay in tune

According to experts, up to ten per cent of the population in Thailand may have some sort of hearing problem. Adults with a history of ear infections, long-term use of antibiotics, or diabetes are particularly susceptible to hearing problems and should get regular checkups. Anybody who experiences a diminished ability to hear, who has an attack of giddiness, or who hears ringing in their ears should also seek medical attention.

In Thailand, the most common hearing problems stem from ear infections, working among loud noises, using ototoxic drugs and trauma of the ear. Listening to loud walkmans can also contribute to hearing loss. Bumrungrad Hospital’s Dr Sirikun Vannasaeng says that many people don’t realise that they have lost some of their ability to hear. "Sometimes hearing impairment is minimal, and there is a gradual deterioration so people [don’t recognise they have a problem] until their symptoms reach a certain degree."

All problems are not alike

There are two groups of hearing problems. The most common are conductive, meaning they occur from the middle ear outwards, and can lead to a hearing loss of up to fifty per cent. These problems can be corrected by wearing a hearing aid, or surgery. The cost of a hearing aid depends on the type worn – they can range from less than Bt10,000 (for the old-fashioned "bodyworn" ones) up to around Bt60,000 (for the more sophisticated in-the-ear models), and usually last up to around five years.

The second are sensory problems, involving the nerve leading from the ear to the brain. These may be correctable by having more sophisticated surgery, costing around Bt3,000 in a government hospital, or up to Bt20,000 in a private one, or they may be permanent. Samitivej Hospital’s Dr Nattapong Kumut says that in the near future, cochlea implants may be available in Thailand to help those with sensory loss who cannot be helped by hearing aids. "This could help people with complete hearing loss, but will be very expensive."

What testing involves

Various tests are available. The HRC and Chulalongkorn University’s Dr Manut Utoomprurkporn suggests flicking your fingers together close to your ears as an initial test. "It’s a very simple way to screen your hearing yourself." It’s also important to remain aware of other indicators of impaired hearing, such as a ringing mobile phone that others can hear but you can’t. Dr Manut says this is the most common complaint today among patients coming to see him.

At a doctor’s surgery, the most basic test is carried out during a routine checkup, and involves flicking a tuning fork held near a patient’s ear. The next step is an audometry, a half-hour behavioural test where the degree and type of hearing loss (conductive or sensory) can be determined. This test can also be used to fit a hearing aid.

Then there’s tympanometry, a twenty-minute test which provides information about any conductive problems a patient may have, and an otoacoustic (OAE) test. The latter involves bouncing soundwaves into the patient’s ear to check the condition of their ears’ nerves.

Finally, the one- to two-hour audiobrainstem response test is an objective test of hearing ability that’s reliable and painless. It is not always required in addition to the others.

Don’t stay quiet

Despite the availability of testing, and the affordability of it in Thailand compared to other countries, Dr Manut says that many Thais avoid getting their hearing tested. "First, people don’t like other people to know they have a problem. Second, they believe there is no way of treating their problem, and third – particularly for elderly people – they accept it without even trying to find a cause."

So don’t fall into one of these groups. Getting your hearing corrected may be easier and cheaper than you think, and it may improve your quality of life far beyond what you expect.

Swim for fitness and fun

In a city as steamy and polluted as Bangkok, what could be more pleasurable than jumping into a cool, fresh pool to do some exercise? Besides burning off the calories, you’ll feel refreshed and re-energised afterwards as well.

The benefits

"Swimming provides many benefits – it improves your cardiovascular system, your blood pressure, it strengthens your muscles," says Bancha Nonpolgrang, assistant manager of the JW Marriott’s health club, which recently introduced swimming classes. Unlike most other forms of exercise, swimming works all of the body’s major muscle groups.

Swimming is also a non-weight bearing activity. "That means if you’re pregnant or overweight, or have joint problems, it can still be a suitable way of exercising," says Debbie Jackson, manager of the Sukhothai’s health club. "That’s why swimming is used in so many rehabilitation programmes." So that sore back, aching knee or weak ankles – or even that arthritis – can no longer be an excuse for being lazy.

You can, however, do more than just swim in the water – aquaaerobics, for instance, might be more suitable for people who find aerobics difficult due to joint injuries. "The water supports about fifty per cent of your weight," explains Bancha. "If you weigh 50kg and jump on land, you’re putting about a 100kg impact on your joints. If you jump in water, you halve that to about 25kg."

For many people, swimming is also a kind of meditation. "Being in the water can enhance your sense of well-being and reduce stress," says Jackson.

Regularity is the key

Bancha recommends that people who want to get some real aerobic benefits from swimming train three to four times a week. "Beginners should swim for 20 to 25 minutes – that’s non-stop swimming, without relaxing. Intermediates should aim for 30 to 40 minutes, and advanced swimmers can gradually increase from there."

Jackson emphasises that you really do need to work hard in the pool to get the same sort of calorific output as other forms of exercise, such as running or cycling. "You need to look at doing 80 laps or so, because the intensity is just not as great as other activities. You’ll find that 90 per cent of people can’t swim at a steady rate – they’ll go for ten minutes, and collapse."

If you are really serious about burning off weight, there’s always sea swimming, which Jackson says is much more intense. "You’re dealing with tides, currents, waves, so you’ll burn off more weight."

But if you don’t live near the sea, you may prefer to incorporate swimming into a cross-training programme. "You can still make swimming the major focus of your programme, but cross-training will give you better results."

Take a class

If you are serious about swimming to stay fit, consider taking a class to improve your technique and style. Even those who have been swimming for years can benefit from taking a class, says Bancha. "Many members who swim here still don’t know how to swim smoothly. You need to learn how to move properly – everybody has different problems."

Jackson, too, advises taking swimming lessons to get the most from your time in the pool. Your teacher can then give you drills to work on, and start to improve your weaker strokes. Getting proper instruction can also help prevent the injuries that might be sustained if your technique isn’t quite right.

Now try finding a pool

Despite the heat, unless you join a gym in Bangkok, live in a condominium with a pool or have your own, pools aren’t as easy to track down in Bangkok as many other towns. Nevertheless, there are some around, so pick one close to you, grab your swimmers and towel, and get ready to embark on a new fitness regime.

Challenge your mind and your body

Based on various beliefs from China, Japan, Korea, Thailand and other countries, the martial arts are about more than physical exercise: they involve intellectual and spiritual components to help develop the individual as a complete person as well. Objectives may include connecting the mind with the body, or the individual with the universe, and physical practice helps to achieve this. Here’s a list of what’s available in Bangkok.

Aikido: Based on a variety of older martial arts such as jujitsu and judo, Aikido (the way of harmony with the chi force") is relatively new. Morihei Ueshiba, who wanted to follow a disciplined, philosophical approach to self-defense, created it in 1942. It is defensive, and is based on using the opponent’s motions against them; disabling rather than harming opponents is the objective. Techniques include punches, kicks, weapons and hands, and there is a focus on motion and dynamics.

Judo (the way of flexibility): Sometimes called a simplified version of Jujutsu, Judo was developed in Japan in 1882 as a modern sport. It focuses on timing, speed, balance, and falling and is based on numerous grappling and throwing techniques.

Jujutsu (the art of giving way): Jujutsu, one of the oldest forms of Japanese hand-to-hand combat, was developed from several combat systems of warfare that each focused on a type of weaponry. Jujutsu as a term was not used until the 1600s, when Japanese martial arts as were moving from weaponed to weaponless styles, and were collectively named Jujutsu.It’s a grappling art, with practitioners using leverage, weight, and momentum to defeat opponents.

Karate-do (the way of the empty hand): Karate-do or karate developed in response to a ban on weapons in the 1700s on the Japanese island of Okinawa. Physically demanding, it’s a mix of Kung Fu and the Okinawan style of boxing, and is recognized by its wide array of hand and foot strikes, concentration on breathing and repetitive practice of blocking, striking, and breaking techniques.

Krabii-krabong: Considered to be a more "pure" tradition than Muay Thai, Krabii Krabong focuses on several hand-held weapons, the krabii (sword), plong (quarter-staff), ngao (halberd), daap sawng meu (a pair of swords held in each hand) and mai sun-sawk (a pair of clubs). The moves involve Thai boxing techniques and judo-like throws along with the use of the weapons. The weapons, however, are not actually used to hit opponents.

Kung Fu (ability, or skill and effort): Kung Fu is an ancient martial art that originated in China when a Tibetan Buddhist monk taught Shaolin monks exercises to improve their health. This became Shaolin Kung Fu style – but there are now some 1,500 different schools. There are two main categories, external/hard and internal/soft. The former features powerful foot and hand strikes, and is physically intensive, while the latter emphasises inner spiritual development.

Muay Thai: One of the most brutal martial arts and most physical sports in the world, Thailand’s national sport is based completely on combat. It’s said to have originated in 1560 when King Naresuen was captured by the Burmese and offered his freedom in return for defeating the Burmese ; however, some believe the art is older and was influenced by Chinese boxing and the Indian arts. Muay Thai concentrates on hand and leg techniques, using all parts of the body for self-defense including punching, kicking, elbowing and kneeing.

Tae Kwon Do (the art of kicking and punching): This Korean art, where kicking is emphasised over punching, dates back to the seventh century AD. With the invasion of the Japanese, it went underground, but when Korea was liberated in 1945 the modern period of the art began, which saw the elimination of Japanese influences and a return to traditional schools (kwans). In 1955 the name Tae Kwon Do was chosen for the styles that were unified into a national sport.

Tai Chi: Popular with older people, but just as suitable for the young, this is a refined, smooth and gentle low-impact or no-impact art based on relaxation, yielding and non-aggression. It opens up the body and helps preserve physical fitness into the older years. It’s not self-defence – you don’t meet force with force as in other arts – but some describe its power as "steel wrapped in silk".

Colour yourself beautiful

Like the length and style of your hair but tired of your look? Colouring is an option, and the choices available have never been so wide.

The trends

According to one international stylist passing through Bangkok recently, from the mid-90s onwards, styling was "extremely boring, especially colouring. But now you can do absolutely anything. Hair is getting longer, so colouring is more important this season than before. The trend is more definite than it has been for a long time."

In New York and Paris, this stylist says, it’s pretty much anything goes, but there are several notable directions. "Blondes are golden, browns are very light and have some ash in them, and highlights are golden, whiskey or honey." But for Asian hair, the trend is browns: "three to four shades of brown, and the look is now more solid. Full colour is becoming popular."

Director of the Attitude hair salon John Moy says that the trend in Bangkok is for vibrant looking hair. "Strong colour is in, especially for working ladies in Bangkok, even if they don’t have any grey. It’s fashionable, and it fits in with a Bangkok lifestyle."

And Moy says that Thai women are becoming more daring. "They’re choosing some stunning colours now, such as purple-red – they call it Coke colour – and radish reds. But if you overdo the colour, they’re not so comfortable. The Thai market is also now blending dark blonde with a lightening of the base colour, or adding a few streaks of light blonde."

But blonde is one of the most difficult colours to maintain. "For black or quite dark hair, a contrast colour such as light blonde can be stunning for the first couple of weeks. But then in Bangkok, the polluted air, the sun, the hard water – it’s not good for blonde hair. The chemicals fight the blonde."

Your options

So what’s what? A permanent colour, tint or dye are all the same thing: targetted colours containing ammonia, which prepares the hair to take the colour, and peroxide, which lightens the pigment. If you’re trying to cover grey hair, or you’re lightening your hair colour considerably, you’ll need to use such a colour, which won’t go away until cut off. The downside is that when used over many years, permanents cause the hair to thicken and eventually give it a straw-like appearance. This is because the peroxide causes the colour pigment to swell up to 400 times its normal size. However, used occasionally to change your hair colour by only one or two shades, it may dry the hair slightly but will not cause it to become unmanageable.

Highlights blend in with the hair’s main colour. Chemically, they are the same as permanents, but are applied using different techniques, including:

· traditional foils, which are labour intensive and usually the most expensive;

· cap highlights, where the hair is pulled through holes in a skull cap

· freehand foils, which are currently the most in vogue. Freehand foils allow the stylist to place or "weave" colour randomly through the hair, making regrowth less obvious.

Then there are semi-permanents, which gradually wash out after around a dozen washes. These are gentler on the hair, and can improve shine and manageability. If you’re not changing your colour too drastically, this could be an option. However, semi-permanents usually cost the same as a permanent.

Temporary colours lasts until you next wash your hair.

Before and after

Don’t wash your hair for at least 24 hours before you head to the salon, as having oil over your hair shaft will help to protect it.

After the colour, use a colour rinse shampoo once a week, a shampoo for coloured hair the rest of the time, and get regular protein treatments. Before being exposed to the sun and/or before swimming, protect your hair by rubbing an oily substance such as a leave-in conditioner or some baby oil through its top layer.

Return for a touchup around five weeks after your colour, or when around 1cm of regrowth is visible. However, stylist Moy advises that if there’s not so much of a contrast between the regrowth and the colour, you could wait for eight weeks.

Shop around for that special delivery

With the coming of the economic downturn, more hospitals have developed so-called baby or maternity packages, so that customers have a better idea of what the final price of delivery might be. Usually three packages are offered: for normal delivery, normal delivery with an epidural, and caesarian section delivery. The quoted price usually includes the delivery team and necessary medications, and a limited length of stay.

Bangkok Nursing Home’s Dr Boonlert Triam-amornwooth advises that a couple choose a package that’s financially manageable, and that they carefully check to see what’s included, although they usually don’t vary much. Complications requiring extra treatment and medication, though, will increase the cost. "Patients sometimes pay more than the package, but most births are standard," says Dr Boonlert. Even if the delivery is normal, though, extra costs may be incurred. For instance, a baby with jaundice may need to be kept under observation for a third night, and normal packages usually include only a two-night stay; this will add to the bill.

Dr Boonlert also notes that while cheaper packages suggest the quality of facilities and care might be lower than elsewhere, even an expensive package won’t guarantee that a birth will go smoothly.

But price is just one of the many factors to consider when choosing a hospital to have your baby at. "People should not choose their hospital based on the package – the benefits of the package are only financial," says Samitivej Hospital’s Dr Yaowaluk. You should like the hospital; take a walk through the wards to get a feel for the place. And ask questions on the issues that matter to you; the warmth of the staff and their willingness to help you are important in gauging the level of care you’ll be given.

Another important factors will be choosing a doctor you trust. "The patient should try to find a doctor they feel confident and satisfied with, and who can answer the questions they have," says Dr Boonlert. For many, where their doctor works will be the decisive factor in choosing the hospital.

Sound out the facilities and availability of staff, too. "Check that your doctor is on call all of the time in case of an emergency and make sure that the operating room can be opened very quickly," suggests Dr Boonlert. "Ensure that an anaesthetiologist will be available at all time, and that after delivery, a paediatrician will be on call."

Prospective parents may also want to check on the hospital’s rate of Caesarian sections. The standard rate in the US for 1995 was just over 20 per cent. Your doctor’s individual attitude that is very relevant, so try to find out your doctor’s personal rate.

Another important statistic is the rate of administration of epidural anesthesia, which is thought by some to increase the length of labour, the likelihood of a caesarean section or the need to use forceps. As well, ask how many high risk births a hospital deals with, and how many sick infants they care for. It might be difficult to interpret the statistics, but knowing that a hospital keeps careful records can be an indication of their professionalism.

If breastfeeding is important to you, choose a UN-designated baby-friendly hospital. These are hospitals that support breastfeeding (for more information, see http://www.who.dk/who%2Deuro/about/babies.htm#ten. In Thailand, Samitivej Hospital and all public hospitals except university teaching hospitals are designated baby-friendly). Also find out the percentage of mothers who have successfully breastfed their infants at that hospital.

And in a town with traffic problems like Bangkok, proximity to the hospital is another consideration. "It may come down to choosing which hospital is convenient to your residence, in order to avoid traffic problems," says Dr Boonlert.

How to keep that smile in shape

Studies repeatedly find that even though people around the world are aware of the importance of oral health, they avoid going to dentists – and there’s no reason to suspect that Thailand is any different. "In every country there is a section of the population who will put a priority on their health, and will have check-ups, while some people don’t. It’s the same everywhere," says Dr Kiertichai Pongpairoj.

Dentists say that an integral part of your oral health routine should include, wherever possible, checkups on average every six months – more frequently if teeth are in bad shape, or just once a year if good oral health is maintained.

Daily care is vital

According to Dr Kiertchai, the main factor in oral health is how you treat your teeth on a daily basis at home. "Checkups are not as important as your oral hygiene on a daily basis. It’s your lifetime’s homework. They’re your teeth – it’s your job to take care of them."

This means that a normal checkup with most dentists will usually involve some oral hygiene education. Dr Kiertchai says he’ll explain to patients two important things – how to brush your teeth to get rid of accumulated bacteria without damaging the teeth or gums, and how to floss your teeth, both of which should be done daily. "The most important time to brush is at bedtime, because during the night there will be dilution of bacteria as you’re not drinking and there’s little saliva to flush the bacteria away," he advises.

But you can rest easy when it comes to choosing what you eat – so long as you don’t leave damaging foods or liquids in contact with the teeth for a long time. "Sour things like lime juice are acidic and can wash off the enamel surface of teeth, while sweet things can lead to cavities. But you can eat whatever you like, so long as you rinse, or preferably brush, afterwards."

But checkups are still important

Even with the best of oral hygiene care, regular checkups should be scheduled for a number of reasons – the main one being that a dentist could save your life, as dentists are usually the first to discover mouth cancer.

During a normal checkup, dentists will usually check the gum’s condition, looking for any inflammation or irritation, they’ll check for cavities, and they may take an x-ray to check that your teeth and jawbone structure are normal. Dr Kiertchai says that up to 50 per cent of people can potentially develop a problem with the alignment of their jaw. "In most cases, mother nature does the job perfectly well, but various factors such as improperly extracted teeth or fillings may change the vertical relationship in the jaw," he says. If the problem is caught early, it may simply involve filing a tooth in order to prevent a bigger problem.

For most people, a checkup will simply be that – a checkup. Dr Smile’s Dr Visit Chotchompoo says that patients almost always only need just a clean. "Sometimes I will find something, but then it’s up to the patient to decide on whether we will continue with the treatment or not right away." And if good oral hygiene has been maintained since the last visit, not even a clean might be necessary.

Some people avoid dentists simply because they think there will be pain involved in a visit, often because of a bad past experience during childhood, or outdated knowledge of what dentistry is like today. If you’re afraid, you should still get to a dentist, and tell your dentist about your fears. "I’ll talk to patients if they are afraid about having a check up, or afraid of what will be done. Once I’ve spoken to them, they’re usually no longer afraid," says Bumrungrad Hospital’s Dr Chalorsak.

Cervical cancer: The importance of screening

Doctors say that cervical cancer, which begins in the lining of the lower part of a woman’s uterus, is the most common form of cancer in Thai women, and the cancer that causes the most deaths. This form of cancer, however, is easily detected and treated if found early. In Thailand, the National Cancer Institute estimates that for 1993 to 1997, the average incidence of cervical cancer was 18.6 cases per 100,000, but this is probably a considerable underestimation, given shortcomings in reporting.

Bumrungrad Hospital gynacologist Dr Dejaphongs Bhucharoen says that the most important reason for the high incidence of cervical cancer is that women do not have regular screening tests. "Particularly after they have children, women don’t come back [to see their doctor]. Doctors should tell their patients after they’ve had a baby to make sure they come back. And it’s the culture – Thai women are very shy about their bodies, but there is still this lack of awareness."

Samitivej Hospital’s Dr Yaowaluk Rapeepattana agrees. "This is due to socioeconomic factors, also perhaps that women’s health care is not good enough, and to education."

What leads to cervical cancer?

Most cases of cervical cancer are caused by the human papilloma virus (HPV), a sexually transmitted virus also known as the wart virus. The virus usually infects women aged up to their 30s – condoms do not offer protection – but it can take 20 years for abnormalities to develop. The virus can cause abnormal cell growth, known as dysplasia, which may lead to cancer. Other terms used to describe abnormal cells are squamous intraepithelial lesion (SIL) and cervical intraepithelial neoplasia (CIN). Cigarette smoking is another reported cause of dysplasia.

Pap smears are the key to early detection

Dysplasia sufferers will show no symptoms, and in its early stages cancer will not manifest itself externally either, and this is why regular screening – in the form of quick and painless Papanicolau or "Pap" smears – is so important. The procedure involves a doctor or clinician inserting a speculum into the patient’s vagina to open it, and taking a sample of cells from in and around the cervix with a scraper or a small brush. The specimen is then placed on a glass slide and sent to a laboratory for examination.

"If we can detect the cancer in situ [before it has become invasive], we can treat it because it develops very slowly," says Dr Dejaphongs. Mild dyspasia can take up to seven years to develop into invasive cancer.

American guidelines recommend that a woman should have her first Pap smear after she has become sexually active, or after she has turned 18. The best time for the test is between 10 and 20 days after the first day of the menstrual period. Doctors generally agree that if you have a test annually for three consecutive years with no abnormalities, you can then have the test every two to three years, as this is generally the amount of time it takes for cells to go from normal to abnormal.

If your Pap smear is abnormal

Treatment options will depend on the level of dysplasia in the cervix. If it’s mild, you may simply have further Pap smears every four months as there is a good chance the cells will return to normal themselves. If this does not happen, or if the dysplasia is moderate to severe in the first instance, a colposcopy (non-invasive examination of the cervix using a microscope like instrument) may be performed, followed by a biopsy, which is the removal a small amount of cervical tissue for examination, and the only definite way of checking whether the abnormal cells indicate cancer. If these tests confirm abnormalities, the area may be removed surgically. Depending upon the stage of cancer and other factors, a hysterectomy may be advised.

Aromatherapy massage: Your nose knows

It may have been popular thousands of years ago – Cleopatra, the last of the ancient Egyptian queens was a famous devotee of it – but aromatherapy has only recently enjoyed a resurgence around the globe. In Thailand, aromatherapy massage in particular has become a standard offered by spas to customers seeking a reduction in their stress levels, and an improvement in their overall health.

It’s only natural

Aromatherapy is a healing art that uses pure essential oils derived from fragrant plants including rose, lavender, lemon, rosemary and eucalyptus. "An essential oil can be up to seventy times stronger than the plant it originally comes from," says Chrissie Davis, a trained aromatherapist and manager of the Sheraton Grande Sukhumvit’s Spa. "The body works better with natural products, which are not held in the body the way synthetic products are."

While scientific research is so far limited, some connection between particular fragrances and improved mood has been demonstrated. Aromatherapy massage involves combining this power that fragrances can have on the brain with the therapeutic benefits of touch. "Depending on the blend of oils used, a massage can be relaxing or energizing, or it can provide strength if you’re feeling emotional and unable to cope," says Chrissie.

Khun Soon from Aromapure says that aromatherapy massage helps maintain your overall body balance. "It simply makes you feel good. And if your mental health is good, this will help your skin, your face – everything else will benefit."

How does it work?

One or more essential oils based on a customer’s needs are combined with a natural massage oil, which is then massaged into the body. Most of the oil that enters the body will do so by travelling down the body’s hair follicles, penetrating the skin and moving into the bloodstream. To a lesser extent, the oil will also pass into the bloodstream via inhalation.

The massage thus assists the entry of the oil into the body, but the massage itself is also beneficial. "Aromatherapy massage uses a distinct technique, just like there is a certain technique used for Swedish massage, remedial massage and so on," explains Chrissie. "You can have a Swedish massage using an oil blend, but that’s called an aromatic massage."

The aromatherapy technique specifically focuses on opening up the body’s lymphatic system. "Particularly if you don’t exercise every day, toxins will build up in the body," says Soon. "They will wait to be be expelled via the lymphatic system, which can sometimes become blocked. The massage will allow the toxins to be released."

Which oil is for you?

Shelley from Tamarind Springs on Ko Samui says that choosing an oil is a very individual choice. "We let our guests choose the oil based on their reaction to the aroma. I think smell is a very visceral and personal sensation, and a smell can evoke a memory or an association very powerfully. Our instincts often guide us to choose the right oil," she says. "Of course, every oil also has different properties, and that helps in the selection."

Your aromatherapist – do make sure yours is properly trained – should be able to tell you about the properties of the oils available for your massage, and together you can decide on the best choice for you.

Treat yourself once a week

The optimum frequency of massages depends on the individual and their particular needs. "I would recommend a massage at least once a week for ninety minutes," says Chrissie. "A massage has both physical and mental benefits. It relieves stress, and it relieves stress build-up."

After an aromatherapy massage, it’s best not to go into the sun for around three hours afterwards as the sun may cause some oils to react unfavourably.

The oral contraceptive pill

Oral contraceptives, known commonly as "the pill", have been available in Thailand since the 1960s, and have long been the most popular contraceptive due to their availability – unlike in many other countries it can be bought over-the-counter – and low cost. In addition, when taken correctly, the pill is 99 per cent effective.

"The pill has been the flagship of family planning in this country," says Dr Pansak Sugkraroek from Bumrungrad Hospital. "Women can obtain the contraceptive pill for free, or for about a five baht donation, from any government hospital." The pills obtained this way, however, usually contain higher dosages of oestrogen and have more side effects than those bought through commercial channels.

If starting out, see a gynaecologist

Dr Yaowaluk Rapeepattana from Samitivej Hospital says that there are over 300 different brands of the contraceptive pill on the market. "So how can women know what is the best fit for them? I recommend that women go to see a gynaecologist before using the pill. There are many conditions that mean you must be careful when taking the pill. And even the new arrivals, the pills containing low-dose hormones, can have side-effects."

The 300-plus brands all contain the same active ingredients – oestrogen and progestogen. The price depends on where a particular brand is made and how it is marketed. "When a particular pill is still under license, it will usually be made abroad and will be more expensive" says Dr Pansak. Pills marketed as being premium brands, and as being able to reduce acne, enlarge the breasts or not lead to an increase in weight, will also cost more.

How it works

A standard "combined pill" contains 50mg of oestrogen, while low-dose pills usually contain 30mg. The type of oestrogen used is ethinylestradiol, while there are various types of progestogen – and it is this hormone that will determine a pill’s side effects. Two per cent of pills globally contain only progestogen and are known as mini-pills.

Oestrogen and progestogen work together to prevent the ovary releasing an egg each month, and the progestogen also thickens mucus in the cervix, making it more difficult for sperm to enter. Progestogen-only pills have only the latter effect. Both pills can prevent fertilised eggs staying in the uterus.

Benefits

The main benefit is of course reduced risk of pregnancy. But there are some additional benefits for women on the pill, including a lower risk of several types of cancer, less benign breast disease, fewer ovarian cysts, less pelvic inflammatory disease and a more regular menstrual cycle with less blood loss, fewer cramps and fewer premenstrual symptoms.

A small number of women may experience temporary side effects, such as nausea, weight gain or loss and breast tenderness, particularly for the first few cycles.

It’s not for everybody

Some women should not take the pill, including women aged over 35 who smoke, or have heart disease. Women with high blood pressure, high cholesterol levels, liver disease, fibroid uterine growths and several other conditions should also avoid the pill. "A gynaecologist will take into account your family history, your age, whether you smoke and various other factors before recommending the pill," Dr Yaowaluk says.

Serious complications from taking the pill are rare. "The most serious effect can be thrombosis – the formation of blood clots," says Dr Yaowaluk. This risk has decreased over the years as most pills have reduced oestrogen levels from 100mg to a 50mg – but those available cheaply in Thailand may still have a higher dosage.